Journal of Pediatric Rehabilitation Medicine - Volume 17, issue 2

Authors: Nelson, Virginia Simson

Article Type: Editorial

DOI: 10.3233/PRM-249003

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 145-146, 2024

Authors: Koenig, Kevin D. | Hall, Michelle J. | Gormley, Caroline | Kaleta, Mary | Munger, Meghan | Laine, Jennifer | Morgan, Sara J.

Article Type: Review Article

Abstract: OBJECTIVE: This study aimed to identify clinical measures that have been used to evaluate function, health related quality of life (HRQoL), and/or satisfaction in children who use lower limb prostheses (LLP). The data reported on psychometric properties for children who use LLP were collected for each measure. METHODS: First, PubMed, CINAHL, and Web of Science databases were searched using broad search terms to identify standardized outcome measures of function, HRQoL, and/or satisfaction with treatment used in pediatric LLP research published in 2001 or after. For each of the eligible measures found, a second search was performed to identify …psychometric properties (e.g., validity, reliability) assessed with children who use LLP. RESULTS: Forty-four standardized outcome measures were identified from 41 pediatric LLP research articles. Five measures (i.e., Gait Outcomes Assessment for Lower Limb Differences, Functional Mobility Assessment, Child Amputee Prosthetics Project- Prosthesis Satisfaction Inventory, Child Amputee Prosthetics Project- Functional Scale Index, and Lower Limb Function Questionnaire) had data on psychometric properties for children who use LLP. CONCLUSIONS: Few studies report psychometric data for assessing the overall HRQoL, function, and/or satisfaction for children who use LLP. Further research is needed to validate or create new outcome measures that assess the HRQoL, satisfaction, and/or function of children who use LLP. Show more

Keywords: Outcome measures, psychometric properties, children, amputation, artificial limbs

DOI: 10.3233/PRM-230014

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 147-165, 2024

Authors: Gill, Irwin | Davidson, Sue-Anne | Stevenson, Paul G. | Robinson, Rae | Pool, Dayna | Valentine, Jane

Article Type: Research Article

Abstract: OBJECTIVE: Intensive rehabilitation aims to improve and maintain functioning in young people who experience disability due to illness or injury. Day rehabilitation may have advantages for families and healthcare systems over inpatient models of rehabilitation. METHODS: This study evaluated the goals and outcomes of a cohort of young people in Western Australia who attended a specialist intensive day rehabilitation programme (“iRehab”) at Perth Children’s Hospital. Analysis of the iRehab service database was performed. Rehabilitation goals and outcomes were recorded as per the Canadian Occupational Performance Measure (COPM), Children’s Functional Independence Measure (WeeFIM), and Goal Attainment Scale (GAS). …RESULTS: There were 586 iRehab admissions between August 11, 2011, and December 31, 2018. Admissions were divided by diagnosis: Cerebral Palsy (228, 38.5%), Acquired Brain Injury (125, 21.3%), Spinal Cord Disorders (91, 15.5%), and Other (141, 24.2%). Mean COPM Performance increased by 2.78 points from admission to discharge (95% CI 2.58 to 2.98, p  < 0.001). Mean COPM Satisfaction was 3.29 points higher at discharge than admission (95% CI 3.07 to 3.51, p  < 0.001). Mean total WeeFIM score improved by 6.51 points between admission and discharge (95% CI 5.56 to 7.45, p  < 0.001), and by 3.33 additional points by six months post discharge (95% CI 2.14 to 4.53, p  < 0.001). Mean GAS T-scores increased by 27.85 (95% CI 26.73 to 28.97, p  < 0.001) from admission to discharge, and by 29.64 (95% CI 28.26 to 31.02, p  < 0.001) from admission to six months post discharge, representing improvement consistent with team expectations. CONCLUSION: This study describes a model by which intensive rehabilitation can be delivered in a day rehabilitation setting. A diverse population of young people who experienced disability achieved significant improvements in occupational performance, independence, and goal attainment after accessing intensive day rehabilitation. Improvements were measured in all diagnostic subgroups and were maintained six months after discharge. Show more

Keywords: Rehabilitation, acquired brain injury, spinal cord injury, outcome measures, cerebral palsy

DOI: 10.3233/PRM-220102

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 167-178, 2024

Authors: Shirel, Tyler | Sylvanus, Tonye | Cho, Kelly | Authement, Amy | Krach, Linda E.

Article Type: Research Article

Abstract: OBJECTIVE: Idiopathic toe-walking (ITW) is a diagnosis of exclusion. A relationship between ITW and decreased range of motion (ROM) is postulated. Treatments focus on increasing ankle dorsiflexion including serial casting. There is no consensus for duration of serial casting. This study aimed to determine ROM changes with cast change intervals of one vs. two weeks, and the rate of ITW recurrence. METHODS: This was a retrospective study of 86 patients, ages 0–9 years with ITW undergoing weekly casting (N  = 29) and two-week casting (N  = 57) at a children’s hospital from 2014–2020. ROM at baseline, two weeks, four weeks, …and final cast removal were collected. Statistical analyses included chi-squared tests, two-sample t-tests, and linear mixed regression. Outcome distributions were assessed for normality. P -values < 0.05 were considered statistically significant. RESULTS: After adjusting for baseline ROM, the mean change in ROM from baseline to two weeks was 10.6∘ vs 7.5∘ in the one-week vs. two-week casting interval, respectively (p  < 0.001). The baseline to final measurement was 13.4∘ vs 9.8∘ in the one-week vs. two-week casting interval, respectively (p  < 0.001). The rate of recurrence of ITW was similar between the two groups. CONCLUSION: This study suggests greater improvement in ROM in the one-week vs. two-week casting interval group. Show more

Keywords: Idiopathic toe-walking, serial cast, toe-walker, toe-walking, rehabilitation

DOI: 10.3233/PRM-230041

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 179-184, 2024

Authors: Samargia-Grivette, Sharyl | Hartley, Helen | Walsh, Karin | Lemiere, Jurgen | Payne, Allison D. | Litke, Emma | Knight, Ashley

Article Type: Research Article

Abstract: OBJECTIVE: Pediatric cerebellar mutism syndrome (pCMS) can occur following resection of a posterior fossa tumor and, although some symptoms are transient, many result in long-lasting neurological deficits. A multi-disciplinary rehabilitation approach is often used in cases of pCMS; however, there have been no clinical trials to determine gold standards in rehabilitation practice in this population, which remains a research priority. The purpose of this study was to identify and compare intervention practices used in pCMS throughout the disciplines of occupational and physical therapy, speech-language pathology, and neuropsychology across geographic regions. METHODS: A 55-question e-survey was created by an …international multidisciplinary research group made up of members of the Posterior Fossa Society and sent to rehabilitation professionals in pediatric neuro-oncology centers in the US, Canada, and Europe. RESULTS: Although some differences in the type of intervention used in pCMS were identified within each discipline, many of the targeted interventions including dose, frequency, and intensity were similar within disciplines across geographic regions. In addition, there were common themes identified across disciplines regarding challenges in the rehabilitation of this population. CONCLUSION: These results provide a foundation of current practices on which to build future intervention-based clinical trials. Show more

Keywords: Cerebellar mutism syndrome (CMS), neuropsychology, occupational therapy, physical therapy, speech-language pathology

DOI: 10.3233/PRM-230006

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 185-197, 2024

Authors: Wentz, Jordan R. | Wentz, Erin E. | Pierce, Samuel R.

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to evaluate the impact of a standardized vision screen guideline on occupational therapy vision screens in a pediatric inpatient rehabilitation unit. METHODS: Charts of patients admitted to a pediatric inpatient rehabilitation before guideline implementation (n  = 47) versus charts after implementation (n  = 47) were randomly, retrospectively reviewed to explore differences in visual skills screened and use of standardized assessments. RESULTS: Significant improvements (p  < = 0.05) were found in the number of visual skills screened (p  = 0.034), use of standardized assessments (p  = 0.005), and screening of the specific visual skills of accommodative amplitude (p  = 0.05), …suppression (p  = 0.015), and double vision (p  < 0.001). CONCLUSION: Implementation of a standardized vision screen guideline improved the frequency of vision screens during occupational therapy evaluations in a pediatric inpatient rehabilitation unit. The use of standardized assessments may also improve the quality of vision screens by encouraging staff to complete more comprehensive vision screens, including screening more visual skills, and by prompting use of standardized assessments, which can improve accuracy of screening procedures. Show more

Keywords: Occupational therapy, vision, vision screening, pediatrics

DOI: 10.3233/PRM-220137

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 199-209, 2024

Authors: Dahiya, Vijeyta | Picardo, Naina | Thejesh, Ramanadham | John, Mary | Varghese, Ajoy Mathew

Article Type: Research Article

Abstract: OBJECTIVE: Diagnosis and management of swallowing problems in children is crucial for improvement of their health status and quality of life. This study aimed to determine the accuracy of clinical feeding assessment (CFA) as a screening test to detect aspiration in children using fibreoptic endoscopic evaluation of swallowing (FEES) as the gold standard. METHODS: A prospective study of 80 children aged below 16 years who were referred to a paediatric otolaryngology clinic for swallowing complaints was completed from 2019 to 2020. Swallowing was assessed by both CFA and FEES. Presence of any one of the following symptoms was …considered positive for aspiration in CFA: cough, wet vocal quality, and respiratory distress. Aspiration on FEES was measured using the Penetration Aspiration Scale. The clinical predictors of aspiration were analysed. RESULTS: The majority of the children (78.8%) had an associated neurological condition, with cerebral palsy being the most common. CFA had a sensitivity ranging from 80% to 100% and a specificity ranging from 68% to 79% for predicting true aspiration for different food consistencies. The significant risk factors predicting aspiration (p value <0.05) were history of prior intubation (p  = 0.009), history of nasal regurgitation (p  = 0.002) and spasticity on examination (p  = 0.043). CONCLUSION: This study showed that CFA can be used as a screening test in evaluation of paediatric dysphagia. In those with negative CFA, the chances of aspiration are less while those with positive CFA need further evaluation. In addition, the availability and cost-effectiveness of the test make it a good tool for screening aspiration in low-resource settings. Show more

Keywords: Swallowing disorders, pediatric, clinical feeding assessment, fibreoptic endoscopic evaluation of swallowing, aspiration, penetration

DOI: 10.3233/PRM-220052

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 211-219, 2024

Authors: Fergus, Andrea | Wyker, Carlee | Heyl, Nicole | Lewis, Tayler | Hartsook, Katherine

Article Type: Research Article

Abstract: OBJECTIVE: The family-centered care framework of Early Intervention (EI) has shifted the focus toward caregiver engagement, but the underlying processes that build this are unknown. The aims of this study were 1) to describe the process of caregiver engagement in therapy and (2) to identify factors perceived to influence caregiver buy-in, confidence, and engagement in EI. METHODS: This preliminary descriptive study utilized quantitative questionnaires and qualitative semi-structured interviews of EI participants (23 caregivers and four physical therapists). Interviews were transcribed and theme coded until saturation was achieved and a concept map was developed. RESULTS: All caregivers …believed that their children benefited from EI, that they were empowered and confident in caring for their children, and their quality of life improved based on the quantitative data. The qualitative data revealed that building a rapport and therapeutic relationship is the foundation to developing buy-in. Reciprocal communication is critical to the relationship and the buy-in. Caregiver knowledge and awareness of progress foster caregiver buy-in and confidence once the relationship is established. CONCLUSION: Improved understanding of the factors influencing the development of buy-in will provide a framework for the clinician to enhance caregiver buy-in. Enhanced buy-in may promote parental engagement and improved outcomes for the child and family. Show more

Keywords: Early intervention, therapeutic alliance, buy-in, parental involvement, therapeutic relationship

DOI: 10.3233/PRM-230025

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 221-235, 2024

Authors: Hess, Skylar M. | Adu-Amankwah, Dorothy | Elaiho, Cordelia R. | Butler, Liam R. | Ranade, Sheena C. | Shah, Brijen J. | Shadman, Kristin | Fields, Robert | Lin, Elaine P.

Article Type: Research Article

Abstract: OBJECTIVE: This study explored family satisfaction and perceived quality of care in a pediatric neuromuscular care clinic to assess the value of the multidisciplinary clinic (MDC) model in delivering coordinated care to children with neuromuscular disorders, such as cerebral palsy. METHODS: Caregivers of 22 patients were administered a qualitative survey assessing their perceptions of clinic efficiency, care coordination, and communication. Surveys were audio-recorded and transcribed. Thematic analysis was completed using both deductive and inductive methods. RESULTS: All caregivers reported that providers adequately communicated next steps in the patient’s care, and most reported high confidence in caring …for the patient as a result of the clinic. Four major themes were identified from thematic analysis: Care Delivery, Communication, Care Quality, and Family-Centeredness. Caregivers emphasized that the MDC model promoted access to care, enhanced efficiency, promoted provider teamwork, and encouraged shared care planning. Caregivers also valued a physical environment that was suitable for patients with complex needs. CONCLUSION: This study demonstrated that caregivers believed the MDC model was both efficient and convenient for pediatric patients with neuromuscular disorders. This model has the potential to streamline medical care and can be applied more broadly to improve care coordination for children with medical complexity. Show more

Keywords: Complex care, children with medical complexity, neuromuscular disorders, multidisciplinary care, family-centered care

DOI: 10.3233/PRM-230011

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 237-246, 2024

Authors: Ahmed, Faruq | Islam, Asma | Akter, Suria | Al Zubayer, Md Abdullah | Mahmud, Md Nasim | Yeasmin, Hosneara | Mawa, Zannatul

Article Type: Case Report

Abstract: Spinal muscular atrophy (SMA) is a neuromuscular ailment that leads to the deprivation of motor neurons in the spinal cord, producing denervation and muscle weakness. This case report explains how a patient with type 2 SMA used a therapeutic exercise rehabilitation program in a school environment. Motor functions were assessed by Gross Motor Function Measure-88 (GMFM-88), Manual Muscle Testing (MMT), and Hammersmith Functional Motor Scale (HFMS), which is validated and reliable. This study employed a repeated pre-test post-test measures design. During a year of treatment sessions, the child underwent twice weekly 45-minute physical therapy sessions for 48 weeks. The research …was carried out between March 2022 and February 2023. The purpose of the intervention, which comprised a variety of therapeutic workouts, was to enhance physical function and gross motor abilities in an age-appropriate manner. The intervention utilized in this study led to improvements in GMFM-88, HFMS, and MMT total scores. The results of this case study showed that a child with type 2 SMA aged nine had successfully improved their gross motor skills and muscle strength. Show more

Keywords: Spinal muscular atrophy, physical therapy, physical rehabilitation, inclusive education

DOI: 10.3233/PRM-230008

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 247-252, 2024