Journal of Pediatric Rehabilitation Medicine - Volume 9, issue 3
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Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach is an international journal designed to parallel the multi-disciplinary team approach of caring for a child with an acute or chronic disease. The issues will primarily be themed and broad in scope including, but not be limited to cerebral palsy, traumatic brain injury, spinal cord injury, spina-bifida, amputation, muscular dystrophies of all types, stroke, cancer, mental retardation, developmental delays, and others.
The aim is to include a wide range of experts who care for children with the above diagnosis. Authorship by two different disciplines is requested though not required to encourage an interdisciplinary and collaborative approach. The goal is for the reader to obtain not just the medical perspective, but also nursing, occupational, physical and speech therapy, psychology, home care, etc., in providing the most comprehensive care for children. Manuscripts will be blinded and peer reviewed with appropriate feedback. Statistical analysis will be reviewed by the biostatistician. Readers are encouraged to submit and or suggest case reviews, commentaries, editorials, original research, conference schedules, or reviews.
Abstract: PURPOSE: To describe the prevalence, location, severity, and daily impact of pain reported by youth and young adults with cerebral palsy (CP). A secondary aim was to identify any significant associations between the constructs of interest. METHOD: An observational study of 112 participants with CP to understand their experience of pain through a questionnaire. Participants were 56 males and 55 females with a mean age of 18y 9mo (SD 4y 5mo). RESULTS: Pain was reported by 75% of males and 89% of females. Both severity and impact of pain were significantly greater in…females. In addition, severity and impact of pain were significantly different between specific GMFCS levels. There were no significant differences in location of pain by gender or GMFCS level. A strong positive correlation between the severity and impact of pain was observed (rs = 0.80). CONCLUSION: The gender differences in the severity and impact of pain and the overall and high prevalence of pain reported here provide healthcare practitioners with an increased awareness of pain distribution/characteristics among young adults with CP. Understanding the impact of pain on daily life can assist practitioners to efficiently manage pain and improve the quality of life for individuals with CP.
Keywords: Cerebral palsy, pain, prevalence, severity, impact, youth, young adult
Abstract: PURPOSE: Diffusion tensor imaging (DTI) can detect injury to specific white matter (WM) tracts involved with sensorimotor processing and may provide sensitive measures for latent or nascent motor skills. We hypothesized that DTI measures of WM fractional anisotropy (FA) could predict early motor scores on a standardized assessment in a cohort of preterm infants at risk for WM injury. METHODS: In this prospective study, preterm infants (n= 26, 11 female, 15 male, mean gestational age 29.1 ± 2.5) underwent the Test of Infant Motor Performance (TIMP) at term and at 12 weeks corrected age…(CA) and underwent an non-sedated magnetic resonance imaging (MRI) with DTI at a mean of 42 ± 1.5 weeks CA. Fractional anisotropy (FA) was measured by Voxelwise statistical analysis using Tract-Based Spatial Statistics (TBSS) in the specific regions of interest. RESULTS: Significant differences were found between infants with poor versus average performance on motor assessments at 12-weeks and FA values in several left hemispheric WM tracts (p< 0.05). High FA of the left anterior limb of the internal capsule (ALIC) predicted mean increase in TIMP scores on specific items for head lift in prone and head lift turn to sound (p= 0.045 and p= 0.002). CONCLUSION: Subtle WM injury, as indicated by low FA in left WM tracts, can predict outcomes of early motor skills performance testing at 3 months. Early DTI may identify infants with silent WM injury who need early intervention. Further studies may establish if individual tract FA improve after targeted treatment.
Keywords: Premature infant, motor development, diffusion tensor imaging, neuroimaging
Abstract: PURPOSE: To study the impact of a 5-week supported physical activity (PA) intervention on parental report of sleep qualities, sleep duration, and pain severity in children with medical complexity (CMC). METHODS: Twenty-nine CMC participated in 180 minutes of daily supported PA on weekdays over 5 weeks. A pre- and post-test design was used to collect sleep qualities (Children's Sleep Habits Questionnaire) and pain severity (Faces Pain Scale- Revised) as reported by parents. Using a repeated measures design, weekly sleep diaries captured sleep duration. RESULTS: Children with medical complexity experienced no adverse effects, including…pain, with the supported PA intervention. Significant improvements in sleep problems, sleep duration, and pain severity (P< 0.05) were demonstrated. CONCLUSION: Short-term supported PA did not interfere with sleep or pain in CMC, and in fact, seems to have enhanced parental report of sleep qualities, sleep duration, and pain severity. Supported PA appears safe for CMC and healthcare professionals should explore methods to expand opportunities for supported PA participation.
Keywords: Children with medical complexity, sleep quality, sleep duration, pain severity, physical activity
Abstract: PURPOSE: The objective of this study was to evaluate the effectiveness of serial casting of elbow flexion contractures in neonatal brachial plexus palsy. METHODS: A prospective consecutive cohort study was performed with a median follow-up of 5 years. Forty-one patients with elbow flexion contractures ≥ 30° were treated with serial casting until the contracture was ≤ 10°, for a maximum of 8 weeks. Range of motion, number of recurrences and patient satisfaction were recorded and analyzed using Wilcoxon signed-rank and Cox regression tests. RESULTS: Passive extension increased from a median of…-40° (IQR -50 to -30) to -15° (IQR -10 to -20, p < 0.001). Twenty patients showed 37 recurrences. The baseline severity of passive elbow extension had a hazard ratio of 0.93 (95% CI 0.89 to 0.96, p < 0.001) for first recurrence. Median patient satisfaction was moderate. Four patients showed loss of flexion mobility and in two patients serial casting had to be prematurely replaced by night splinting due to complaints. CONCLUSION: Serial casting improved elbow flexion contractures, although recurrences were frequent. The severity of elbow flexion contracture is a predictor of recurrence. We recommend more research on muscle degeneration and determinants involved in elbow flexion contractures to improve treatment strategies and prevent side-effects.
Keywords: Muscles, contracture, elbow, brachial plexus, serial casting
Abstract: PURPOSE: Responsiveness of the PEDI-CAT Mobility, Daily Activities, and Social/Cognitive domains and Wheelchair subdomain was evaluated for youth admitted to a pediatric post-acute care hospital. METHODS: Inpatients ages 2-21 years, with a length of stay of ≥ 5 days and with both admission and discharge scores were included. The difference between mean admission and discharge PEDI-CAT scaled scores were analyzed using paired t-tests. Effect sizes, standard response means (SRMs), and minimal detectable change values were calculated. Score comparison between diagnostic subgroups (Traumatic Brain Injury, Neurological, Orthopedic, Medical) and age groups ( ≤ 5, > 5…but < 13, ≥ 13 years) were evaluated for the Mobility domain. RESULTS: Sample size differed by domain with 66 Mobility, 30 Daily Activities, 19 Social/Cognitive and 9 Wheelchair subdomain pairs. Significant differences were found for all domains when mean admission and discharge scaled scores were compared. Moderate to large effect sizes and SRMs were found for the Mobility and Daily Activities domains and Wheelchair subdomain. Small effect size but large SRM was found for the Social/Cognitive domain. The Mobility domain was also responsive to changes in all diagnostic and age groups. CONCLUSION: The PEDI-CAT was responsive to functional changes for youth discharged from an inpatient pediatric rehabilitation hospital.
Keywords: Functional outcomes, pediatric post-acute care, inpatient pediatric rehabilitation, PEDI-CAT
Abstract: PURPOSE: To further characterize Attention-Deficit/Hyperactivity Disorder (ADHD) in a clinic-referred sample of youth with epilepsy. METHODS: Children and adolescents with epilepsy who were referred for comprehensive neuropsychological evaluation comprised the sample. Data were obtained via archival record review. Youth with epilepsy were grouped according to ADHD diagnosis (no ADHD, ADHD - Combined Type, and ADHD - Predominantly Inattentive Type) and compared for a number of neurocognitive variables, seizure-related variables, and parent and teacher completed behavior rating scale variables. Data was examined via analysis of variance and logistic regression models with post hoc pairwise comparisons, employing Tukey…procedure where appropriate. RESULTS: Youth in this clinical case series (N = 204) demonstrated a high rate of ADHD diagnosis. ADHD - Combined Type was identified with slightly greater frequency than ADHD - Predominantly Inattentive Type. Age of seizure onset, seizure classification, and seizure frequency did not differ significantly between the groups. The groups also did not differ on most cognitive variables examined. Significant group differences were found for parent and teacher completed behavior rating scales assessing inattention, hyperactivity, and executive dysfunction. CONCLUSION: Screening for ADHD in youth with epilepsy is important as these symptoms can significantly interfere with rehabilitative efforts. Behavior rating scales may be the most efficient and cost effective way to identify ADHD in youth with epilepsy.
Abstract: PURPOSE: This study used kinematic analysis to identify a reliable and rapid assessment method for abnormal patterns of motor development in preterm infants. METHODS: In a retrospective analysis, we examined video of n= 35 preterm infants at 3mo corrected age (CA) who had concurrent Test of Infant Motor Performance (TIMP) scores. Hyperflexion at the hip produces common gait anomalies seen in children with CP, therefore we analyzed hip angle in the prone head lift position at 3 months CA. Magnetic Resonance Spectroscopy (MRS) was performed at term equivalent (n= 23) and Bayley-III neurodevelopmental tests were performed…at 1 year (n= 28). We correlated hip angles with TIMP and Bayley-III scores, and MRS neuronal metabolites. RESULTS: Hip angle positively correlated with TIMP at 3 months (r= 0.642, p≤ 0.001), but not with Bayley-III at 1 year (r= 0.122, p= 0.529). Hip angle correlated negatively with myo-inositol (mI) ratios in frontal white matter tracts (mI/Cr r= -0.520, p= 0.011). CONCLUSIONS: These results suggest prone hip angle may be a quantitative proxy for the 42-item TIMP at 3 months, and that hypertonicity in the hip flexor musculature is a manifestation of white matter metabolic abnormalities (elevated mI ratios) that may indicate occult white matter injury.
Abstract: PURPOSE: This quality improvement project aimed to improve parental experiences with healthcare delivery and collaborative health care offered at a school serving children with medical complexity (CMC) by implementing telehealth services. METHODS: Parents of students at an urban public charter school for CMC were surveyed before and after telehealth was implemented at the school for two months, and again one year later, using the Measure of Processes of Care (MPOC-20). RESULTS: Parental scores on the MPOC-20 were generally high both before and after the implementation of telehealth. There were no significant differences in…the scores. Anecdotally, parent satisfaction with telehealth services was high. A review of the utilization of school-based telehealth during the 2015-2016 school year among 13 schools, including this unique school for CMC, revealed that the odds of having a telehealth visit at the school for CMC vs the other 12 schools was 23.8 (p value < 0.001; CL:11.2 to 50.6). CONCLUSION: Parental experiences with healthcare delivery were high both before and after the implementation of telehealth at an urban public charter school for CMC. Utilization of telehealth at the school for CMC was significantly higher than that of children enrolled in the program at 12 other schools. Further research is needed to evaluate parental experiences with school-based telehealth services.
Keywords: Telehealth, school health services, disabled children
Abstract: PURPOSE: The aim of the study was to estimate the energy expenditure (EE) during a quiet standing task in children with bilateral spastic CP (BSCP) in comparison with typically developing (TD) children, using gas analyzer. METHODS: The study was an observational cross-sectional study of children with BSCP (Gross Motor Function Classification System [GMFCS] levels II and III; n = 30; 10 males, 20 females; mean weight 27.46 kgs; mean age 10 years) and TD children (n = 30; 16 males, 14 females; mean weight 25.35 kgs; mean age 9 years, 9 months). The energy expenditure during…quiet standing task was measured by using Cosmed K4b2 gas analyzer and expressed in terms of peak oxygen consumption (VO2 max, ml/kg body weight/min). RESULTS: Children with BSCP expended 1.4 times higher energy during standing than TD children (p< 0.0001). CONCLUSION: We identified that standing puts an additional energy demand in ambulant children with BSCP. Findings suggest that both dependant and independent ambulating children with BSCP might need to exert more effort to maintain a static standing position. Therefore, clinicians must evaluate standing position for balance control and energy expenditure to evaluate the efficiency of physical therapy and rehabilitation.
Keywords: Oxygen, consumption, gas analyzer, energy, cost, static, balance