Journal of Pediatric Rehabilitation Medicine - Volume 16, issue 2

Authors: Bandyopadhyay, Tapas | Maria, Arti | Vallamkonda, Nagaratna

Article Type: Research Article

Abstract: PURPOSE: To assess the performance of premature infant oral motor intervention for transition from gavage to full spoon feeding in preterm infants. METHODS: Preterm neonates born between 28 + 0 –32 + 6 weeks gestation (n  = 32) were randomised into an intervention group (premature infant oral motor intervention) for five minutes twice a day along with routine care (n  = 16) and a control group (routine care, n  = 16) once they reached a feed volume of at least 150 ml/kg/day administered by gavage method. The primary outcome measure was time (in days) to transition from gavage to full spoon feeds. RESULTS: …The mean (SD) time to transition from gavage to full spoon feeds was attained significantly earlier in the intervention group than the control group (9.93 [5.83 ] vs 16.43 [10.46 ] days; mean difference, -6.5 days; 95% CI, -12.58 to -0.41). There was no significant difference between the two groups in terms of the duration of hospital stay, rates of physiological stability, and culture positive sepsis. CONCLUSION: Premature infant oral motor intervention, as used in this specific population, significantly reduces the time to transition to full spoon feeds without increasing culture positive sepsis and physiological instability. Show more

Keywords: Premature infant oral motor intervention, gavage feeds, spoon feeds, suck burst, PIOMI

DOI: 10.3233/PRM-210132

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 2, pp. 361-367, 2023

Authors: Juneja, Hemant | Frandsen, Christian | Nielsen, Nina Odgaard | Larsen, Kim | Praestegaard, Jeanette

Article Type: Research Article

Abstract: PURPOSE: The Wii Balance Board (WBB) can be used for assessment of steady state balance (SSB), but its reliability has not been studied in children aged 6–9 years. This study aimed to determine the test-retest reliability of the WBB for measuring SSB in this population. A secondary aim was to determine the minimum detectable change (MDC) and standard error of measurement (SEM) of the WBB in children aged 6–9 years. METHODS: 52 children between 6–9 years of age participated. “One leg stand balance” was used to assess center of pressure velocity (COPV) and center of pressure area (COPA) …on three occasions by the same tester. Two tests were conducted on the same day (Day 1) and the third test was performed on another day (Day 2), with a period of 5–13 days between the two test days. Intraclass correlation coefficient (ICC 3,1 ), SEMs, and MDC were calculated. RESULTS: Intra-day test-retest reliability of COPA was found to be good (ICC3,1 =0.86; 95% confidence interval [CI]: 0.75, 0.92) and that of COPV was also found to be good (ICC3,1 =0.87; 95% CI: 0.77, 0.92). Inter-day test-retest reliability was found to be good for COPA (ICC3,1 = 0.87; 95% CI: 0.75, 0.93) and COPV (ICC3,1 = 0.89; 95% CI: 0.81, 0.94). SEM for COPA in intra-day testing was 18.90 mm2 (15.78%), and in inter-day testing it was 16.44 mm2 (13.61%). SEM for COPV in intra-day testing was 1.12 mm/s (7.6%), and in inter-day testing it was 1.01 mm/s (6.9%). MDC for COPA in intra-day testing was 52.41mm2 (42.75%), and in inter-day testing was 45.58 mm2 (35.75%). MDC for COPV in intra-day testing was 3.11 mm/s (21.2%), and in inter-day testing it was 2.80 mm/s (18.9%). CONCLUSION: The WBB has good test-retest reliability for assessing SSB of children between 6-9 years. COPA measurements appear to be less sensitive to clinical changes in SSB when compared to COPV. Assessment of validity of the WBB in this age group is recommended before it can be considered as a potential balance assessment tool in children. Show more

Keywords: Wii Balance Board, center of pressure, reliability, steady state balance

DOI: 10.3233/PRM-210106

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 2, pp. 369-380, 2023

Authors: Kempert, Heidi | Benore, Ethan

Article Type: Research Article

Abstract: PURPOSE: This exploratory study demonstrates the application of functionally relevant physical exercises (FRPE) to objectively assess physical functioning among children with chronic pain. Intensive interdisciplinary pain treatment (IIPT) focuses on functional improvements as a primary outcome. FRPEs aim to enhance clinical assessments and monitoring by providing relevant data for physical and occupational therapies. METHODS: Children enrolled in three weeks of IIPT provided data for study. They completed two self-report measures of functioning (Lower Extremity Functioning Scale [LEFS] and Upper Extremity Functioning Index [UEFI]), measure of pain intensity, and six separate FRPEs (box carry, box lifts, floor to stand, …sit to stand, step ups, and modified six-minute walk test). Data from 207 participants aged 8–20 years old were analyzed. RESULTS: Upon admission, over 91% of children could perform each FRPE at some level to provide clinicians with a baseline assessment of functional strength. Following IIPT, all children were able to complete FRPEs. Overall, children reported statistically significant gains in functioning on all subjective reports and FRPEs (p ’s < 0.001). Spearman correlations demonstrated that LEFS and UEFI were weakly to moderately correlated to all FRPEs at admission (r’s between.43–.64, p ’s < 0.001 and.36–.50, p ’s < 0.01 respectively). Correlations between all subjective and objective measures were comparatively lower at discharge. CONCLUSION: FRPEs appear to serve as good objective measures of strength and mobility for children with chronic pain, measuring variability across patients and change over time, which is unique from subjective data gathered via self-report. Due to face validity and objective measurement of functioning, from a clinical practice perspective, FRPEs provide meaningful information to support initial assessment, treatment planning, and patient monitoring. This study offers initial support for a novel measurement method that is easily administered and replicated to effectively measure functional improvement in children with chronic pain. Show more

Keywords: Chronic pain, occupational therapy, outcome measures, pediatric pain rehabilitation, physical therapy

DOI: 10.3233/PRM-220036

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 2, pp. 381-389, 2023

Authors: Lopez, Adriana S. | Kidd, Sarah | Yee, Eileen | Dooling, Kathleen | Routh, Janell A.

Article Type: Research Article

Abstract: PURPOSE: Acute flaccid myelitis (AFM), an uncommon but serious neurologic condition, primarily affects children, and can progress quickly to paralysis and respiratory failure. Data on long-term outcomes of patients with AFM are limited. This study reports on functional status through 12 months for AFM patients who became ill in 2018 in the United States. METHODS: Health departments collected information on outcomes at 6 and 12 months after onset of AFM using a standardized form that asked patients or their parents/guardians about functional status. Analyses were restricted to confirmed cases. RESULTS: Of the 238 confirmed AFM cases …reported to CDC in 2018, 90 (38%) had assessments at 6 months, 82 (34%) at 12 months, and 49 (21%) at both 6 and 12 months. Among the 49 patients with data at both time points, the proportion of patients reporting significant or severe impairment at 6 months ranged from 2% to 59% depending on the outcome. Although proportions decreased by 12 months and ranged from 2% to 51%, most patients had some impairment at 12 months. No deaths were reported. CONCLUSION: Six- and 12-month outcomes in patients with onset of AFM in 2018 span a wide range of functionality, particularly of upper and lower extremities. Importantly, improvement appears to occur over time in some patients. Show more

Keywords: Acute flaccid myelitis, functional outcomes, impairment

DOI: 10.3233/PRM-220054

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 2, pp. 391-400, 2023

Authors: Beardsley, Jessica | McCoy, Andrew | Freeman, Megan | Cramer, Natan | Neville, Desiree | Owusu-Ansah, Silvia | Houtrow, Amy | Sinha, Amit

Article Type: Case Report

Abstract: Acute flaccid myelitis (AFM) is a “polio-like” neurologic disorder of the spinal cord gray matter characterized by asymmetric, flaccid limb weakness of rapid onset following prodromal viral illness. It has affected the pediatric population of the United States since 2014, but there is a paucity of literature describing the post-acute comprehensive rehabilitation management that maximizes functional outcomes for patients. This case series attempts to mitigate this by describing the complete acute and post-acute care course of six children diagnosed with AFM in Western Pennsylvania. It is critical that pediatric rehabilitation medicine providers be knowledgeable about the complex medical and rehabilitation …management for patients with AFM. Show more

Keywords: Acute flaccid myelitis, rehabilitation, WeeFIM, disability functional quotient, functional electrical stimulation, function

DOI: 10.3233/PRM-210120

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 2, pp. 401-413, 2023

Authors: Nguyen, Alan T. | Hemphill, Sydney | Donahue, Bridgette | Menendez, Maria | Rodriguez, Samuel | Caruso, Thomas J.

Article Type: Case Report

Abstract: Virtual reality (VR) technology has seen increasing use in physical rehabilitation and in the management of acute and chronic pain. Functional movement disorders (FMDs) are a source of disability with no known association to neurologic pathology, and patients are generally offered multidisciplinary treatment approaches to improve functional movement. However, patients who are not compliant with rehabilitation may have persistent FMD and long-term disability. Given VR’s use in physical rehabilitation, it may serve as a useful adjunct for the management of FMD. Utilizing an application called MovementTM to create a playlist of targeted applications for the restoration of motor function …and balance, this case study presents the application of VR as a tool to engage patients in physical therapy for the management of FMD. The VR games were selected to encourage movement while customization of levels within the games facilitated achievement of physical therapy goals. Physical rehabilitation aided by VR, when used in collaboration with a multidisciplinary care team, may be used to facilitate recovery from FMD. Show more

Keywords: Functional movement disorder, functional neurologic disorder, psychogenic movement disorder, conversion disorder, dyskinesias, virtual reality

DOI: 10.3233/PRM-210009

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 2, pp. 415-423, 2023