Cases reported "Cerebral Palsy"

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1/12. Team collaboration: a case study of an early intervention team.

    The study described in this article sought to examine the workings of an interdisciplinary team as a research entity and as a service provider. There were two levels of analysis in the study: the process of collaborating on the research and the results of the research observation of an interdisciplinary team in a clinical setting. An interdisciplinary research team studied the interaction of a single clinical team over a 6-month period working with one child in a hospital-based early intervention program. The data were collected through intensive interviews, direct observations of the family and team members, and selected videotaping of team meetings. Qualitative data analysis methods were used, and five themes emerged: who takes the lead, the classroom as a way station, we like our freedom but..., who is giving and who is taking advice, and communication comes in few forms.
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keywords = communication
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2/12. Grammar and lexicon in facilitated communication: a linguistic authorship analysis of a Finnish case.

    This case study adds a new dimension to the discourse on the authorship issue in facilitated communication. The linguistic structure produced by a young Finnish man with severe cerebral palsy was examined. Data are based on transcripts he produced from 1993 until 1996 after facilitated communication had been introduced to him. In the data analysis, as explicit criteria for his idiosyncrasies, we used patterns typical of children acquiring Finnish as their first language and those found in normal slips of the tongue, acquired aphasia, and specific language impairment. Based on the analysis (i.e. the idiosyncrasy and agrammaticality of word-forms and sentences), we strongly suggest that his output can hardly be a product of any other speaker of Finnish, including that of his facilitators.
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ranking = 6
keywords = communication
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3/12. Clinical application of an EEG-based brain-computer interface: a case study in a patient with severe motor impairment.

    OBJECTIVE: This case study describes how a completely paralyzed patient, diagnosed with severe cerebral palsy, was trained over a period of several months to use an electroencephalography (EEG)-based brain-computer interface (BCI) for verbal communication. methods: EEG feedback training was performed in the patient's home (clinic), supervised from a distant laboratory with the help of a 'telemonitoring system'. Online feedback computation was based on single-trial analysis and classification of specific band power features of the spontaneous EEG. Task-related changes in brain oscillations over the course of training steps was investigated by quantifying time-frequency maps of event-related (de-)synchronization (ERD/ERS). RESULTS: The patient learned to 'produce' two distinct EEG patterns, beta band ERD during movement imagery vs. no ERD during relaxing, and to use this for BCI-controlled spelling. Significant learning progress was found as a function of training session, resulting in an average accuracy level of 70% (correct responses) for letter selection. 'Copy spelling' was performed with a rate of approximately one letter per min. CONCLUSIONS: The proposed BCI training procedure, based on electroencephalogram (EEG) biofeedback and concomitant adaptation of feature extraction and classification, may improve actual levels of communication ability in locked-in patients. 'Telemonitoring-assisted' BCI training facilitates clinical application in a larger number of patients.
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ranking = 2
keywords = communication
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4/12. The Americans With Disabilities Act of 1990 expands employment opportunities for persons with developmental disabilities.

    The primary purpose of the ADA is the full inclusion of persons with disabilities within their communities. The ADA prohibits discrimination on the basis of disability in the areas of employment, transportation, public accommodations, telecommunications, and state and local government agencies. The person described in this report encountered some of this discrimination. He successfully obtained paid community-integrated employment only after overcoming major obstacles and barriers, the greatest being transportation. In our highly mobile society, reliable transportation is essential for the acquisition and maintenance of community-integrated employment. The participant was repeatedly denied access to public transportation on the basis of his disability. To help overcome this barrier, Transition Services had to provide needed transportation at great expense, which delayed opportunities for the participant to gain control of this aspect of his life. Enactment of the ADA makes it more difficult for public transportation agencies to deny services to persons with disabilities by claiming inconvenience or lack of accessible vehicles. When publicly funded transportation programs assume their full responsibility for transportation to the public, agencies like Transition Services can focus on individualized employment and training issues rather than on providing transportation. In the workplace, the employer's willingness to work cooperatively with the participant and the staff of Transition Services resulted in several low-cost and reasonable accommodations based on the participant's needs and abilities. A simple rearrangement of work space allowed the participant to perform his job while benefiting the other workers in the crowded restaurant kitchen.(ABSTRACT TRUNCATED AT 250 WORDS)
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keywords = communication
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5/12. An unusual cause of overdose after baclofen pump implantation: case report.

    OBJECTIVE AND IMPORTANCE: Intrathecal baclofen delivery for the treatment of spasticity has been used for almost 20 years with a great deal of success. A wide variety of complications and pitfalls have been described. This report details a novel complication involving inadvertent and initially unrecognized canalization of the subdural space with the spinal catheter, which ultimately resulted in an overdose. CLINICAL PRESENTATION: An intrathecal pump system was implanted in a 15-year-old girl with spasticity. This initially resulted in a lack of therapeutic effect. The diagnostic workup ultimately led to contrast administration through the pump system, which precipitated a baclofen overdose when sequestered medication in the subdural compartment was released into the intrathecal space. INTERVENTION: The spinal catheter was subsequently revised, and the patient made a full recovery. CONCLUSION: The possibility of a subdural catheter should be included in the differential diagnosis in patients who experience a lack of drug effect after pump implantation, despite increases in dosage. Close monitoring is required because of the risk of spontaneous or induced overdose, which may occur when a communication develops between the subdural and intrathecal compartments.
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ranking = 1
keywords = communication
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6/12. Physiotherapy assessment and treatment for an ambulant child with cerebral palsy after botox A to the lower limbs: a case report.

    BACKGROUND AND PURPOSE: Botulinum toxin A is a relatively new, noninvasive treatment option for children with cerebral palsy, providing an effective, short-term intervention to reduce spasticity. It is used as an adjunct to other management including physiotherapy. The purpose of this case report is to evaluate assessment and management by physiotherapy following Botox injections to hamstring and gastrocnemius muscles. CASE DESCRIPTION: Examination of function and impairment for a 3.5-year-old child with spastic diplegia included the Gross Motor Function Measure, Goal Attainment Scaling, the Physician Rating Scale of gait, dynamic and passive range of movement, and selective motor control. Physiotherapy intervention was play based and occurred at home, at a preschool, and in the therapist's usual clinic setting, twice a week for the first five weeks, then once a week for another five weeks. Intervention consisted of whole and part practice of functional skills using closed and open chain exercises through the full available muscle range. OUTCOMES: The child showed increased ability in function; however, impairment level results were inconsistent and may not be effective at discerning change in a clinical setting. DISCUSSION: An increased level of physiotherapy was easily implemented by frequent and clear communication with those directly involved with the child's everyday activities. This is believed to have contributed to the successful outcomes seen.
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ranking = 1
keywords = communication
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7/12. The able self: adaptive patterns and choices in independent living for a person with cerebral palsy.

    An ethnographic approach was used to study adaptation to independent living of a 53-year-old woman with cerebral palsy in a West Coast Canadian city. The subject's adaptation through her use of technology (including augmentative communication systems and a powered wheelchair), activity routines, and social supports was documented with the life history method. Short-term accommodations to disruption or breakdown of stable adaptations were observed through participant observation. The criterion of function alone was found insufficient to account for the subject's choice of adaptive techniques, routines, and social supports. Adaptive choices appeared to depend on the subject's desire to be perceived as able, especially as mentally competent, to the greatest extent possible. The way field experiences may be used to challenge professionals' assumptions, in this case, concerning disability and treatment, is modeled for future ethnographic research in occupational therapy.
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ranking = 1
keywords = communication
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8/12. Facilitating conversation through self-initiated augmentative communication treatment.

    We examined the conversational skills of 2 adult males with severe motor and speech deficits resulting from cerebral palsy. A multiple baseline design across subjects was used to determine the effectiveness of an intervention strategy designed to teach them to use an augmentative communication system (touch Talker) independently. The dependent measure was the number of conversation initiations relative to conversation reactions during spontaneous communication across baseline and treatment. The treatment included specific training on using the augmentative system to participate in communication. Once the intervention began, the production of conversation initiations accelerated at a rapid rate. The treatment program was effective in training the subjects to use the augmentative system to increase conversation participation. These results demonstrate that training on the operation of the device alone is not sufficient to ensure improvement in conversation performance, and that it is important to incorporate direct conversational treatment when providing instruction on the use of augmentative communication systems for severely speech-impaired individuals.
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ranking = 8
keywords = communication
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9/12. The use of powered leisure and communication devices in a switch training program.

    The ability to operate switches in order to communicate more effectively and to control leisure activities has greatly enriched Pam's life. The switches have opened up a world of entertainment that she can enjoy independently. Both her desire and her ability to explore and master her environment have increased--a major thrust of functional independence so important in occupational therapy.
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ranking = 4
keywords = communication
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10/12. Computer-aided communication device for a child with cerebral palsy.

    This paper describes a portable computer-aided communication device designed for a 13-year-old child with athetoid cerebral palsy. The device was intended to provide vocal output, hard-copy, correctable display, word storage capabilities, and utilize currently available technology. The design incorporated the Epson HX-20 computer, the Votrax Type 'N Talk speech synthesizer, and a customized laptray.
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ranking = 5
keywords = communication
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