Journal of Pediatric Rehabilitation Medicine - Volume Pre-press, issue Pre-press
Purchase individual online access for 1 year to this journal.
Price: EUR 105.00
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: Electrophysiological event-related potentials (ERP’s) have been reported to change after concussion. The objective of this study is to use a simple 2-tone auditory P300 ERP in routine clinical settings to measure changes from baseline after concussion and to determine if these changes persist at return to play when other standard measures have normalized. METHODS: Three-hundred sixty-four (364) student athletes, aged 17–23 years, participating in contact sports were tracked over consecutive years. In this blinded study P300, plus physical reaction times and Trail Making tests, were collected alongside standard clinical evaluations. Changes in these measures after concussion…were compared to clinical outcomes over various stages of post-injury recovery. RESULTS: Concussed players experienced significant reaction time and/or P300 amplitude changes compared to pre-concussion baseline measurements (p < 0.005). P300 changes persisted in 38% of the players after standard measures, including reaction times, had cleared. Many of those players slow to normalize were part of the sub-concussive symptom group and/or appeared more prone to repeat concussions. CONCLUSION: These data suggest significant P300 amplitude changes after concussion that are quantifiable and consistent. These changes often normalized slower than other standard assessments. More data are needed to determine if slow normalization relates to sub-concussive or repeated events.
Keywords: Concussion, sports, electroencephalogram, event related potentials, P300, reaction time, trail making, return to play
Abstract: PURPOSE: Though knowledge of normal childhood developmental milestones, essential for physician subspecialists, begins in medical school, it continues in pediatric subspecialty residency and fellowship training. Despite widespread education in developmental milestones, published curricula related to this content area are lacking. This pilot curriculum was developed to address the lack of published developmental curricula. METHODS: Participants included pediatric rehabilitation trainees who completed 8–12 sessions per year of a novel, adult-learner centered child development curriculum, for two consecutive years. Outcome measures included a novel survey, knowledge based test, verbal feedback sessions, and the end of the year program…evaluation committee meeting. RESULTS: Trainees were successfully able to attend curricula sessions within their typical fellowship and residency responsibilities. Pediatric rehabilitation medicine fellows reported improved competence in normal growth and development. Pediatric rehabilitation residents rated the curriculum as a high value to their education (3.5 ± 0.58 on a 1–4 point scale). While not statistically significant, ratings of perceived knowledge of developmental milestones, structured educational sessions attended related to development, and overall interest in the topic increased from pre-curriculum to post-curriculum. CONCLUSION: This study introduces a novel approach to developmental milestones education that is tailored to the adult learner and pediatric rehabilitation trainees.
Abstract: PURPOSE: Arteriovenous malformation (AVM) rupture in children can cause debilitating neurological injury. Rehabilitation is key to recovery, though literature details little regarding rehabilitation outcomes. We examined a single-center experience with pediatric AVMs as related to acute inpatient rehabilitation outcomes. METHODS: At our institution, a retrospective chart review was completed examining all cases of intracranial AVMs in patients age 18 and younger who completed our acute inpatient rehabilitation program between 2012–2018. Patient characteristics, clinical data, treatment modality, and functional outcomes were reviewed. RESULTS: 14 patients with AVMs underwent acute inpatient rehabilitation; nine (64.3%) treated…surgically at our institution, two (14.3%) non-surgically at our institution, and three (21.4%) surgically at an outside facility prior to transitioning care at our institution. Eight (57.1%) were male, seven (50.0%) Caucasian, and seven (50.0%) Hispanic. Seven (50.0%) presented with AVM rupture; six (42.9%) were found incidentally on imaging. Clinical courses, treatment outcomes, and post-treatment complications varied. Several patients underwent repeat treatment or additional procedures. Neurological deficits identified included hemiparesis, dystonia, spasticity, epilepsy, hydrocephalus, and ataxia. Inpatient rehabilitation unit length of stay was on average 21 days (SD 9.02, range 9–41). Functional Independence Measure for Children (WeeFIM ® ) scores, including self-care, mobility, and cognition, demonstrated improvement upon discharge. The mean total change was 36.7 points in those treated surgically, 16.5 in those treated non-surgically, and 25.7 in those treated surgically at another facility. CONCLUSION: We found that all pediatric patients with intracranial AVMs, across all treatment modalities, demonstrated improved outcomes across all functional domains after an acute inpatient rehabilitation program.
Abstract: BACKGROUND: The brachial plexus is a network of nerves exiting the spinal cord through the fifth, sixth, seventh, and eighth cervical nerves (C5-C8) as well as the first thoracic nerve (T1) to conduct signals for motion and sensation throughout the arm. Brachial plexus birth injuries (BPBI) occur in 1.5 per 1,000 live births. The purpose of this study was to determine the perceived change in musculoskeletal health-related quality of life of brachial plexus patients utilizing the Pediatric Outcomes Data Collection Instrument (PODCI). PODCI scores were examined along with the patient’s procedure history (surgical or Botulinum Toxin), extent of involvement…and demographics. PATIENTS: A total of 81 patients from two to eighteen years of age from nine different states met the inclusion criteria of having a pre-procedure and post-procedure PODCI score along with a Narakas score from 2002–2017. These patients were seen at the Brachial Plexus Center, which is an interdisciplinary clinic at a large academic medical center METHODS: This retrospective study utilized PODCI data collected annually during their regular brachial plexus clinic visits. Upper extremity (UE) and global functioning (GFx) scores pre- and post-procedure were stratified by Narakas Classification. Data were analyzed using paired t-test and ANOVA testing. RESULTS: Patients with a Brachial Plexus Birth Injury (BPBI) had lower PODCI scores for UE and GFx when compared with the pediatric normative scores for age-matched healthy children. Scores in both UE and GFx domains were higher after procedure in the groups of Narakas I and IV. There was significant correlation between UE and GFx scores and documented first PODCI score (2 years of age) and age at intervention (5 years of age). CONCLUSION: Procedures increased the perceived quality of life for children with a BPBI and increased their overall PODCI scores for both UE and GFx.
Abstract: BACKGROUND: Respiratory muscle weakness is a primary cause of morbidity and mortality in patients with Pompe disease. We previously described the effects of our 12-week respiratory muscle training (RMT) regimen in 8 adults with late-onset Pompe disease [1 ] and 2 children with infantile-onset Pompe disease [2 ]. CASE REPORT: Here we describe repeat enrollment by one of the pediatric participants who completed a second 12-week RMT regimen after 7 months of detraining. We investigated the effects of two 12-week RMT regimens (RMT #1, RMT #2) using a single-participant A-B-A experimental design. Primary outcome measures were maximum inspiratory…pressure (MIP) and maximum expiratory pressure (MEP). Effect sizes for changes in MIP and MEP were determined using Cohen’s d statistic. Exploratory outcomes targeted motor function. RELEVANCE : From pretest to posttest, RMT #2 was associated with a 25% increase in MIP and a 22% increase in MEP, corresponding with very large effect sizes (d = 2.92 and d = A 2.65, respectively). Following two 12-week RMT regimens over 16 months, MIP increased by 69% and MEP increased by 97%, corresponding with very large effect sizes (d = 3.57 and d = 5.10, respectively). MIP and MEP were largely stable over 7 months of detraining between regimens. Magnitude of change was greater for RMT #1 relative to RMT #2.
Keywords: Pompe disease, glycogen storage disease type II, skeletal muscle, neuromuscular disease, rehabilitation, respiratory muscle training
Abstract: PURPOSE: To describe the incidence and risk factors of communication, swallowing, and orofacial myofunctional disorders in a cohort of children and adolescents with cancer and benign neoplasms. METHODS: A prospective cohort study conducted with children aged ⩾ 2 years and adolescents of both genders admitted at the Pediatric Oncology Department of the Instituto Nacional de Câncer (INCA) between March 2014 and April 2015. Study participants were submitted to a Speech-Language Pathology (SLP) assessment at three different times: (T1) at hospital admission; (T2) six months after admission; (T3) one year after admission.…RESULTS: One hundred and sixty individuals were evaluated. At the time of hospital admission, 68 individuals (42.5%) presented with some type of SLP disorder. After one year of follow-up, 22.8% of the patients had developed new impairments. The occurrence of new speech-language disorders had a statistically significant association with the tumor site. In the risk analysis for the development of speech-language disorders with respect to the primary tumor site, compared to other sites, the central nervous system (CNS) tumor group was 8.29 times more likely to present some new alterations, while the head and neck (HN) tumor group had a 10.36-fold higher risk. CONCLUSION: An incidence of 22.8% for communication, swallowing, and orofacial myofunctional disorders was observed. The development of these disorders was greater in individuals with tumors in the CNS and in the HN region.
Keywords: Speech, language and hearing sciences, oncology, pediatrics, communication disorders, deglutition disorders
Abstract: PURPOSE: Youth with physical disabilities have lower psychosocial health and attention compared to their typically developing peers. Recent research has shown positive associations between sports participation and these outcomes. The purpose of the current study was to explore whether a school-based sports program affects psychosocial health and attention in youth with physical disabilities. METHODS: Seventy children and adolescents (mean age (SD) 13.8 (2.9) years, aged 8–19 years, 54% boys) with physical disabilities were included in this quasi-experimental study from schools for special education. The sports group (n = 31) followed a…school-based sports program (45 min/week) for six months. The control group followed the regular curriculum. Psychosocial health was assessed with self-perception (Self-Perception Profile for Children) and quality of life (DISABKIDS Chronic Generic Measure, DCGM-37). Attention was measured with experimental tasks on search efficiency, sustained attention, and distractibility. RESULTS: Linear regression analyses revealed no differences between the sports and control group for self-perception, quality of life, and attention. CONCLUSION: A school-based sports program seems to have no effect on psychosocial health and attention in youth with physical disabilities. Research into the important factors influencing these variables is needed before further resources can be given to improve sports participation for increasing psychosocial health and attention.
Keywords: Youth, sports, physical disability, quality of life, self-concept, attention