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Journal ArticleDOI

Pain, Anxiety, and Cooperativeness in Children with Cerebral Palsy After Rhizotomy: Changes Throughout Rehabilitation

01 Oct 1997-Journal of Pediatric Psychology (Oxford University Press)-Vol. 22, Iss: 5, pp 689-705
TL;DR: Results of the Observational Scale of Behavioral Distress and observer Likert ratings confirmed the hypothesis that children's pain and anxiety decrease over time and children's physical functioning and cooperativeness improve over time.
Abstract: Assessed pain, anxiety, physical functioning, and cooperativeness in 32 children with spastic cerebral palsy. This is the first study to assess children throughout rehabilitation following selective posterior rhizotomy. Results of the Observational Scale of Behavioral Distress and observer Likert ratings confirmed the hypothesis that children's pain and anxiety decrease over time. Children's physical functioning and cooperativeness improve over time. No significant correlation was found between pain and changes in physical functioning. Cognitive impairment, parental involvement, and children's pain behaviors explained 77% and 56% of the variance in two forms of cooperativeness. Research and clinical implications are discussed, and special considerations regarding pain assessment and management in this population are addressed.

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Citations
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Journal ArticleDOI
01 Sep 2002-Pain
TL;DR: Results indicated that children's ability to communicate pain verbally did not influence whether or not their parent reported observing pain, and stretching was the daily living activity most frequently identified as painful by parents, and the one with the highest mean pain intensity.
Abstract: To obtain parents' identification and description of the behaviors, health care procedures and daily living situations associated with pain in children with cerebral palsy (CP), surveys were sent to parents of children with CP recruited via a clinic case list and a parents' newsletter. Forty-three parents completed the survey. Results indicated that children's ability to communicate pain verbally did not influence whether or not their parent reported observing pain. Most children (67%) were reported to have displayed pain within the month prior to rating. All pain behaviors on the Non-Communicating Children's Pain Checklist (Dev Med Child Neurol 40 (1998) 340) were endorsed by some parents, and few additional pain behaviors were identified, suggesting that this instrument adequately samples the pain behavior of children with CP. Assisted stretching was the daily living activity most frequently identified as painful by parents (93% of those reporting pain), and the one with the highest mean pain intensity. Needle injection (40%) was the medical and nursing procedure most frequently identified by parents as painful for their children. Range of motion manipulation was the therapy most frequently identified as painful by parents (58%), and the one with the highest mean intensity. Parents are able to observe pain in their children with CP regardless of the child's verbal fluency. Knowledge of behaviors and painful situations identified by parents can facilitate management of pain in children with CP.

152 citations

Journal ArticleDOI
TL;DR: Pain and fatigue represent potentially modifiable targets for interventions designed to improve school functioning in children with CP and supported the existence of an indirect relationship between diagnostic subtypes and school functioning that was partially mediated by both pain and fatigue.
Abstract: Objective This study tests a model of how pain and fatigue, independently or in combination, relate to school functioning in pediatric cerebral palsy (CP). Methods One hundred eighty-nine parents of children with CP completed the Pediatric Quality of Life Inventory™ (PedsQL™) 4.0 Generic Core Scales and the PedsQL™ 3.0 Cerebral Palsy Module. Seventy-three children with CP completed the PedsQL™. Path-analytic and mediational techniques were utilized to test the a priori model. Results Data from both parent proxy-report and child self-report were found to have acceptable model fit. Results supported the existence of an indirect relationship between diagnostic subtypes and school functioning that was partially mediated by both pain and fatigue. Conclusions Pain and fatigue represent potentially modifiable targets for interventions designed to improve school functioning in children with CP.

96 citations

Journal ArticleDOI
TL;DR: A number of themes emerged from the data including learning to live with pain, dealing with uncertainty, expression of pain and making decisions as well as an uncertain and complex process requiring parents to draw on skills and knowledge developed over a number of years.
Abstract: Background. Despite advances in the assessment and management of children's pain, children with profound special needs are especially vulnerable to poor pain management. Their underpinning condition often severely compromises their ability to express pain through the usual verbal and behavioural routes. The lack of any appropriate framework for assessment results in a suboptimum and inaccurate approach to an important aspect of their care. Purpose. The purpose of the study was to explore the ways in which parents of children with profound special needs assess and manage their children's pain. Methods. Qualitative case study design underpinned the study using guided interviews with the 15 parents/carers (of 12 children aged 5–16 years with profound special needs). Ethical approval. Ethics Committee approval was gained. Findings. A number of themes emerged from the data including learning to live with pain, dealing with uncertainty, expression of pain and making decisions. Conclusions. Parents felt that their child had learned to live with significant levels of chronic and acute pain. Assessment of pain was an uncertain and complex process requiring parents to draw on skills and knowledge developed over a number of years. Parents used different strategies for both the assessment and management of pain based on an intimate knowledge of their child's usual nonpain state. Even with a limited repertoire of behaviours available to them, children were able to express pain. Parents often felt isolated in relation to pain management and under-used as a resource by health professionals.

82 citations


Cites background from "Pain, Anxiety, and Cooperativeness ..."

  • ...1999, Oberlander et al. 1999). Parents relied to a large extent on their 'checklist' consisting primarily of a range of behavioural indicators. These behavioural cues included facial and vocal expression, changes in tone and movement, and the child withdrawing into themselves. These behaviours were also described by Giusiano et al. (1995) and McGrath et al....

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Journal ArticleDOI
TL;DR: A review of current literature indicates pain is a common experience for children with CP and has been understudied in this population, and further emphasis and research on appropriate assessment and management strategies sensitive to the unique characteristics and limitations of children withCP are warranted.
Abstract: Children with cerebral palsy (CP) face many challenges including impaired motor control and coordination, functional impairment, sensory disturbances, and, sometimes, communication difficulties and cognitive deficits. Pain also may be a problem for children with CP due in part to the inherent deficits associated with the disease, as well as the invasive medical and surgical procedures and rehabilitative activities children with CP undergo on a regular basis. A review of current literature indicates pain is a common experience for children with CP and has been understudied in this population. Further emphasis and research on appropriate assessment and management strategies sensitive to the unique characteristics and limitations of children with CP are warranted.

81 citations

References
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Journal ArticleDOI
TL;DR: The use of continuous infusions of morphine and midazolam, along with adjunct ketorolac, to be effective in treating postoperative pain and muscle spasms following SDR is found.
Abstract: Selective dorsal rhizotomy (SDR) is a neurosurgical procedure used for treating lower extremity spasticity in patients with cerebral palsy. The purpose of this paper is to present a review of our institution's first three years' experience with postoperative pain and spasticity management in patients who have undergone SDR. The medical records of the 55 patients who had an SDR during the study period were reviewed. The basis of postoperative analgesia was morphine, with the majority of patients receiving continuous morphine infusions (20-40 micrograms.kg-1.hr-1 (n = 49), 60 micrograms.kg-1.hr-1 (n = 1)). Four patients used a patient-controlled delivery system. One patient had successful analgesia with epidural morphine. Ketorolac (1 mg.kg-1 i.v. loading dose followed by 0.5 mg.kg-1 i.v. every six hr for 48 hr) was used as an adjunct to morphine in six patients. For management of postoperative muscle spasm, an intravenous benzodiazepine was used (diazepam 0.1 mg.kg-1 (n = 2), or midazolam infusion 10-30 micrograms.kg-1.hr-1 (n = 51)). All patients were cared for on a ward where nurses were familiar with the use of continuous opioid and benzodiazepine infusions. All patients received continuous cardiorespiratory monitoring as well as frequent nursing assessment. There were no episodes of postoperative apnoea or excessive sedation. We have found the use of continuous infusions of morphine and midazolam, along with adjunct ketorolac, to be effective in treating postoperative pain and muscle spasms following SDR.

35 citations

Book ChapterDOI
01 Sep 1994

9 citations


"Pain, Anxiety, and Cooperativeness ..." refers background in this paper

  • ...The research to date has revealed no reliable pattern of demographic characteristics or of patients' knowledge of their illness/treatment that predicts compliance or cooperation (Bearison, 1994)....

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Book ChapterDOI
01 Jan 1991
TL;DR: To understand the rationale of this procedure, a summary of the current theories of the pathophysiology is helpful.
Abstract: During the past three years interest in the use of selective functional rhizotomy to treat spasticity has increased, particularly in the United States. This is due largely to the positive experiences of surgeons employing various techniques of sensory rhizotomies during the 1960’s, 1970’s and early 1980’s in Europe and South Africa (Fasano et al. 1980, Fraioli and Guidetti 1977, Gros et al. 1973, Laitinen et al. 1983, Peacock et al. 1987, Privat et al. 1976, Sindou et al. 1974, 1987). To understand the rationale of this procedure, a summary of the current theories of the pathophysiology is helpful.

5 citations

Journal Article
TL;DR: The hospital environment is a threatening atmosphere to a child and so is even the most innocent intervention, so the intervention then turns into a battle between doctor and patient.
Abstract: The hospital environment is a threatening atmosphere to a child and so is even the most innocent intervention. The sight of a group of doctors, nurses, and students surrounding his on her bed terrifies a young child before he or she is even touched. If the child has experienced an unpleasant or painful intervention in the past, he or she will not permit it to happen again unless forced to do so. This usually means that four or six hands will be needed to restrain the child. The intervention then turns into a battle between doctor and patient.

5 citations