Journal of Pediatric Rehabilitation Medicine - Volume 16, issue 1

Authors: Kim, Heakyung | Byrne, Rachel | Green, Michael

Article Type: Editorial

DOI: 10.3233/PRM-239002

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 1-2, 2023

Authors: McLaughlin, Matthew J. | Fisher, Mark T.

Article Type: Other

DOI: 10.3233/PRM-230003

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 3-9, 2023

Authors: Brandenburg, Joline E.

Article Type: Position Paper

Abstract: Baclofen is often considered a first-line treatment option for spasticity management in children. However, adverse effects, administration, and dosing can be barriers to effectiveness. In my practice, other medications for spasticity management are often used prior to initiating baclofen. In this article, baclofen use for spasticity management in children is briefly reviewed along with discussion of approaches using other medications as first-line treatment options. I will present a rationale for medication selection for spasticity management and discuss the approaches I take in medication selection that incorporate spasticity severity, patient goals, and medication side effect profiles.

Keywords: Pediatric, children, cerebral palsy, botulinum toxin

DOI: 10.3233/PRM-230001

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 11-17, 2023

Authors: Srinivasan, Rajashree

Article Type: Position Paper

Keywords: Spasticity, cerebral palsy, baclofen

DOI: 10.3233/PRM-230005

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 19-24, 2023

Authors: Smith, Julianna | DiVito, Michelle | Fergus, Andrea

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to examine the reliability and discriminant validity of the Quantitative Timed up and Go (QTUG) in typically developing (TD) children and children with cerebral palsy (CP). METHODS: Twenty-eight TD children and 8 with CP (GMFCS I-II) completed 3 TUG trials while wearing QTUG sensors. Test-retest reliability and discriminative ability were examined for the 57 constituent parameters of the TUG. Relationships between age and these parameters were also examined. RESULTS: Forty-four of the parameters demonstrated moderate to excellent test-retest reliability, with measures of angular velocity being the most reliable. Twenty-six …parameters were different between TD children and those with CP, and twenty-eight gait parameters demonstrated correlations with age, further supporting its discriminative ability. CONCLUSION: The QTUG is a clinically feasible tool that is capable of both reliably measuring and discriminating many of the movement parameters with the TUG mobility task in TD children and those with CP GMFCS I-II. The results of the present study provide preliminary evidence that the QTUG can discriminate between children on several of the gait parameters within the TUG. Show more

Keywords: Cerebral palsy, children, children, gait, inertial sensors, QTUG, Quantitative Timed Up and Go, reliability

DOI: 10.3233/PRM-210034

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 25-35, 2023

Authors: Ashouri, Somayeh | Letafatkar, Amir | Thomas, Abbey C. | Yaali, Rasoul | Kalantari, Minoo

Article Type: Research Article

Abstract: PURPOSE: This study investigated the effects of the challenge point framework (CPF) to improve stepping reactions and enhance balance in children with hemiplegic cerebral palsy (HCP). The CPF relates practice variables to the skill level of the individual and task difficulty. METHODS: Nine children with HCP (age: 7.7±2.4 years) completed six weeks (12 sessions) of a CPF intervention which consisted of progressively fewer sets and repetitions of a stepping reaction task wherein participants sought to improve both step length and reaction rate. Stepping reaction (step length and reaction rate) to a balance perturbation in the anterior, posterior, and …lateral directions and static and dynamic balance (via the Pediatric Balance Scale) were measured at baseline, a second baseline 3 weeks later, and post-intervention. Repeated measures ANOVAs determined within-group changes. Cohen’s d effect sizes were calculated. RESULTS: Participants improved balance (d  = 0.948, p  = 0.010), step length (forward d  = 0.938, p  = 0.002; backward d  = 0.839, p  = 0.001; and lateral d  = 0.876, p  = 0.002), and reaction rate (forward d  = 0.249, p  = 0.042; backward d  = 0.21, p  = 0.047; and lateral d  = 0.198, p  = 0.049). CONCLUSION: These findings indicate that children with HCP may benefit from completing a CPF program with a motor learning approach. This approach of retraining stepping reactions helped to improve static and dynamic balance. The CPF may aid progression of functional task training in children with HCP aged 4–12, though more studies with a long-term follow-up analysis are needed to confirm this result. Show more

Keywords: Cerebral palsy, challenge point framework, balance

DOI: 10.3233/PRM-201522

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 37-48, 2023

Authors: Nawge, Surabhi | Karthikbabu, Suruliraj

Article Type: Research Article

Abstract: PURPOSE: Sixty percent of children with bilateral cerebral palsy have impaired hand function. The study’s purpose was to examine the benefits of bimanual task practice on the manual ability and hand function of children with bilateral spastic cerebral palsy. METHODS: In this pre-post study design, 18 children with bilateral spastic cerebral palsy with an average age of 11.5 (+/-1.9) years, Manual Ability Classification System levels I-III and Bimanual Fine Motor Function levels I-III participated in bimanual task practice of upper extremities. The task practice included clay activities, paper manipulation and activities of daily needs. The children underwent 45-minute …training sessions 3 times a week over 6 weeks. The outcome measures were ABILHAND-Kids, Quality of Upper Extremity Skills Test and grip strength. RESULTS: Post-training, a mean change of 6.44 logits in ABILHAND-Kids, 11 points on the Quality of Upper Extremity Skills Test, and 3.3 and 3.1 kilograms grip strength in the dominant and nondominant hands respectively were observed with a statistical significance (p  < 0.05). CONCLUSION: Bimanual task training might be beneficial in improving manual ability, hand function and grip strength in children with bilateral spastic cerebral palsy. Show more

Keywords: Bimanual training, bilateral spastic cerebral palsy, grip strength, task training, upper limb function

DOI: 10.3233/PRM-210109

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 49-57, 2023

Authors: Kolit, Zeynep | Ekici, Gamze

Article Type: Research Article

Abstract: PURPOSE: The study aimed to examine the effects of “Cognitive Orientation to daily Occupational Performance” (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents’ satisfaction level. METHODS: Thirty-two children with CP were randomized to experimental (n  = 16) or control (n  = 16) groups, with n  = 2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT. RESULTS: No baseline differences existed, except for years …of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (p  < 0.05). CONCLUSION: CO-OP is expected to be beneficial if incorporated into CP rehabilitation. Show more

Keywords: Cerebral palsy, occupations, cognitive orientation, functional status

DOI: 10.3233/PRM-210085

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 59-70, 2023

Authors: Bootsma, Jael N. | Campbell, Fiona | McCauley, Dayle | Hopmans, Sarah | Grahovac, Danijela | Cunningham, BJ | Phoenix, Michelle | de Camargo, Olaf Kraus | Geytenbeek, Johanna | Gorter, Jan Willem

Article Type: Research Article

Abstract: PURPOSE: This study aimed to 1) investigate the convergent and discriminant validity, internal consistency, and test-retest reliability of the Canadian English version of the Computer-Based instrument for Low motor Language Testing (C-BiLLT-CAN), and 2) explore feasibility of the C-BiLLT assessment for children with cerebral palsy (CP) and complex communication needs in the Canadian health care context. METHODS: Eighty typically developing children between 1.5 and 8.5 years of age completed the C-BiLLT-CAN, the Peabody Picture Vocabulary Test-IV (PPVT-4), the receptive language sub-test of the New Reynell Developmental Language Scales (NRDLS), and/or the Raven’s 2. Correlations between raw scores were …calculated for estimates of convergent and discriminant validity. Internal consistency was calculated for all items and separately for items pertaining to vocabulary and grammar. To calculate the standard error of measurement (SEM) and intraclass correlation coefficient (ICC), 33 participants were re-tested with the C-BiLLT within three weeks. Feasibility was explored with nine participants with CP. RESULTS: C-BiLLT-CAN’s convergent validity was good to excellent (Spearman’s rho > 0.78) and discriminant validity was higher than hypothesized (Spearman’s rho > 0.8). Internal consistency (Cronbach’s alpha = 0.96), test-retest reliability (ICC > 0.9), and measurement error (SEM < 5%) were excellent. The feasibility study could not be fully completed due to the COVID-19 pandemic. Preliminary data demonstrated some technical and practical barriers for using the C-BiLLT in children with CP in Canada. CONCLUSION: The C-BiLLT-CAN showed good to excellent psychometric properties in a sample of typically developing children, indicating that it is an adequate test for measuring language comprehension in English-speaking Canadian children. Further research is needed to investigate the feasibility of the C-BiLLT-CAN in children with CP. Show more

Keywords: Cerebral palsy, language comprehension, psychometrics, non-verbal communication, cognition

DOI: 10.3233/PRM-210101

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 71-81, 2023

Authors: Bonfert, Michaela | Heinen, Florian | Kaňovský, Petr | Schroeder, A. Sebastian | Chambers, Henry G. | Dabrowski, Edward | Geister, Thorin L. | Hanschmann, Angelika | Althaus, Michael | Banach, Marta | Gaebler-Spira, Deborah

Article Type: Research Article

Abstract: PURPOSE: This pooled analysis of data from three Phase 3 studies investigated the effects of incobotulinumtoxinA on spasticity-related pain (SRP) in children/adolescents with uni-/bilateral cerebral palsy (CP). METHODS: Children/adolescents (ambulant and non-ambulant) were evaluated for SRP on increasingly difficult activities/tasks 4 weeks after each of four incobotulinumtoxinA injection cycles (ICs) using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to lower limb [LL] or upper limb [UL] spasticity and respondent type [child/adolescent, interviewer, or parent/caregiver]). IncobotulinumtoxinA doses were personalized, with all doses pooled for analysis. RESULTS: QPS key item responses were available from …331 and 155 children/adolescents with LL- and UL-spasticity, respectively, and 841/444 (LL/UL) of their parents/caregivers. IncobotulinumtoxinA efficacy was evident with the first IC. Efficacy was sustained and became more robust with further subsequent ICs. By Week 4 of the last (i.e. fourth) IC, 33.8–53.3% of children/adolescents reported complete SRP relief from their baseline pain for respective QPS items. Children/adolescents reported reductions in mean LL SRP intensity at levels that surpassed clinically meaningful thresholds. Similarly, parents/caregivers observed complete SRP relief and less frequent SRP with incobotulinumtoxinA. Similar results were found for UL SRP. CONCLUSION: These findings indicate that incobotulinumtoxinA could bring considerable benefit to children/adolescents with spasticity by reducing SRP, even during strenuous activities. Show more

Keywords: Botulinum toxin, muscle spasticity, all movement disorders, all pediatric, cerebral palsy, pain

DOI: 10.3233/PRM-220020

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 83-98, 2023

Authors: Reyes, Fabiola I. | Herge, Whitney M. | Cerza, Shelby L. | Savedra, Allen | Thompson, Catherine E.

Article Type: Case Report

Abstract: PURPOSE: The goal of this retrospective chart review study was to explore factors that contributed to consideration of or actual pump explantation in pediatric patients with intrathecal baclofen (ITB) pumps. METHODS: Medical records of 30 patients with ITB pumps were reviewed. Quantitative data, including demographic, clinical, psychosocial, and service utilization variables were culled from the records. Qualitative data were collected from clinic visit notes, pump-related follow-up phone calls, and any pump-related emergency room visits. RESULTS: Of those reviewed, six underwent ITB pump explantation, and two considered explantation. Factors contributing to pump explantation or consideration of explantation …included the following: postoperative infection, pump malfunction, non-adherence, anxiety/behavioral factors impacting the patient’s tolerance of the pump, distance to the medical provider, frequency of required pump refill appointments, lack or perceived lack of intrathecal baclofen effect, and difficulty transitioning to adult care providers. CONCLUSION: Due to the complex care regimen associated with ITB pumps and various psychosocial and logistical factors that impact treatment success, a standardized multidisciplinary pre-implantation education, screening, and assessment process should be developed. Such a process would ensure that patients/families receive appropriate education, including proactively identifying treatment barriers and potential complications, possibly minimizing dissatisfaction with treatment and the need for explantation. Show more

Keywords: Pediatric, psychosocial needs assessment, baclofen, intrathecal baclofen pump

DOI: 10.3233/PRM-210097

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 99-108, 2023

Authors: Pennington, Jared | Contini, Shawnelle | Brown, Miraides | Goel, Nupur | Chen, Tsulee

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to evaluate the effectiveness of intrathecal morphine following selective dorsal rhizotomy in pediatric patients previously diagnosed with cerebral palsy. METHODS: This was a retrospective, cohort analysis over the course of four years. The analysis consisted of a treatment group which received intrathecal morphine (5 mcg/kg) injection and a control group that did not receive the injection prior to dural closure. All patients underwent multilevel laminectomies for selective dorsal rhizotomy at Akron Children’s Hospital. The effectiveness of the treatment was measured by total dose of hydromorphone administered on patient-controlled analgesia (PCA), number …of days on oral narcotics, and cumulative dose of oral narcotic. RESULTS: Of the analyzed 15 pediatric patients, seven patients received intrathecal morphine injection while the other eight did not receive the treatment prior to dural closure. There was a difference of 1135 mcg in total PCA dose between the study group (3243 mcg) and the control group (4378 mcg). The total PCA dose based on weight was lower in the study group (163 mcg/kg) than in the control group (171 mcg/kg). CONCLUSION: Based on these findings, the administration of intrathecal morphine clinically reduces the opiate need in the first 96 hours post-operatively. Show more

Keywords: Cerebral palsy, selective dorsal rhizotomy, pain control, intrathecal morphine

DOI: 10.3233/PRM-220048

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 109-114, 2023

Authors: Rajkumar, Lavanya | Ventatakrishnan, Abhinaya | Sairam, Smitha | Khosla, Megha | Khanna, Ritu | Das, Biswajit | Mishra, Devendra | Juneja, Monica

Article Type: Research Article

Abstract: PURPOSE: The incidence of dystonic cerebral palsy causing significant morbidity is on the rise. There is a paucity of evidence for the management of dystonia in children. METHODS: Forty-one children aged 6 months-5 years with predominantly dystonic cerebral palsy were started on a predetermined protocol of trihexyphenidyl (0.25–0.52 mg/kg) and followed up at 3, 6 and 12 weeks. Dystonia severity, motor function and developmental age at baseline and 12 weeks were compared using the Global Dystonia Scale (GDS), the Gross Motor Function Measure (GMFM), and Fine Motor/Perceptual Subscale of the Early Developmental Profile-2. Thirty-four children completed the entire 12 …weeks of intervention. RESULTS: The mean age of participants was 25±11 months. A significant decrease in median total dystonia scores on the GDS was observed post-intervention (74.5 to 59, p  < 0.0001), and 64% of participants gained motor milestones. GMFM scores increased significantly from a median of 19.8% pre-intervention to 26.5% post-intervention (p  < 0.0001). There was improvement in the fine motor domain as compared to the baseline (p  < 0.0001). The number of children classified at Gross Motor Function Classification System levels 1 and 2 increased to 47.05% from 5.88% in the pre-intervention group. CONCLUSION: Trihexyphenidyl significantly improved dystonia, motor function and development in children with dystonic cerebral palsy in this study. Additional studies are needed to clarify its role in larger numbers of children with this condition. Show more

Keywords: Dystonia, cerebral palsy, trihexyphenidyl, young children, developmental delay, perinatal asphyxia

DOI: 10.3233/PRM-210087

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 115-124, 2023

Authors: Gantelius, Stefan | Vikerfors, Sandra | Edqvist, Josefin Jansson | von Walden, Ferdinand | Hagströmer, Maria | Pontén, Eva

Article Type: Research Article

Abstract: PURPOSE: This study aimed to explore the feasibility of using time-matched uniaxial accelerometers for measuring movement in daily life in children with cerebral palsy (CP) before and after botulinum toxin injections. METHODS: This observational study of clinical care with a pre-post design was set in the home and school environment. Participants included eleven children (4–13 years of age) with CP (GMFCS I-III). The children wore uniaxial accelerometers (ActiGraph, model GT1M) for 4 days on both wrists, the right ankle and around the waist before, 3 weeks and 3 months after BoNT-A injections in the legs. Five children also …got BoNT-A in the most affected arm. All injections were given according to clinical indications and routine. The accelerometers were all time-matched to define ambulation, arm swing, voluntary activity of arms, and bimanual activity. The feasibility of wearing accelerometers with this setup was evaluated. A linear mixed model was used for analysis of the percentage time and at which intensity the different activities were performed. The confidence interval demonstrated any difference between the dominant and non-dominant arm. RESULTS: Time-matching of accelerometers placed on both wrists, the waist, and one ankle is a feasible method of registering ambulation, arm swing during gait, and arm movements while not ambulating. Before injections, the children spent 5.6% of their time ambulating. This value declined to 3.9% at 3 months. Contrary to clinical goals, arm movement did not increase after injecting the most affected arm with BoNT-A, however, injections may have decreased mirror movements, which are often bothersome for the child. CONCLUSION: A time-matched 4-accelerometer set-up is feasible in children with cerebral palsy. A future study including time-matched multi-axial accelerometers on all four limbs, could provide important information on the effect of BoNT-A in daily life. Show more

Keywords: Accelerometry, adolescent, botulinum toxins, Type A, cerebral palsy, child, extremities

DOI: 10.3233/PRM-210112

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 125-137, 2023

Authors: Greve, Kelly R. | Bailes, Amy F. | Zhang, Nanhua | Long, Jason | Aronow, Bruce | Mitelpunkt, Alexis

Article Type: Research Article

Abstract: PURPOSE: This study aimed to examine outpatient hospital utilization (number of specialties seen and number of visits to each specialty) in the year after single event multi-level surgery (SEMLS) in children with cerebral palsy (CP), and to determine if utilization differs across the medical center in the year after compared to the year before SEMLS. METHODS: This retrospective cross-sectional study used electronic medical record data of outpatient hospital utilization in children with CP who underwent SEMLS. RESULTS: Thirty children with CP (Gross Motor Function Classification System Levels I–V, mean age of 9.9 years) were included. In …the year after surgery, a significant difference (p  = 0.001) was found for the number of specialties seen, with non-ambulatory children seeing more specialties than ambulatory children. No statistically significant difference was found between the number of outpatient visits to each specialty in the year after SEMLS. Compared to the year before SEMLS, fewer therapy visits occurred in the year after SEMLS (p  < 0.001) but significantly more visits to orthopaedics (p  = 0.001) and radiology (p  = 0.001). CONCLUSION: Children with CP had fewer therapy visits but more orthopaedic and radiology visits the year after SEMLS. Nearly half of the children were non-ambulatory. Examination of care needs in children with CP undergoing SEMLS is justified with consideration of ambulatory status, surgical burden, and post-operative immobilization. Show more

Keywords: Cerebral palsy, single event multi-level surgery, surgical burden

DOI: 10.3233/PRM-220051

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 139-148, 2023

Authors: Baniasad, Mina | Asheghan, Mahsa | Ziya, Mohammadreza | Holisaz, Mohammad Taghi

Article Type: Research Article

Abstract: PURPOSE: This study evaluated the effects of an instrumented balance board on the balance parameters in children with spastic cerebral palsy by carrying out a pilot single-group pre-post clinical trial. METHODS: Five children aged 5 to 15 years with spastic diplegia and a Gross Motor Function Classification System level of I or II were included. All participants attended 20 sessions with an instrumented balance board, 45 minutes per session, 3 times a week for 7 weeks. The main outcome measures included the center of pressure excursion, velocity, and overshoot during quiet standing with open and closed eyes. The …assessments were performed in the mediolateral and anteroposterior directions at pre- and one week post-intervention. RESULTS: Non-parametric tests showed that the excursion did not change significantly except in the mediolateral direction with eyes closed (p  < 0.05). The velocity of the center of pressure improved in both directions and eye conditions (p  < 0.05). Also, the maximum velocity decreased with eyes open (mediolateral, anteroposterior, and total) (p  < 0.05), while the change was not significant with the eyes closed. The overshoot measurements did not change significantly. CONCLUSION: It is recommended to consider balance board training for improving balance parameters in children with cerebral palsy. Show more

Keywords: Cerebral palsy, spastic, balance board, balance, center of pressure, rehabilitation

DOI: 10.3233/PRM-201526

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 149-156, 2023

Authors: Analan, Pinar Doruk | Aslan, Hulya

Article Type: Research Article

Abstract: PURPOSE: In children with cerebral palsy (CP), gastrocnemius muscle spasticity may lead to pes equinus posture which causes insufficient ankle joint dorsiflexion for normal gait. The aim of this study was to analyze the stiffness of gastrocnemius and tibialis anterior muscles by shear wave elastography (SWE) in children with pes equinus deformity due to spastic CP. METHODS: 24 legs of 12 children (6 females and 6 males, mean age 45.8 months) with CP were prospectively included in the study. Tissue stiffness quantification with shear-wave velocity (SWV) was analyzed. RESULTS: The mean SWVs of the gastrocnemius and …tibialis anterior muscles were 3.91±0.26 m/s and 2.67±0.18 m/s, respectively. The stiffness of the gastrocnemius muscle was significantly higher than the stiffness of the tibialis anterior muscle (p  < 0.0001). There was no correlation between the stiffness of these muscles (r  = 0.129, p  > 0.05). CONCLUSION: Gastrocnemius muscles were stiffer than tibialis anterior muscles in patients with spastic CP. But stiffness between these muscles was not correlated with each other. Pes equinus may be related to stiff gastrocnemius in these patients. This study demonstrates the clinical potential for SWE as a non-invasive tool for analyzing calf muscle stiffness. Show more

Keywords: Spastic cerebral palsy, equinus, shear wave elastography, muscle stiffness

DOI: 10.3233/PRM-201511

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 157-161, 2023

Authors: Paker, Nurdan | Yavuz Mollavelioglu, Tugce | Bugdaycı, Derya | Ones, Kadriye | Bardak, Ayse Nur | Karacan, Ilhan | Yıkıcı, Ilgın | Kesiktas, Fatma Nur

Article Type: Research Article

Abstract: PURPOSE: The aim of this study was to assess serum vitamin D levels and related factors in children with cerebral palsy (CP). METHODS: One hundred and nineteen children with CP between the ages of 1 year to 10 years 9 months who were admitted to the children’s inpatient rehabilitation unit of a tertiary rehabilitation hospital between January 1, 2017, and December 31, 2018, were included in this study. Demographic and clinical characteristics were obtained from the patient files. CP types and serum 25 hydroxyvitamin D (25OHD) levels were recorded. Gross Motor Function Classification System (GMFCS) was used to …assess the functional level. RESULTS: Mean age was 5.1±2.9 years. Forty-two (35.3%) were girls, 105 (88.3%) were spastic, and 14 (11.7%) were ataxic and mixed type CP. Mean GMFCS level was 4 (IQR:2). Thirty-one (26.1%) were getting extra liquid feed while the rest were eating a normal diet. Mean serum 25OHD level was 27.4±15.7 (3–79) ng/mL. Vitamin D levels were normal in 68 children (57.1%), whereas 36 (30.3%) had vitamin D insufficiency and 15 (12.6%) showed vitamin D deficiency. Those whose serum vitamin D levels were within a normal range had a median age of 3.8 (IQR:4.2) years. On the other hand, mean age was 6.4 (4.3) years for those with low vitamin D level (p  < 0.0001). Vitamin D level was 19.8 (21.4) ng/mL in those (n  = 88) who had regular diets, whereas it was 31.0 [16 ] ng/mL in those (n  = 31) who were getting extra liquid feed (p  = 0.015). There was no statistically significant correlation between vitamin D level and gender, GMFCS, CP type, season or antiepileptic drug treatment. A binary logistic regression model showed that older age and having only regular meals were significant risk factors for low vitamin D. CONCLUSION: In this study, 42.9% of the children with CP had low vitamin D. Older children with CP or those who had regular diets were higher risk groups in terms of low vitamin D. Show more

Keywords: Children, cerebral palsy, vitamin D

DOI: 10.3233/PRM-190622

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 163-169, 2023

Authors: Khandelwal, Rohit | Manjunath, Vivek Vankalapati | Mehta, Leeni | Mangajjera, Shivalingappa Bussenahalli

Article Type: Research Article

Abstract: PURPOSE: Cerebral palsy is a common pediatric neurological problem that has multiple comorbidities, including nutritional issues. Hematological and biochemical parameters significantly affect the health status of patients with cerebral palsy, and till now very few studies have analyzed these parameters. This study aimed to describe the hematological and biochemical parameters of children diagnosed with cerebral palsy. METHODS: This four-year observational study included children with cerebral palsy who were admitted to the Department of Pediatrics of a medical college teaching hospital. Hemoglobin, platelet count, white blood count (WBC), red blood cells (RBCs), packed cell volume, RBC indices, and biochemical …parameters (urea, creatinine, total bilirubin, total protein, albumin, globulin, aspartate transaminase, alanine transaminase, electrolytes, calcium and alkaline phosphatase) were noted and values (mean, standard deviation, and interquartile range) presented. Age and gender-based analyses were performed. RESULTS: The average hemoglobin level was 11.48 mg/dl, platelet count was 301.24×109 /L, and WBC count was 11.13 109 /L. Anemia was observed more commonly in males younger than nine years of age. Of 282 patients, 14 (4.96%) had a platelet count of less than 150×109/L. Abnormal alkaline phosphatase levels were observed more commonly in patients who were younger than nine years of age and in females more than males, and the difference was statistically significant. Protein levels and calcium levels were similar between both age groups. CONCLUSION: Anemia was more common in younger patients and males with cerebral palsy. Abnormal bone turnover markers (alkaline phosphatase) were more common in young patients and females with cerebral palsy. Understanding the differential effect of age and gender on various investigational parameters will help improve care of children with cerebral palsy by initiating appropriate and timely clinical interventions, thereby providing a better quality of life. Show more

Keywords: Cerebral palsy, hematological parameters, biochemical investigations, anemia, alkaline phosphatase

DOI: 10.3233/PRM-201514

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 171-177, 2023

Authors: Szewczyk, Anna K. | Mitosek-Szewczyk, Krystyna | Dworzańska, Ewa

Article Type: Review Article

Abstract: Music is an art form that strongly affects people and can elicit many different emotions at the same time, including happiness, anxiety, sadness, and even ecstasy. What is it about music that causes such a strong reaction from each of us? Music engages many senses, which in turn can produce a multiplicity of responses and help create more extensive neuronal connections, as well as influence behaviour through structural and functional changes in the brain. Music-based interventions as a therapeutic tool in rehabilitation are becoming more common. It is said that the impact of music on the human body is positive. …However, what impact does music have on the young nervous system, especially the affected one? This review presents the advantages and disadvantages of the use of music in paediatric neurology to treat dyslexia, cerebral palsy, and stroke, among others. Potential negative impacts such as musicogenic epilepsy and hallucinations will be discussed. Show more

Keywords: Music, music therapy, brain, neuroplasticity, children and adolescents, neurological disorders

DOI: 10.3233/PRM-200802

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 179-194, 2023

Authors: Karatekin, Bilinc Dogruoz | Kacar, Gulnihal | Icagasioglu, Afitap

Article Type: Research Article

Abstract: PURPOSE: Obesity prevalence and the relationship between obesity and motor function in children with ambulatory cerebral palsy (CP) were investigated. METHODS: This was a cross-sectional study. The obesity profile of 75 children aged 2–18 years with ambulatory CP was investigated. GMFCS levels were recorded, and BMI was calculated using height and weight data and converted into Z-scores. Age- and gender-specific growth charts were used for children and adolescents. RESULTS: The mean BMI of the participants was 17.78, with an obesity rate of 18.67% and an overweight rate of 16%. Gross motor function was found to be …associated with height, weight, and BMI (p  < 0.05). No relationship was found between obesity + overweight and gender and CP subtype (p  > 0.05). CONCLUSION: Turkish children with CP had a higher rate of obesity compared to typically developing peers and also their counterparts in other countries. There is a need for studies to identify the causes of obesity and to develop effective intervention programs for prevention of it in children with CP. Show more

Keywords: Cerebral palsy, obesity, overweight, GMFCS, ambulatory

DOI: 10.3233/PRM-210093

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 195-202, 2023

Authors: Gbonjubola, Yusuf Tunde | Fatudimu, Margaret Bukola | Hamzat, Talhatu Kolapo

Article Type: Research Article

Abstract: PURPOSE: The demands of caring for children with cerebral palsy (CWCP) may lead to burnout among the informal caregivers of these children. However, this subject area has not received significant research attention in Nigeria. The primary aim of this study was to investigate the association between burnout level of informal caregivers of CWCP and the motor performance of the CWCP. The association between burnout level of the informal caregivers and selected clinical variables of CWCP was also investigated. METHODS: This is a descriptive study of 75 consecutively-sampled informal caregivers (34.76±8.7 years) of CWCP and an equal number of …their CWCP. Burnout level of the caregivers and motor performance of the CWCP were assessed using the Copenhagen Burnout Inventory (CBI) and Gross Motor Function Classification System Family Questionnaire (GMFCSFQ) respectively. Descriptive and inferential statistics were used to analyse results at alpha = 0.05. RESULTS: There was a statistically significant positive association between the CBI scores and the GMFCSFQ scores (p  < 0.05). Age of the CWCP as well as type and topography of the cerebral palsy were not significantly associated with the caregivers’ burnout level. Similarly, the age and sex of the caregivers had no statistically significant association with their burnout level (p  > 0.05). CONCLUSION: Caregiving for children with lower motor performance is associated with higher burnout among caregivers. This may impact negatively on the overall health of the caregivers and the quality of care for the CWCP. Show more

Keywords: Cerebral palsy, informal caregivers, burnout

DOI: 10.3233/PRM-200675

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 203-209, 2023

Authors: Shetty, Triveni | Ganesan, Sailakshmi | Johari, Ashok | Mullerpatan, Rajani

Article Type: Research Article

Abstract: PURPOSE: The current study aimed to explore Gross Motor Function Measure (GMFM) profiles among children with cerebral palsy (CP) at various Gross Motor Function Classification System (GMFCS) levels in a low-resource setting. METHODS: Ambulatory capacity of children with CP was classified using GMFCS levels. Functional ability of all participants was measured using GMFM-88. Seventy-one ambulatory children with CP (61% males), were studied after signed informed consent was obtained from parents and assent from children older than 12 years. RESULTS: Children with CP in a low-resource setting had 12–44% lower GMFM scores in dimensions of standing, walking, …running, and jumping with reference to children from high-resource settings with similar ambulatory capacity reported previously. The most affected components across various GMFCS levels were ‘sitting on a large and small bench from floor,’ ‘arm-free squatting,’ ‘half-kneeling,’ ‘kneel-walking,’ and ‘single-limb hop’. CONCLUSION: Knowledge of GMFM profiles can guide clinicians and policymakers in low-resource settings for strategic rehabilitation planning and extend the focus of rehabilitation from restoration of body structure and function to the wider domain of social participation in leisure, sport, work, and the community at large. Additionally, providing tailored rehabilitation based on a profile of motor function can ensure an economically, environmentally, and socially sustainable future. Show more

Keywords: Motor function, low-resource, GMFM dimensions, standing, walking, running, jumping, low-resource setting

DOI: 10.3233/PRM-220039

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 211-218, 2023

Authors: Daunter, Alecia K. | Pruente, Jessica | Bowman, Angeline | Whitney, Daniel G.

Article Type: Research Article

Abstract: PURPOSE: Existing evidence identifies racial and ethnic disparities impacting the prevalence and severity of cerebral palsy (CP). There is a paucity of literature examining the impact on associated treatment. METHODS: In this retrospective cohort study, an institutional database search identified outpatient encounters for pediatric patients with spastic CP. Additional filters were used to determine treatments received. For each treatment, the proportion of African American (AA) patients receiving treatment was compared to the proportion of Caucasian (C) patients receiving the same treatment. RESULTS: 3,686 children with spastic CP were seen in outpatient clinics associated with an academic …tertiary hospital over a 21-year period. There was no significant difference between the proportion of any treatment compared to the entire sample for AA or C patients. CONCLUSION: In this sample, there was no significant evidence of a racial disparity for AA patients receiving treatments for spasticity. This data is limited by several factors. Further research is needed to determine whether pediatric patients with disabilities are receiving equitable care. Clinicians should consider systematically monitoring their practices to identify areas of bias or inequity in accessing care. Show more

Keywords: Race, spasticity, cerebral palsy, treatment

DOI: 10.3233/PRM-210094

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 219-222, 2023

Authors: Nishibu, Hisato | Seino, Tsugumi Hosokawa | Himuro, Nobuaki

Article Type: Research Article

Abstract: PURPOSE: The study sought to examine the content validity, the intra- and inter-rater reliability, and concurrent validity of the Japanese versions of the Manual Ability Classification System, the Communication Function Classification System, and the Eating and Drinking Ability Classification System, and representation of the distribution of the levels of each classification systems in comparison to the Gross Motor Function Classification System levels for children with cerebral palsy. METHODS: The Japanese versions were developed using the back-translation method. For content validity, professionals were asked to complete a questionnaire including items on the appropriateness of the translation, its validity, and …distinctions among levels. For reliability, professionals used the three classification systems twice in children with cerebral palsy. For concurrent validity, relationships among the four classification systems were examined by correlation analyses. RESULTS: Participants included twenty-one professionals and 290 children with cerebral palsy (mean age: 12 years two months, female: 132, male: 158). The content validity was generally good. For reliability, the lower limit of the 95% confidence interval for the intraclass correlation coefficients was greater than 0.89, and the correlation coefficients were high. CONCLUSION: The results of this study showed good reliability and validity of the functional classification systems in Japan. Show more

Keywords: Cerebral palsy, manual ability classification system, communication function classification system, eating and drinking ability classification system

DOI: 10.3233/PRM-210098

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 223-233, 2023

Authors: MacCarthy, Matthew

Article Type: Article Commentary

DOI: 10.3233/PRM-220114

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 235-236, 2023

Article Type: Correction

DOI: 10.3233/PRM-239001

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 237-237, 2023