Journal of Pediatric Rehabilitation Medicine - Volume 15, issue 4

Authors: Wickham, Azadeh | McElroy, Susan F. | Austenfeld, Lindsey | Randall, J. Hogan | Carrasco Jr. , Alonso | Weddle, Gina | Bowlin, Paul | Koenig, Joel | Gatti, John M.

Article Type: Research Article

Abstract: PURPOSE: Patients with neurogenic bladder (NB) often perform clean intermittent catheterization (CIC) and are predisposed to bladder colonization. Antibiotics are not routinely indicated in those with asymptomatic bacteriuria (ASB). The original purpose of this study was to compare patients that received antibiotics for ASB and those that did not. However, because the non-antibiotic group was very small, the final analysis evaluated treatment patterns of ASB in children with NB. METHODS: A retrospective chart review was completed, including patients who presented with urinary tract infection (UTI) and NB managed by CIC. Patients with symptoms of UTI were excluded. Basic …demographics, urinalysis, culture results, and antibiotic prescriptions were collected. RESULTS: The sample included 272 patient encounters for 109 unique patients. Of these, 50.7% were female, and the median age was 10.25 years. More than half the urine cultures (56.2%) grew gram-negative organisms, and 31.3% contained 2 or more organisms. Nearly all encounters received treatment with antibiotics. Twenty-three encounters with no culture performed or the culture resulted in no growth received antibiotic therapy. CONCLUSIONS: Antibiotic resistance and antibiotic stewardship are primary concerns in healthcare today. This organization’s current practice pattern shows high antibiotic use for ASB in patients with NB. Future studies are required to identify outcomes associated with treatment versus non-treatment in these patients. Show more

Keywords: Urinary bladder, neurogenic, spinal dysraphism, urinary catheterization, antimicrobial stewardship, bacteriuria

DOI: 10.3233/PRM-210051

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 633-638, 2022

Authors: O’Connor, Deirdre | Menzies, Rebecca | Cao, Xingshan | Berndl, Anne

Article Type: Research Article

Abstract: PURPOSE: The primary objective was to estimate the risk of preterm delivery in a population of women with a skeletal dysplasia and short stature. The secondary outcome was to identify factors that increase the risk of preterm delivery. METHODS: A cross sectional survey was performed asking detailed pregnancy and reproductive health questions, aimed at a convenience sample of women who were little people, administered through Little People of America, Little People UK, Little People Canada, and the World Dwarf Games. Comparisons were made on gestational age at delivery between pregnancies with and without the outcomes. RESULTS: …The survey had a response rate of 74% (117/158). There was a total of 55 eligible subjects who had 72 live births. Delivery prior to 37 weeks occurred in 19/72 live births, which equates to a preterm birth rate of 26.4%. Besides short stature, no single factor was identified that could solely explain the elevated preterm birth risk in the study population. CONCLUSION: The risk of preterm delivery in women with skeletal dysplasias and short stature is elevated compared to the general population. This information will assist healthcare providers in pregnancy management and counseling. Show more

Keywords: Pregnancy, dwarfism, bone diseases, developmental, premature birth

DOI: 10.3233/PRM-210117

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 639-646, 2022

Authors: Houtrow, Amy J. | Pruitt, David W.

Article Type: Brief Report

Abstract: PURPOSE: The objective of this study was to determine how the COVID-19 pandemic impacted the work and compensation of pediatric physiatrists during the first year of the pandemic. METHODS: Pediatric physiatrists were surveyed in the spring of 2021 about how the first year of the COVID-19 pandemic impacted their practices as a part of a larger survey examining pediatric rehabilitation medicine practices. The COVID-19 specific questions covered three topic areas: 1) personal experiences with COVID-19; 2) occupational workflow changes due to COVID-19, including telehealth; and 3) employment consequences of the COVID-19 pandemic. RESULTS: Thirteen of 259 …pediatric physiatrists reported having a COVID-19 infection, of whom none required hospitalization. Nearly all (96.5%) of pediatric physiatrists reported using telehealth during the pandemic compared to 14% prior to the pandemic. They reported numerous changes to their clinical operations, and 50% reported not having adequate personal protective equipment available for themselves or their staff all of the time. Fifteen pediatric physiatrists (5.9%) reported being furloughed, and three reported job loss during the first year of the pandemic. CONCLUSION: While only a small percentage of pediatric physiatrists contracted COVID-19 during the first year of the pandemic, nearly all experienced workflow changes. Show more

Keywords: Physiatry, COVID-19, workforce, pandemic

DOI: 10.3233/PRM-220012

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 647-654, 2022

Authors: Batson, Lora | Donohue, Pamela K. | Boss, Renee D. | Seltzer, Rebecca R.

Article Type: Research Article

Abstract: PURPOSE: This study aimed to explore the family experience and associated challenges of transporting children with medical complexity (CMC) in personal vehicles. METHODS: Parents/guardians of CMC in Maryland were recruited to participate in an audiotaped, semi-structured interview. Conventional content analysis was applied to transcripts. RESULTS: Data from 29 participants who indicated use of personal vehicles to transport their CMC were included in the analysis. Transportation challenges were common, and analysis revealed the following themes: 1) challenges transitioning in/out of the vehicle: excess planning time, child factors (e.g., weight), equipment factors (e.g., wheelchair), physical and environmental factors, …2) safety and comfort: CMC positioning/restraints, driver distraction, 3) financial challenges: travel costs related to medical care, accessible modification costs, transportation equipment costs, insurance delays in equipment coverage, 4) adverse family repercussions: parental physical health, isolation, and 5) evolving and unpredictable transportation needs. CONCLUSION: Families with CMC experience multifactorial challenges that impact all phases of travel in personal vehicles and negatively impact child and family safety, access to community and medical care, family finances, and overall well-being. Health care providers can support families by identifying transportation challenges that contribute to health inequities, tailoring solutions to the family’s unique needs, and advocating at a policy level to promote change. Show more

Keywords: Transportation, travel, children with medical complexity, family

DOI: 10.3233/PRM-220015

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 655-665, 2022

Authors: Sugiyama, Mizuki | Aoki, Sayaka | Kawate, Nobuyuki | Hashimoto, Keiji

Article Type: Research Article

Abstract: PURPOSE: The purpose of the study was to explore whether a developmental test provides enough information to estimate a child’s functional independence. The strength of the relationship between developmental level and functional independence of different skills was investigated. METHODS: The participants were 397 children (age 0–7 years) who were referred to NCCHD for suspected developmental delay. The participants’ developmental level was measured with the Kyoto Scale of Psychological Development (KSPD) and their functional independence was assessed through a Japanese version of the WeeFIM II®. To calculate the strengths of the relationship between developmental age (DA) in different domains …of the KSPD and WeeFIM II item scores, partial correlation analyses were conducted, controlling for chronological age. RESULTS: Partial correlation coefficients between the score of each of the 18 WeeFIM II items and each of the three KSPD domain DAs (controlling chronological age) fell in the ranges of r  = 0.169–0.581 (Posture-Motor; P-M), r  = 0.377–0.627 (Cognitive-Adaptive; C-A), and r  = 0.332–0.655 (Language-Social; L-S). When the participants were divided into three age groups, the correlations ranged from –0.095 to 0.552 for the youngest group (mean age = 14.21 months), from 0.283 to 0.653 for the middle group (mean age = 32.98 months), and from 0.345–0.692 for the oldest group (mean age = 57.48 months), depending on the combinations of the WeeFIM II items/developmental domains of the KSPD. The results indicated that for most of the daily living skills, its functional independence was only partially explained by the scores of a developmental test, once chronological age was controlled. CONCLUSION: This study showed the limitation of a developmental test as a tool to measure the functional independence of children and the necessity of using an independent tool, such as WeeFIM II, to evaluate the level of required support for each daily living skill. Show more

Keywords: Functional Independence Measure for Children (WeeFIM II®); Kyoto Scale of Psychological Development (KSPD), Activities of Daily Living (ADL), infants, toddlers

DOI: 10.3233/PRM-210079

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 667-676, 2022

Authors: Stępień, Agnieszka | Sobińska, Małgorzata | Rekowski, Witold | Krawczyk, Maciej Julian

Article Type: Research Article

Abstract: PURPOSE: Restrictions related to the COVID-19 pandemic can negatively affect patients who require physiotherapy. This study aimed to analyze the consequences of limited physiotherapy on the functional state of children with neuromuscular diseases (NMD). In addition, the caregivers’ well-being and caregiver opinions on physiotherapy were analyzed. METHODS: A questionnaire was shared with parents of children with NMD immediately after the COVID-19 lockdown. The survey included questions regarding the physical and mental condition of children and parents before the pandemic and during lockdown as well as their views on physiotherapy and telephysiotherapy. Statistical analysis was performed using the Wilcoxon …Matched-Pairs Signed Ranks test, Spearman’s Rank Correlation test, McNemar test, and Chi-square test. RESULTS: Parents of 235 children participated in the study. Results indicated that children devoted more time to physiotherapy before the pandemic than during the lockdown period, which was true for those living in cities and the countryside. The functional state of 50.2% of the children deteriorated during the lockdown, in the opinion of their parents. Significant correlations were found between limited physiotherapy time and the deterioration of children’s functional condition, ability to maintain a standing position, and increased anxiety. The majority of parents reported increased levels of fear and anxiety (72.8%), fatigue (67.7%), and pain (53.2%). In-person physiotherapy was rated significantly higher than telephysiotherapy by parents. CONCLUSIONS: Limited access to physiotherapy and shorter therapy times may lead to functional deterioration in children with NMD, but this assumption needs to be objectively confirmed. According to the parents’ opinions, telephysiotherapy is less beneficial than direct physiotherapy but may support therapy conducted directly by a physiotherapist. Results based on subjective parental opinions may be helpful in planning future projects. Show more

Keywords: Neuromuscular diseases, neuromuscular, children, COVID-19, physiotherapy, telephysiotherapy

DOI: 10.3233/PRM-210002

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 677-689, 2022

Article Type: Other

DOI: 10.3233/PRM-229006

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 691-694, 2022

Authors: Pico, Elaine L.

Article Type: Other

DOI: 10.3233/PRM-229007

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 15, no. 4, pp. 695-695, 2022