Journal of Pediatric Rehabilitation Medicine - Volume 16, issue 3

Authors: Srinivasan, Rajashree

Article Type: Article Commentary

Abstract: Burnout in health professionals gained attention during the COVID-19 pandemic. There have been numerous strategies in addressing this issue proving there is no one silver bullet to mitigate it. We need to find solutions for our health and for the benefit of patients to provide best care. Lifestyle medicine strategies have been proven to be beneficial in the management of Burnout.

Keywords: Burnout, lifestyle medicine

DOI: 10.3233/PRM-230047

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 465-467, 2023

Authors: Skinner, Stephen R.

Article Type: Book Review

Keywords: Physician burnout, moral injury, healthcare management

DOI: 10.3233/PRM-230023

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 469-470, 2023

Article Type: Other

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 471-471, 2023

Authors: Lohiya, Nirali | Srivastava, Leena | Lohiya, Nikhil | Kalrao, Vijay

Article Type: Research Article

Abstract: PURPOSE: Parenting a child with special health care needs (SHCN) is often stressful. This study aimed to measure and compare stress among mothers of children with (a) Autism Spectrum Disorder (ASD) - ASD group, (b) Developmental delay without ASD group, (c) SHCN without developmental delay group, and (d) Typically developing group. To assess factors associated with maternal stress in children with developmental disorders. METHODS: A cross-sectional analytical study was performed with children aged 2–12 years and their mothers. The study population was classified into four groups as defined above help of detailed history, developmental & behavioral assessments, psychological …assessments, and Child Special Health Care Needs Screener (CSHCN). Parental Stress Scale (PSS) Questionnaire was administered. The main outcome measurement was the PSS and various factors affecting it. RESULTS: The mothers of the ASD group reported a high stress score (50.4±11.4) compared to SHCN without developmental delay group (38.2±8.8) and the Typically developing group (22.3±3.3) (p  < 0.05) and higher but not significant stress than Developmental delay without ASD group (45.3±9.6, p  > 0.05). Maladaptive behavioral issues and irregular interventions were the factors contributing to higher parental stress in the ASD group (p  < 0.05). A moderate positive correlation was observed in rewarding and challenging scores of PSS among mothers of the ASD group, Developmental delay without ASD group, and SHCN without developmental delay group. CONCLUSION: Mothers of the ASD group perceived higher stress as compared to SHCN without developmental delay group and Typically developing group. Evaluation of stress and stressors is crucial for holistic management of ASD. Show more

Keywords: Autism spectrum disorder, special health care needs, maternal stress, maternal child relationship

DOI: 10.3233/PRM-220014

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 473-481, 2023

Authors: Hewawitharana, Bimba D.R. | Wijesinghe, Champa J. | De Silva, Aruna | Phillips, John P. | Hewawitharana, Gemunu P.

Article Type: Research Article

Abstract: PURPOSE: This study aimed to identify factors, including degree of disability, that contribute to the caregiver burden of raising children with cerebral palsy in Sri Lanka. METHODS: Participants were caregivers of children with cerebral palsy attending the pediatric neurology clinic of the only tertiary care center in southern Sri Lanka. The locally validated Caregiver Difficulties Scale (CDS) was administered, and demographic information was obtained in a structured interview. Disability data was accessed through the medical record. RESULTS: Of 163 caregivers who participated in this study, 133 (81.2%) demonstrated a moderate to high level of burden, and …91 (55.8%) were at high risk for psychological burden. In the bivariate analysis, caregiver burden significantly correlated with degree of physical disability based on the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), the presence of medical co-morbidities, and having two or more children. However, only the GMFCS level and number of children remained significant predictors of caregiver burden after controlling for confounding effects. CONCLUSION: Raising a child with cerebral palsy in Sri Lanka is likely to cause caregiver burden, particularly if they have a high level of disability or one or more siblings. Monitoring caregiver burden as part of routine cerebral palsy management is important, which allows targeting psychosocial support to families most in need. Show more

Keywords: Caregiver burden, cerebral palsy, level of disability, GMFCS, MACS

DOI: 10.3233/PRM-220070

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 483-491, 2023

Authors: Haque, Mahfujul Z. | Ahmed, Frass | Khandaker, Shaima | Syed, Sameer | Bazzy, Yusef A.

Article Type: Other

Abstract: This cross-sectional analysis of Pediatric Rehabilitation Medicine (PRM) fellowship program websites in the United States assesses their comprehensiveness based on 43 variables commonly sought by applicants. The study found that 30% of programs had a direct link to the PRM fellowship page, with limited information on criteria such as education resources, research stipend, mentorship opportunities, and fellow wellness. The results underscore the need for improved accessibility, content expansion, and yearly link maintenance. These improvements could enhance the applicant experience, foster informed decisions, and streamline the application process. The findings offer a roadmap for PRM fellowships to better align their online …platforms with applicant needs, reflecting the current shift toward virtual interactions in the post-pandemic era. Show more

Keywords: Pediatric physical medicine and rehabilitation, online; fellowship, residency, accessibility, pediatric rehabilitation medicine, physical medicine and rehabilitation, physiatry, social media, online content, criteria, fellowship websites

DOI: 10.3233/PRM-220139

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 493-496, 2023

Authors: Johnson-Kerner, Bethany L. | Colao, Kathleen | Evanson, Nathan K. | Taylor, J. Michael

Article Type: Research Article

Abstract: PURPOSE: More than 50,000 children are hospitalized yearly in the U.S. for acquired brain injury (ABI) with no established standards or protocols for school re-entry and limited resources for hospital-school communication. While ultimately the school has autonomy over curricula and services, specialty physicians were asked about their participation and perception of barriers in the school re-entry process. METHODS: Approximately 545 specialty physicians were sent an electronic survey. RESULTS: 84 responses (43% neurologists and 37% physiatrists) were obtained with a response rate of ∼15%. Thirty-five percent reported that specialty clinicians currently make the plan for school re-entry. …The biggest challenge for school re-entry noted by physicians was cognitive difficulties (63%). The biggest gaps perceived by physicians were a lack of hospital-school liaisons to help design and implement a school re-entry plan (27%), schools’ inability to implement a school re-entry plan (26%), and an evidence-based cognitive rehab curriculum (26%). Forty-seven percent of physicians reported that they did not have adequate medical personnel to support school re-entry. The most commonly used outcome measure was family satisfaction. Ideal outcome measures included satisfaction (33%) and formal assessment of quality of life (26%). CONCLUSION: These data suggest that specialty physicians identify a lack of school liaisons in the medical setting as an important gap in hospital-school communication. Satisfaction and formal assessment of quality of life are meaningful outcomes for this provider group. Show more

Keywords: Traumatic brain injury, acquired brain injury, school re-entry, cognitive rehabilitation, access to care

DOI: 10.3233/PRM-210130

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 497-505, 2023

Authors: Biagioni, Jenny | Easley, Tricia | DeAlmeida, Mary L. | Vova, Joshua | Fujimoto, Akane B. | Graessle, Shelby | Nelson, Jennifer

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to examine the relationship between early mobility (EM) of pediatric patients mechanically ventilated and functional outcomes in rehabilitation using WeeFIM scores, as well as hospital length of stay (LOS), ICU LOS, and rehabilitation LOS. METHODS: A retrospective chart review of 189 patients was completed to compare those who received EM interventions to those who did not in the ICU. Data extracted from the years 2015-2019 included: all patients who were between zero and 21 years, were mechanically ventilated via endotracheal tube (ETT) for > 48 hours, and then transferred to the comprehensive inpatient …rehabilitation unit (IRU). RESULTS: For respiratory patients, the EM group had higher WeeFIM scores in all categories at admission to IRU compared to the comparison group. Neurosurgery patients had higher cognition and total WeeFIM scores in the EM group at admission to IRU. All diagnoses demonstrated shorter hospital, ICU, and IRU LOS for the comparison group versus the EM group. CONCLUSION: EM of mechanically ventilated pediatric patients with a primary respiratory diagnosis demonstrated improved function at admission to IRU compared to those who did not participate in EM. Prospective research needs to be done to examine this relationship further. Show more

Keywords: Early mobility, pediatric intensive care unit, physical and/or occupational therapy, critical care, rehabilitation, WeeFIM

DOI: 10.3233/PRM-220043

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 507-515, 2023

Authors: Toopchizadeh, Vahideh | Nezamoleslami, Elaheh | Rafeey, Mandana | Jahanjoo, Fatemeh | Khabbaz, Mohammad Sadegh | Jafari-Rouhi, Amir Hossein

Article Type: Research Article

Abstract: PURPOSE: This study aimed to compare the result of the six-minute walk test (6MWT) in patients with cystic fibrosis (CF) aged < 20 years old and individuals without CF. METHODS: In this cross-sectional study, 50 children and adolescents with CF and 20 children and adolescents without CF underwent the 6MWT. Vital signs before and immediately after the 6MWT and six-minute walk distance (6MWD) were evaluated. RESULTS: The mean change in heart rate, percentage of peripheral oxygen saturation (SpO2%), systolic blood pressure, respiratory rate, and dyspnea severity during the 6MWT was significantly higher in patients with CF. In the …case group, 6MWD was associated with regular chest physical therapy (CPT) and forced expiratory volume (FEV)> 80%. Patients with CF receiving regular CPT or mechanical vibration and with FEV in the first second > 80% showed better physical capacity during the 6MWT (smaller Sp02% decline and lower dyspnea perception). CONCLUSION: Children and adolescents with CF have lower physical capacity compared to individuals without CF. CPT and mechanical vibration could be used to increase physical capacity in this population. Show more

Keywords: Cystic fibrosis, physical capacity, six-minute walk test, chest physical therapy

DOI: 10.3233/PRM-210089

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 517-528, 2023

Authors: Inal, Busra | Ozengin, Nuriye | Bakar, Yesim | Ankaralı, Handan | Ozturk, Yusuf

Article Type: Research Article

Abstract: PURPOSE: This study aimed to examine symptom severity, posture, and balance of children with primary monosymptomatic nocturnal enuresis (PMNE) and compare to a healthy control group. METHODS: Thirty-five children with PMNE and 34 healthy children were included in this study. Physical and sociodemographic characteristics of the children were recorded. Symptom severity was assessed with a Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES), a four-day bladder diary and a seven-day bowel diary. Standing postural alignment was assessed with the Spinal Mouse device, and the sensory integration of static balance and dynamic standing balance was assessed with …the Biodex Balance System SD. RESULTS: Compared to healthy controls, children with PMNE demonstrated increased symptom severity (p  = 0.001), increased upright lumbar lordosis (p  = 0.018) and sacral-hip angles (p  = 0.029), decreased static balance in the sensory condition of unstable surface with eyes closed (p  = 0.001), and decreased mediolateral dynamic balance (p  = 0.049). CONCLUSION: Children with PMNE demonstrate altered postural alignment, static and dynamic postural instability, and greater symptom severity on the Vancouver NLUTD/DES than age-matched controls. Show more

Keywords: Nocturnal enuresis, posture, postural balance, quality of life

DOI: 10.3233/PRM-210105

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 529-537, 2023

Authors: Sinn, Clarice N. | Rinaldi, Robert J. | McLaughlin, Matthew J.

Article Type: Research Article

Abstract: PURPOSE: The aim of this study was to determine the effectiveness of botulinum toxin type A (BoNT-A) injections in infants with congenital muscular torticollis (CMT) who were refractory to conservative management. METHODS: This was a retrospective study in which all subjects included were seen between 2004 and 2013 and were deemed appropriate for BoNT-A injections. A total of 291 patients were reviewed for inclusion in the study, and 134 patients met the inclusion criteria. Each child was injected with 15–30 units of BoNT-A into each of the following muscles: ipsilateral sternocleidomastoid, upper trapezius, and scalene muscles. The key …outcome and variable measurements analyzed included age at time of diagnosis, age at time of initiation of physical therapy, age at time of injection, total number of injection series utilized, muscles injected, and degrees of active and passive cervical rotation and lateral flexion pre- and post-injection. A successful outcome was documented if a child could achieve 45° of active lateral flexion and 80° of active cervical rotation post-injection. Secondary variables including sex, age at time of injection, number of injection series utilized, surgery required, adverse effects of botulinum toxin, presence of plagiocephaly, side of torticollis, orthosis used, presence of hip dysplasia, skeletal anomalies, complications during pregnancy or birth, and any other pertinent information regarding the delivery were also measured. RESULTS: Based on this criteria, 82 children (61%) had successful outcomes. However, only four of the 134 patients required surgical correction. CONCLUSION: BoNT-A may be an effective and safe method for treatment in refractory cases of congenital muscular torticollis. Show more

Keywords: Torticollis, nerve block, pediatrics, therapeutics

DOI: 10.3233/PRM-210088

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 539-552, 2023

Authors: Bonarrigo, Kelly | McGuire, Michelle | Dorich, Jenny M. | Bolger, Ashlee | Lambert, Joshua | Horn, Paul S. | Tian, Cuixia

Article Type: Research Article

Abstract: PURPOSE: This study aimed to explore stander use in individuals with Duchenne Muscular Dystrophy (DMD). METHODS: This mixed method research study employed a survey with categorical and open-ended questions related to stander use. Categorical responses were analyzed quantitatively. Qualitative analysis of open-ended responses was linked to the International Classification of Function. Qualitative and quantitative results were merged to derive meta-inferences. RESULTS: Of 147 respondents, 28.6% (n  = 42) reported stander use. Equipment used included sit-to-stand stander (n  = 27), power standing feature in a wheelchair (n  = 13), and unspecified equipment (n  = 2). Economic services were the most common …barrier to stander obtainment. Age of loss of ambulation (LOA) and age of start of stander use were positively correlated (r  = 0.61, p  < 0.0001, n  = 36), with 59.5% initiating stander use after LOA. Twenty-nine respondents reported standing less than the recommended dose of 60–90 minutes at least five days a week, with frequency directionally less than five days per week (p  = 0.06) and time significantly less than 60–90 minutes (p  = 0.002). Respondents’ total dose was significantly lower than the recommended 300 minutes (p  = 0.02). Lack of time and presence of contractures contributed to decreased duration of use. CONCLUSION: This study provides a greater understanding of stander use among individuals with DMD and can assist with decision making about stander use prior to complications of disease progression to promote optimal health despite reported barriers. Show more

Keywords: Duchenne muscular dystrophy, stander, standing, dosing

DOI: 10.3233/PRM-220026

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 553-569, 2023

Authors: Booker, Lyndsey | Omura, Jaclyn

Article Type: Case Report

Abstract: Proximal humerus fractures in pediatric patients are uncommon. This is a case report of a 17-year-old patient with Duchenne muscular dystrophy who sustained an occult proximal humerus fracture. The patient was on chronic steroids and had a history of vertebral and long bone fractures. He was using a wheeled mobility device on public transportation at the time of injury. He had a negative radiograph, but an MRI revealed a right proximal humerus fracture. He had decreased mobilization in the affected extremity, which limited activities of daily living including driving his power wheelchair. After six weeks of conservative management, he returned …to his baseline level of activity. It is important to recognize that chronic steroid use adversely affects bone health, and fractures may be missed on initial imaging. To ensure adequate safety, providers, patients, and their families should be educated on the Americans with Disabilities Act guidelines for using wheeled mobility devices on public transportation. Show more

Keywords: Duchenne muscular dystrophy, fracture, transportation, chronic steroids

DOI: 10.3233/PRM-220074

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 571-574, 2023

Authors: Ishii, Haruki | Osterwald, Ariane | Sukhov, Renat

Article Type: Case Report

Abstract: This case report details the complex case of an adolescent patient with chondroblastic osteosarcoma in the setting of Li-Fraumeni syndrome, leading to hemipelvectomy and post-operative complications. International Classification of Functioning principles were used as a roadmap for optimization of functional restoration and transition of care coordination.

Keywords: Li-Fraumeni syndrome (LFS), ICF principles, rehabilitation, case report, amputation

DOI: 10.3233/PRM-220060

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 3, pp. 575-579, 2023