Research Interests:
Research Interests:
Neonates who undergo major surgery are at risk of neurodevelopmental disability. The General Movements Assessment (GMA) is a valid and reliable method to predict neurodevelopment, however, there are minimal data on the applicability among... more
Neonates who undergo major surgery are at risk of neurodevelopmental disability. The General Movements Assessment (GMA) is a valid and reliable method to predict neurodevelopment, however, there are minimal data on the applicability among infants post-surgery. To describe GMs trajectories following neonatal surgery. Prospective cohort study. 217 infants following major cardiac and non-cardiac neonatal surgery. Infants were assessed following surgery at term age (mean 40weeks, SD 2.3), and at 3months of age (mean 12weeks, SD 1.6) using the GMA and the Bayley Scales of Infant and Toddler Development III. GMA videos were independently scored by three advanced trained assessors, two blinded to infant details. The most common result in the writhing period was 'poor repertoire' (n=117, 54%), however, 99 (84%) of these infants had normal fidgety movements. For infants with normal writhing (n=75, 34%), only four had absent fidgety movements. Cramped synchronised movements were seen in 10 infants, and three of these were rated as absent fidgety. There was no significant difference between the surgical groups. In total, 24 infants (11%) had absent fidgety movements and lower scores on average in all subtests of the BSID-III than those with normal fidgety movements. This is the first report describing GMs trajectories in infants who have undergone neonatal surgery. Similar to other high risk infant populations, this group showed a high proportion of poor repertoire writhing movements, however, most infants demonstrated normal fidgety movements and development at 3months of age.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Precision medicine refers to treatments that are targeted to an individual's unique characteristics. Precision medicine for neurodevelopmental disorders (such as cerebral palsy, attention‐deficit/hyperactivity disorder,... more
Precision medicine refers to treatments that are targeted to an individual's unique characteristics. Precision medicine for neurodevelopmental disorders (such as cerebral palsy, attention‐deficit/hyperactivity disorder, obsessive–compulsive disorder, Tourette syndrome, and autism spectrum disorder) in children has predominantly focused on advances in genomic sequencing technologies to increase our ability to identify single gene mutations, diagnose a multitude of rare neurodevelopmental disorders, and gain insights into pathogenesis. Although targeting specific gene variants with high penetrance will help some children with rare disease, this approach will not help most children with neurodevelopmental disorders. A ‘pathway’ driven approach targeting the cumulative influence of psychosocial, epigenetic, or cellular factors is likely to be more effective. To optimize the therapeutic potential of precision medicine, we present a biopsychosocial integrated framework to examine the ‘gene–environment neuroscience interaction’. Such an approach would be supported through harnessing the power of big data, transdiagnostic assessment, impact and implementation evaluation, and a bench‐to‐bedside scientific discovery agenda with ongoing clinician and patient engagement.What this paper adds Precision medicine has predominantly focused on genetic risk factors.The impact of environmental risk factors, particularly inflammatory, metabolic, and psychosocial risks, is understudied.A holistic biopsychosocial model of neurodevelopmental disorder causal pathways is presented.The model will provide precision medicine across the full spectrum of neurodevelopmental disorders.
Research Interests:
Research Interests:
Research has established inflammation in the pathogenesis of brain injury and the risk of developing cerebral palsy (CP). However, it is unclear if inflammation is solely pathogenic and primarily contributes to the acute phase of injury,... more
Research has established inflammation in the pathogenesis of brain injury and the risk of developing cerebral palsy (CP). However, it is unclear if inflammation is solely pathogenic and primarily contributes to the acute phase of injury, or if inflammation persists with consequence in CP and may therefore be considered a comorbidity. We conducted a scoping review to identify studies that analyzed inflammatory biomarkers in CP and discuss the role of inflammation in the pathogenesis of CP and/or as a comorbidity. Twelve included studies reported a range of analytes, methods and biomarkers, including indicators of inflammatory status, immune function and genetic changes. The majority of controlled studies concluded that one or more systemic biomarkers of inflammation were significantly different in CP versus controls; most commonly serum or plasma cytokines such as tumor necrosis factor, Interleukin (IL)-6 and IL-10. In addition, differences in inflammation were noted in distinct subg...
Research Interests:
Iona Novak1,2*, Madison CB Paton2, Megan Finch-Edmondson2, Nadia Badawi2,3, Michael Fahey4,5, Annate Velde2, Ashleigh Hines2, Leigha Dark6, Amanda Khamis2, Maria Mc Namara2, Emma Stanton2, Cathy Morgan2 1Faculty of Medicine and Health,... more
Iona Novak1,2*, Madison CB Paton2, Megan Finch-Edmondson2, Nadia Badawi2,3, Michael Fahey4,5, Annate Velde2, Ashleigh Hines2, Leigha Dark6, Amanda Khamis2, Maria Mc Namara2, Emma Stanton2, Cathy Morgan2 1Faculty of Medicine and Health, The University of Sydney, Sydney, Australia 2Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Research Interests:
Research Interests:
Research Interests:
IntroductionNeuroplasticity is harnessed through high‐intensity or high‐dose training. Given the costs and time burden for families of children with cerebral palsy (CP), it is important to quantify which rehabilitation training approaches... more
IntroductionNeuroplasticity is harnessed through high‐intensity or high‐dose training. Given the costs and time burden for families of children with cerebral palsy (CP), it is important to quantify which rehabilitation training approaches and doses confer the largest clinical gain. The main objective of this systematic review was to determine any threshold dose of upper limb training needed for children with CP to achieve clinically significant functional improvements.MethodsThis systematic review included studies if they were as follows: randomised controlled trials; participants had a diagnosis of CP or brain injury; mean age of participants was 0–18 years; and intervention was an active upper limb training intervention. Two raters independently extracted data. Data were pooled and analysed using a receiver operator characteristic (ROC) curve and odds ratios to investigate the dose of practice that led to clinically significant gains.ResultsA total of 74 trials were included in th...
Research Interests:
AimTo examine the prevalence, clinical characteristics, and risk factors of cerebral palsy (CP) in children in Bangladesh.MethodThe Bangladesh CP Register is an ongoing population‐based surveillance database of children with CP from a... more
AimTo examine the prevalence, clinical characteristics, and risk factors of cerebral palsy (CP) in children in Bangladesh.MethodThe Bangladesh CP Register is an ongoing population‐based surveillance database of children with CP from a geographically defined area in Bangladesh. Cases were defined based on Surveillance of CP in Europe and Australian CP Register criteria after clinical assessments and identification by the key informant's method.ResultsIn total, 726 children with CP were identified between January 2015 and December 2016. Mean age was 7 years 7 months (standard deviation [SD] 4y 6mo; range: 4.8mo–18y; median 7y 1.2mo; 61.8% male, 38.2% female). Mean age at CP diagnosis was 5 years 2 months (SD 3.8). Observed prevalence was 3.4 per 1000 children (95% confidence interval [CI]: 3.2–3.7), resulting in an estimated 233 514 children (95% CI: 219 778–254 118) with CP in Bangladesh. The majority (79.6%) had spastic CP. Altogether, 79.6% of the children with CP had at least ...
Research Interests:
AimThe aetiology of perinatal stroke is poorly understood. This study aimed to prospectively confirm the risk factors and identify any previously unknown variables.MethodsA prospective case–control study was conducted in Australia.... more
AimThe aetiology of perinatal stroke is poorly understood. This study aimed to prospectively confirm the risk factors and identify any previously unknown variables.MethodsA prospective case–control study was conducted in Australia. Univariate odds ratios (ORs), associated 95% confidence intervals (CIs) and multivariable logistic regression models fitted with backwards stepwise variable selection were used.ResultsSixty perinatal stroke cases reported between 2017 and 2019 included 95% (57/60) with multiple risk factors. Univariate analysis identified emergency caesarean section rather than NVD (P < 0.01), low Apgar score (<7) at 1, 5 and 10 min of age (P < 0.01), resuscitation at birth (P < 0.01), abnormal cord blood gas (P < 0.01), neonatal infection/sepsis (P < 0.01), congenital heart disease (P < 0.01) and hypoglycaemia (P < 0.01) as significant risk factors. Multivariate analysis found smoking during pregnancy (OR: 1.48; 95% CI: 1.09–1.99), 1‐min Apgar score < 7 (OR: 1.54; 95% CI: 1.15–2.08), 10‐min Apgar score < 7 (OR: 1.26; 95% CI: 1.02–1.54) and hypoglycaemia (OR: 1.49; 95% CI: 1.07–2.06).ConclusionsPerinatal stroke is associated with multiple risk factors. Exposure to smoking, 10‐min Apgar score < 7, neonatal infection and hypoglycaemia were independent risk factors. Emergency caesarean section, resuscitation at birth and abnormal cord blood gas were additional risk factors.
Research Interests:
Research Interests:
IntroductionCerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early... more
IntroductionCerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early intervention programme for First Nations Australian infants at high risk of CP (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP).Methods and analysisThis study is a randomised assessor masked controlled trial. Infants with birth/postnatal risk factors will be eligible for screening. Infants at high risk of CP (‘absent fidgety’ on General Movements Assessment, and/or ‘suboptimal score’ on the Hammersmith Infant Neurological Examination) aged 12–52 weeks corrected age will be recruited. Infants and their caregivers will be randomised to receive LEAP-CP (intervention) or health advice (comparator). LEAP-CP is a culturally-adapted programme of 30 home visits delivered by a peer trainer (First Nations Community Health Worker); and inc...
Research Interests:
Umbilical cord blood cells have therapeutic potential for neurological disorders, through a paracrine mechanism of action. A greater understanding of the safety and immunological effects of allogeneic donor cord blood cells in the context... more
Umbilical cord blood cells have therapeutic potential for neurological disorders, through a paracrine mechanism of action. A greater understanding of the safety and immunological effects of allogeneic donor cord blood cells in the context of a healthy recipient immune system, such as in cerebral palsy, is needed. This study aimed to determine how quickly donor cord blood cells were cleared from the circulation in children with cerebral palsy who received a single intravenous infusion of 12/12 human leucocyte antigen (HLA) matched sibling cord blood cells. Twelve participants with cerebral palsy aged 2-12 years received cord blood cell infusions as part of a phase I trial of umbilical blood infusion for cerebral palsy. Digital droplet PCR analysis of DNA copy number variants specific to donor and recipient was used to assess donor DNA clearance at five timepoints post infusion, a surrogate measure of cell clearance. Donor cells were cleared from 3 months post-infusion in 11/12 partic...
Research Interests:
Research Interests:
Historically, the diagnosis of cerebral palsy has been made after 12 months of age, delaying access to crucial early intervention that optimises functional outcomes. This study aimed to identify and specify priority physician diagnostic... more
Historically, the diagnosis of cerebral palsy has been made after 12 months of age, delaying access to crucial early intervention that optimises functional outcomes. This study aimed to identify and specify priority physician diagnostic behaviours to target in implementation interventions to increase the rate of diagnosis of cerebral palsy under 6 months of age in Australia.
Research Interests:
Research Interests:
BackgroundChildren with neurodevelopmental disorders share common phenotypes, support needs and comorbidities. Such overlap suggests the value of transdiagnostic assessment pathways that contribute to knowledge about research and clinical... more
BackgroundChildren with neurodevelopmental disorders share common phenotypes, support needs and comorbidities. Such overlap suggests the value of transdiagnostic assessment pathways that contribute to knowledge about research and clinical needs of these children and their families. Despite this, large transdiagnostic data collection networks for neurodevelopmental disorders are not well developed. This paper describes the development of a nationally supported transdiagnostic clinical and research assessment protocol across Australia. The vision is to establish a harmonised network for data collection and collaboration that promotes transdiagnostic clinical practice and research.MethodsClinicians, researchers and community groups across Australia were consulted using surveys and national summits to identify assessment instruments and unmet needs. A national research committee was formed and, using a consensus approach, selected assessment instruments according to pre‐determined crite...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
To progress stem cell therapies for cerebral palsy, clinicians need to openly engage with patients about emerging evidence and be willing to refer to relevant clinical trials, if and when appropriate. To assess whether education can... more
To progress stem cell therapies for cerebral palsy, clinicians need to openly engage with patients about emerging evidence and be willing to refer to relevant clinical trials, if and when appropriate. To assess whether education can change clinicians’ confidence in information sharing and willingness to refer to relevant clinical trials, an online questionnaire was distributed at a scientific conference before and after a professional workshop on cell therapies for cerebral palsy. Of the 42 participants who completed the survey, 26 self-identified as clinicians. Of these, 81% had had patients ask about stem cells, yet in the pre-workshop questionnaire indicated they were not confident answering questions about cell therapies. Clinicians were most commonly asked about stem cell treatments provided by private clinics, stem cell research and current evidence. Post-workshop, knowledge and confidence regarding stem cells, as well as likelihood to refer to clinical trials using therapies ...
Research Interests:
Research Interests:
Knowledge translation (KT) is a topic of interest for researchers; however, little has been published about how to plan and prioritize KT activities. This article describes the development and outcomes of a KT strategic planning activity... more
Knowledge translation (KT) is a topic of interest for researchers; however, little has been published about how to plan and prioritize KT activities. This article describes the development and outcomes of a KT strategic planning activity for a research organization. An online survey and planning meeting resulted in the identification of six priority areas: engaging families, nurturing partnerships, optimizing access to knowledge, KT capacity building, advancing KT science, and funding for future KT activities. The organization collectively determined short- and long-term objectives, strategies, and measurable outcomes for the KT priority areas. The strategic planning process helped with prioritizing KT activities and engaged members in a collaborative discussion of mutual interest. The process described may be useful for others interested in developing KT strategic plans Résumé: L’application des connaissances (AC) est devenu une topique d’intérêt pour les chercheurs, cependant peu ...
Research Interests:
Research Interests:
Research Interests:
Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and... more
Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and supports parents. In this chapter, first we summarize the best-available tools for accurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy, developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impairment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidence for inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence base for: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focused on inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichment interventions in the neonatal intensive care and community settings, and (e) parent-child interaction interventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatment options at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosis enables early intervention, which improves child and parent outcomes. We now know which interventions provide the biggest gains and the information can be used to help inform parental decision making when designing treatment plans for their children.
Research Interests:
Research Interests: Motor Learning, Cerebral Palsy, Medicine, Physical Therapy, Learning, and 15 moreHumans, Environmental enrichment, Female, Feasibility Studies, Male, Psychological Intervention, Infant, Goals, Parents, Motor Skill, Medicine and Health Sciences, Pilot Projects, Environment, Motor Skills, and Paediatrics and reproductive medicine
Research Interests:
To investigate the relative utility of Canadian Occupational Performance Measure (COPM) (adapted for children) and Goal Attainment Scaling (GAS) as outcome measures for paediatric rehabilitation. A two-group pre-post design investigated... more
To investigate the relative utility of Canadian Occupational Performance Measure (COPM) (adapted for children) and Goal Attainment Scaling (GAS) as outcome measures for paediatric rehabilitation. A two-group pre-post design investigated the impact of a 3-month programme. Forty-one children with spastic hemiplegic cerebral palsy (mean 3.9 years; GMPM level 1; 21 boys, 10 girls) were randomized to occupational therapy only and occupational therapy plus one Botulinum Toxin A injection. The latter was considered a 'proven' intervention for the purpose of this instrumentation study. Intervention impact was investigated using GAS and COPM. Instrument sensitivity, convergent validity, goal/problem profiles and administration were evaluated. Both instruments were sensitive to within group change and detected significant between group change. Likert scale coding for GAS scores was more sensitive than the traditional weighted GAS or COPM. Different constructs were measured by each instrument. COPM was more time efficient in training, development and administration. Study aim, logistic and resource factors should guide the choice of COPM and/or GAS instruments as both are sensitive to change with a proven intervention and both evaluate different constructs.
Research Interests: Life Sciences, Cerebral Palsy, Activities of Daily Living, Comparison, Canadian, and 15 moreHumans, Child, Female, Male, Hemiplegia, Measure, Attainment, Developmental, Arts and Humanities, Goal, Botulinum Toxin, Level, Goal Attainment Scaling, Canadian Occupational Performance Measure, and Child preschool
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Child Welfare, Cerebral Palsy, Adolescent, Medicine, Humans, and 15 moreChild, Female, Male, Confidence intervals, Infant, New South Wales, Motor Function, Linear Regression, Medicine and Health Sciences, Gross Motor Skill, Cross sectional Study, Cross Sectional Studies, Motor Skills, Disability Evaluation, and Child preschool
Evidence is emerging for the use of botulinum neurotoxin type-A (BoNT-A) for niche indications including pain independent of spasticity. Pain indications such as chronic nociceptive back pain, piriformis syndrome, chronic myofascial pain,... more
Evidence is emerging for the use of botulinum neurotoxin type-A (BoNT-A) for niche indications including pain independent of spasticity. Pain indications such as chronic nociceptive back pain, piriformis syndrome, chronic myofascial pain, pelvic pain, complex regional pain syndrome, facial pain and neuropathic pain are outlined in this paper. Of these, class I evidence is available for the treatment of chronic nociceptive low back pain, piriformis syndrome, myofascial pain, facial pain, neuropathic pain and plantar fasciitis. Peri-operative use of BoNT-A is emerging, with indications including planning for surgery and facilitating surgery, as well as healing and improving analgesia post-operatively. Evidence is limited, although there are some reports that clinicians are successfully using BoNT-A peri-operatively. There is class I evidence showing pre-operative use of BoNT-A has a beneficial effect on outcomes following adductor-release surgery. The use of BoNT for treatment of tremor, other than neck tremor in the setting of cervical dystonia, including evidence for upper limb tremor, cranial tremor and non-dystonic neck tremor is reviewed. The evidence is variable at this stage, and further study is required to develop definitive recommendations for the clinical utility of BoNT-A for these indications.
Research Interests: Decision Making, Cerebral Palsy, Adolescent, Activities of Daily Living, Humans, and 15 moreChild, Functional Capacity, Back Pain, Arm, Dystonia, Complex Regional Pain Syndrome, Clinical Sciences, European, Adult, Assessment Tool, Botulinum Toxin, Analgesics, Cervical Dystonia, Clinical Trials as Topic, and Dosing
Research Interests: Evidence Based Practice, Implementation Science, Quality Improvement, Knowledge Translation, Cerebral Palsy, and 14 moreMedicine, Allied Health, Humans, Psychological Intervention, Cluster Analysis, Diffusion of Innovation, New South Wales, Questionnaires, KT, Randomized Controlled Trial, Guidance and Counseling Intervention Programs, Translational Medical Research, Allied Health Personnel, and Medical and Health Sciences
Research Interests:
Cerebral palsy (CP) is the most severe physical disability within the spectrum of developmental delay. CP is an umbrella term describing a group of motor disorders, accompanied by many associated impairments. The disability is a result of... more
Cerebral palsy (CP) is the most severe physical disability within the spectrum of developmental delay. CP is an umbrella term describing a group of motor disorders, accompanied by many associated impairments. The disability is a result of injuries to the developing brain occurring any time from the first trimester of pregnancy through to early childhood. However, for the great majority, their full etiological causal pathway remains unclear. It is important to discriminate as early as possible between: (a) mild or nonspecific motor delay, (b) developmental coordination disorder, (c) syndromes, (d) metabolic and progressive conditions, and (e) CP with its various motor types and distributions. The most promising predictive tool for CP is the general movements assessment, which assesses the quality of spontaneous movements of infants in the first 4 months of life. We propose a change in diagnostic practice. We recommend a shift away from referral for intervention following a formal (most often late) description of CP, to one of referral for intervention which occurs immediately once an infant is considered "at risk" of CP.
Research Interests:
Research Interests:
Research Interests: Cognitive Science, Australia, Risk, Cerebral Palsy, Medicine, and 15 morePhysical Medicine and Rehabilitation, Physical Therapy, Canada, Humans, New Zealand, Infant, Goals, Parents, Randomized Controlled Trial, Clinical Protocols, Environment, Neurosciences, Motor activity, Randomized Controlled Trials as Topic, and Outcome assessment (Health care)
conductors who are teachers (or special education teachers) specializing in conductive education pedagogy (3or 4-year higher-education courses). Most evaluation studies have utilized concepts and methods from the medical and allied health... more
conductors who are teachers (or special education teachers) specializing in conductive education pedagogy (3or 4-year higher-education courses). Most evaluation studies have utilized concepts and methods from the medical and allied health professions. Despite the clue inherent in its English name, however, conductive education has rarely been investigated by means familiar in education. We face a paradox. The general finding has been that conductive education demonstrates little or no measured benefit – yet many users and providers continue to seek and to fund it. How to explain this? One possible explanation is that advocates of conductive education are deluded fools with no respect to the findings of medical science. Another is that medical science has failed to capture the social and personal benefits widely reported by users of this approach. If so, reliance upon medical-style evaluation may have both missed a trick and helped choke off development of a major humane and scientific advance. The absence of evidence is not evidence of absence. It may instead be a function of looking in the wrong place, by the wrong means. If conductive education represents a paradigm, a philosophy, a way of life – in the specific area of childhood a style of childrearing – then medical-style research is but one amongst a number of possible ways to investigate this. Empirical research into the outcomes of conductive education requires other research questions, other outcome measures, and other methodologies if it aspires to achieve a ‘green go’ rather than a ‘red stop’.