Journal of Pediatric Rehabilitation Medicine - Volume 17, issue 2

Authors: Ertzgaard, Per | Nyman, Per | Jakobsson, Maria | Johansson, Jan

Article Type: Case Report

Abstract: Visual difficulties are common after brain tumors, despite a lack of visual complaints at diagnosis. These include difficulties with eye movements, visual coordination, vergence, accommodation, and photophobia, in addition to more obvious problems such as visual field defects. This case report presents the results of a thorough neuro-visual evaluation in a boy with sequelae after a brain tumor including intermittent double vision that was not explained by routine visual examination. Subjective complaints included poor reading perseverance, intermittent blurred and double vision, headache around the eyes when performing near activities, less efficient eye movement behavior in reading tasks, and increased …sensitivity to visual motion. The patient participated in a multidisciplinary visual rehabilitation program that included reading glasses with prism compensation and tinted glasses, as well as training with the aim of improving eye teaming, near vision functions, and perseverance in eye movements. The patient responded quickly to the vision therapy program, with positive changes after just four weeks. Repeated neuro-visual evaluations over eight months showed remarkable improvements that were stable over time. This encouraging case report supports the notion that neuro-visual evaluation and rehabilitation should be included in the follow-up of patients after brain tumors. Show more

Keywords: Pediatrics, brain tumor, vision disorders, orthoptics, oculomotor rehabilitation

DOI: 10.3233/PRM-220127

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 253-260, 2024

Authors: Sheng, Dana L. | Arsenault, Shawna | Wadekamper, Michael | Smith, Eric

Article Type: Case Report

Abstract: Conjoined twins are identical twins joined in utero and are a rare phenomenon. This report discusses a case of female thoraco-omphalo-ischiopagus tripus conjoined twins. The twins were separated at age two, and once medically stable, spent one month in inpatient rehabilitation to improve their sitting balance and gross motor skills. This was followed by outpatient physical therapy. The twins initially had customized ZipZac seats, which they were able to wheel independently. After six months of therapy, the girls began walking with posterior walkers and prostheses. The hemipelvectomy prosthesis included a customized thoracolumbosacral orthosis component and was directly attached to a …non-articulated pylon. A manual-locking hip joint was added to accommodate sitting. An articulated ankle-foot orthosis was used for the intact leg. Care of formerly conjoined twins requires comprehensive care from a multidisciplinary team involving, but not limited to, a physiatrist, orthopaedic surgeon, physical therapist, and orthotist/prosthetist. Complex congenital limb deficiencies are often a major undertaking for the rehabilitation team as continuous treatment and management are needed throughout the patient’s lifetime due to growth, development, and evolving physical demands. Anatomic variations must be examined on a case-by-case basis but often include limb deficiencies, orthopedic abnormalities, and organ comorbidities. Show more

Keywords: Conjoined twins, rehabilitation, hemipelvectomy, congenital limb deficiency, prosthesis

DOI: 10.3233/PRM-220121

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 261-269, 2024

Authors: McKenzie, Courtney | Titzer, Melanie | Hutchinson, Alyssa | Dodge, Camaran | Fergus, Andrea

Article Type: Case Report

Abstract: A novel entry-level collaborative clinical learning experience (CLE) in pediatric physical therapy (PT) delivered via telehealth was implemented involving 12 families, 54 DPT students, and 12 clinical instructors (CIs). Children of various ages, a wide range of home environments, and diagnoses received individualized PT via telehealth during a four-week CLE. Retrospective quantitative and qualitative analyses of student documentation, video recordings of sessions, and CI, student, and caregiver survey responses were performed. All children demonstrated qualitative improvements and 73% demonstrated quantitative improvements. CIs, students, and caregivers believed the children benefited from the experience and 98% believed the children were able to …work toward their goals. Most students (95%) and CIs (100%) felt that it was a valuable and effective learning experience. Most (>71%) CIs and students believed students were able to learn in all relevant domains of the clinical performance instrument. This model provides a unique CLE for students in both pediatric PT and telehealth. Show more

Keywords: Clinical education, experiential learning, pediatrics, telehealth, telerehabilitation

DOI: 10.3233/PRM-220112

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 271-288, 2024

Authors: O’Brien, Jane E. | Dumas, Helene M. | Hughes, M. Laurette | Ryan, Brittany | Kharasch, Virginia S.

Article Type: Brief Report

Abstract: OBJECTIVE: This study aimed to describe daytime and nighttime use and outcome of non-invasive respiratory intervention (NIRI) for infants born prematurely and for children with medical complexity (CMC) during a post-acute care hospital (PACH) admission. METHODS: Thirty-eight initial PACH admissions (October 2018 through September 2020) for premature infants (< 1 year; n  = 19) and CMC (> 1 year; n  = 19) requiring NIRI during the day and/or at night were retrospectively examined. Measures included: 1) daytime and nighttime NIRI use by type (supplemental oxygen therapy via low-flow nasal cannula or positive airway pressure [PAP] via high-flow nasal cannula, continuous positive airway …pressure, or biphasic positive airway pressure at admission and discharge) and 2) daytime and nighttime NIRI outcome—reduction, increase, or no change from admission to discharge. RESULTS: For the total sample (n  = 38), daytime vs nighttime NIRI use was significantly different (p  < 0.001). At both admission and discharge, supplemental oxygen was the most common NIRI during the day, while PAP was most common at night. From admission to discharge, seven (18%) infants and children had a positive change (reduced NIRI) during the day, while nine (24%) had a positive change at night. At discharge, 11/38 (29%) infants and children required no daytime NIRI, while 4/38 (11%) required no day or night NIRI. CONCLUSION: NIRI use differs between day and night at PACH admission and discharge for CMC. Reductions in NIRI were achieved during the day and at night from PACH admission to discharge for both infants born prematurely and for children with varied congenital, neurological, or cardiac diagnoses. Show more

Keywords: Noninvasive ventilation; oxygen; infant; child; post-acute care; hospital

DOI: 10.3233/PRM-220094

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 17, no. 2, pp. 289-293, 2024