Acquisition of autonomy skills in adolescents with myelomeningocele
Acquisition of autonomy skills in adolescents with myelomeningocele
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DOI：
10.1017/s0012162206000569
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发表时间：
2006-04-01
影响因子：
3.8
通讯作者：
Walker, WO
中科院分区：
文献类型：
--
作者：
Davis, BE;Shurtleff, DB;Walker, WO
本研究描述了一个区域队列的脊髓脊膜膨出（MM）患者的典型青少年自主技能的获得年龄（AOA），年龄为12至18岁，平均年龄为14岁11个月（SD 2 y 5 mo）。分析了10年来收集的数据。回归分析，使用广义估计方程，提供了每种技能的第50百分位数和第75百分位数AOA。158名参与者（90名男性，68名女性）参加了378次年度患者就诊。患者接触者在年龄和身体严重程度分组中分布均匀。24%的参与者的功能性病变水平在L2或以上，38%在L3-L5之间，38%在S1或以下。84%的患者有分流性脑积水，24%的患者在成年前就能独立工作，69%的患者在青春期前就能独立工作。自主技能的AOA比正常发育的青少年延迟了25%到30%。认知能力的差异解释了中位年龄的技能获得（p=0.01）比身体病变水平的方差。参与者获得社区技能的中位年龄为16岁6个月。12%的18岁青少年驾驶汽车（9%在监督下，3%独立驾驶），无论身体病变的严重程度如何。我们的结论是，MM青少年获得大多数自主技能2至5年后，比他们通常发展的同龄人。本研究建立了MM青少年自主技能的AOA时间表。
This study describes ages of acquisition (AOA) of typical adolescent autonomy skills in a regional cohort of individuals with myelomeningocele (MM), aged 12 to 18 years, with a mean age of 14 years 11 months (SD 2y 5mo). Prospectively collected data over 10 years were analyzed. Regression analysis, using Generalized Estimation Equation, provided 50th centile and 75th centile AOA for each skill. One hundred and fifty-eight participants (90 males, 68 females) attended 378 annual patient visits. Patient contacts were equally distributed across age and physical severity groupings. Twenty-four percent of participants had functional lesion levels at or above L2, and 38% between L3-L5, 38% at S1 or below. Eighty-four percent had shunted hydrocephalus, 24% were independent in ambulation, and 69% achieved toileting independence before adolescence. AOA for autonomy skills were delayed by 25 to 30% when compared with typically developing adolescents. Differences in cognitive ability explained the variance in median ages for skill acquisition (p=0.01) more than physical lesion level. Participants acquired community skills at a median age of 16 years 6 months. Twelve percent of 18-year-olds drove cars (9% with supervision, 3% independently), regardless of physical lesion severity. We conclude that adolescents with MM acquire the majority of autonomy skills 2 to 5 years later than their typically developing peers. This study establishes AOA timelines for autonomy skills in adolescents with MM.