Active, Open to Enrollment
Active, Not Enrolling Participants
Exploring Shared Decision-Making (SDM) in Children with Neurodevelopmental Disorders
No longer funded, ongoing opportunities for data analysis
Children born prematurely are at risk white matter damage within the brain, particularly in periventricular regions. Children born preterm are also at risk for neurodevelopmental disabilities. The goal of this study is to relate the degree and patterns of white matter injury to linguistic, cognitive outcomes, academic, and behavioral outcomes. Two sophisticated MRI procedures will complement behavioral testing. (1) Diffusion Tensor Imaging (DTI) provides detailed voxel-based quantitative information on the integrity of white matter microstructure. We used multiple analytic strategies to analyze the DTI data, including tract-based spatial statisitcs and tractography. (2) Functional Magnetic Resonance Imaging (fMRI) was used to characterize the patterns of neural activity underlying cognitive skills. fMRI tasks assessed domains known to be supported in mature functioning by widely distributed brain circuitry that may be impaired after white matter injury—comprehension of syntactically complex sentences, which relies on interhemispheric integration, and oculomotor response inhibition and spatial working memory, which rely on occipital-frontal and cortical-subcortical integration.
The combination of methods will allow us to link brain structure, brain functioning, and behavioral outcomes. Participants were a group of children and adolescents, 9 to 16 years old who were born preterm and a matched group born at term. Results thus far have replicated other studies of the preterm population, confirming mild to moderate deficits in multiple domains through to adolescence. We did not find consistent differences in white matter properties comparing the preterm and full term groups. However, within the preterm group we demonstrated strong correlations of white matter properties and behavioral outcomes. Functional imaging results showed that children activate frontal brain regions when processing difficult as compared to simple sentences and the areas differ comparing preterm and full term participants.
The Therapeutic Potential of Deep Massage (Rolfing / Myofascial Structural Integration) in Children with Cerebral Palsy
Cerebral palsy (CP) is the diagnosis of the most prevalent physical disability in childhood. Spasticity is the most common type of CP. In the past, spasticity was attributed solely to neural mechanisms related to central nervous system injury. However, recent evidence implicates structural changes in the muscle and connective tissue or fascia as important contributors to the increased muscle tone and stiffness in CP. Targeting the local structural changes specifically and directly could be a potential mechanism to reduce spasticity and resultant contractures and to improve motor function in children with CP.
Myofascial Structural Integration (MSI) therapy, also known as rolfing, is a specific technique that manipulates muscle and fascia to put the body into proper alignment and facilitate improved motor patterns. Currently classified as a manipulative and movement-based complementary medicine practice, MSI may be a safe and effective treatment for improving motor functions in children with spastic CP. We are currently running a trial of 24 children funded by the Gerber Foundation evaluating the potential functional benefits of MSI.
Creating Effective and Sustainable Change in the Clinical Practice of Developmental-Behavioral Pediatrics Using QI Methods and Tools
The aims of this study are: to test hypotheses and proposals on a microsystem level that are related to clinical practice and workflow; to evaluated intended and unintended effects of clinical process changes; to generate data useful for monitoring and evaluating improvement projects; to facilitate lasting cultural and systematic shifts.
The aims of this study are three fold: to identify characteristics of case studies that increase adoption of SDM strategies; to develop interactive web-based case studies on SDM regarding treatment choices for ASD; and to pilot-test use of the case studies in SDM training with Developmental-Behavioral Pediatrics (DBP) fellows.