Journal of Pediatric Rehabilitation Medicine - Volume Pre-press, issue Pre-press
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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 medical complexity of traumatic spinal cord injury (TSCI) in paediatric patients in Western Australia (WA). Secondly, to determine if Princess Margaret Hospital (PMH) for Children (the tertiary paediatric centre in WA where all TSCI patients are managed) is meeting the requirements of the Australasian Rehabilitation Outcomes Centre (AROC) paediatric rehabilitation minimum data set gathered on each patient. METHODS: Retrospective cohort study of patients seen at PMH between 1996–2016. The AROC minimum dataset information data were gathered on each patient. Functional status and rehabilitation outcomes were assessed using Functional Independence Measure for Children…(weeFIM), Canadian Occupational Performance Measure (COPM), and Goal Attainment Scaling (GAS). Patient complexity was captured by documenting the specialty teams involved, the number of readmissions, and the International Statistical Classification of Disease and Related Health Problems Z codes. RESULTS: Data from 19 patients (13 males, age range 6 months-15 years; 6 females, age range 4 years-13 years) were available. There were 10 cervical TSCIs with a median length of stay of 213 days and 9 thoracic TSCIs with a median length of stay of 49 days. Patients had between zero and six comorbidities prior to their TSCI. CONCLUSIONS: Children with medical complexity are responsive to rehabilitation but have a high burden of care, requiring multiple-specialty care and hospital re-admissions. AROC has set a minimum data set recommendation for the collection and examination of patient data. PMH meets the AROC guidelines for patient data collection and descriptive analyses.
Keywords: Spine, traumatic, paediatric, rehabilitation, outcomes, documentation, weeFIM, COPM, GAS, data set, PMH, Australia
Abstract: Employing a cross-sectional qualitative descriptive design, using individual, semi-structured interviews collected from primary care and specialty clinicians who routinely care for children with medical complexity (CMC) in a largely rural area in central Virginia, this study aimed to better understand the current state of care, the motivations, and barriers for expansion of care for CMC in a semi-rural academic hospital center. Five themes emerged describing the current practice of the participants: (1) complexities of care, (2) compassion and empathy for families, (3) limited resources, (4) essential nature of coordination and teamwork, and (5) proximity to care. Each of the five…themes that emerged from our interviews present both challenges and rewards. The theme of compassion for families of CMC is seen as a key potential motivational driver for expansion and reorganization of clinical care for CMC.
Keywords: Children with medical complexity, coordination of care, compassionate care
Abstract: BACKGROUND: Although considered an advanced area of practice, there has been insufficient standardization in clinical training and preparedness for occupational therapists (OTs), physical therapists (PTs), and speech-language pathologists (SLPs) practicing in the neonatal intensive care unit (NICU). The first step in developing a neonatal therapy certification process was to conduct a practice analysis. PURPOSE: To describe: 1) the collection of OTs, PTs, and SLPs working in NICUs, 2) educational and professional preparation to practice in the NICU, and 3) interest in neonatal therapy national certification. METHODS: An online survey of 468 neonatal therapists…was completed in 2015–2016. RESULTS: There were 208 (47%) participants who were OTs, 140 (32%) PTs, and 94 (21%) SLPs. Among respondents, 187 (50%) neonatal therapists had a clinical doctorate, and 143 (40%) therapists practiced for > 5 years prior to entering NICU practice. There were 299 (88%) therapists who believed oversight and accountability in the NICU is highly important, and 329 (98%) therapists were interested in a neonatal therapy certification program. CONCLUSIONS: Advanced training and skills of neonatal therapists are vital to ensure safe, effective and evidence-based practice. Insufficient standardization in training and variable adherence to education and training guidelines provided credibility for the creation of a neonatal therapy national certification process, which has now been implemented.
Abstract: PURPOSE: To identify factors associated with success of corrective bony hip surgery among patients with cerebral palsy (CP). METHODS: A retrospective review was conducted of medical records of patients diagnosed with CP and hip displacement who underwent surgery from 2004 to 2016 at the authors’ institution and who had one-year minimum follow-up. Patient age, sex, Gross Motor Function Classification System (GMFCS) level, surgical procedure(s), type and extent of CP, presence of preoperative and postoperative hip pain, and hip migration percentages (MPs) were recorded. Surgical success was defined as a postoperative MP ⩽ 30%…and no hip pain at final follow-up. RESULTS: Thirty-eight patients (55 hips) met the inclusion criteria. Mean age at surgery was 10.2 years (range, 2–24 years). Mean MP (standard deviation) improved from 64 ± 29% preoperatively to 22 ± 30% at mean 1.7-year follow-up (p < 0.001). The absence of preoperative hip pain (p = 0.014), surgery after age 5 (p = 0.041), and a milder preoperative MP (p < 0.001) were significantly associated with surgical success. CONCLUSION: In patients with CP and hip displacement, early preventative correction of hip displacement after age 5 may improve clinical outcomes, though future studies are needed to provide more definitive clinical direction.
Keywords: Cerebral palsy, hip displacement, migration percentage, pain, surgical success
Abstract: PURPOSE: In Italy, most children and adolescents affected by oncological diseases are treated in one of the centers within the Italian Association of Pediatric Hematology and Oncology (AIEOP). AIEOP relies on groups of experts; each of them develops interventions in their specific field of expertise to improve the diagnostic, therapeutic, and assistance pathway of patients and families. Although rehabilitation is an important field in pediatric oncology, until recently there was no working group dedicated to it. This study intends to show the steps that led to the creation of the rehabilitation working groups in AIEOP. METHODS:…First of all, a survey to identify the various rehabilitation approaches applied throughout Italian centers was sent via email to 39 AIEOP centers that provide rehabilitation. RESULTS: Answers received from 31 centers showed a lack of homogeneity in rehabilitation methods in terms of type of treatment, number of patients, and outcome measurement. CONCLUSIONS: Some results of the survey were chosen as basic criteria of clinical best practice on which to build the first rehabilitation working-group at the national level to be proposed to the AIEOP commission.
Abstract: PURPOSE: To describe one institution’s experience in the rehabilitation of children with acute flaccid myelitis (AFM). This study reviews the medical and rehabilitative course and functional outcomes of a cohort of children who underwent Activity Based Restorative Therapy (ABRT) at a single center. METHODS: Children with AFM presenting for rehabilitation between March 2005 and January 2017 were identified and a retrospective chart review was conducted. Changes in medical and functional status were assessed using multiple standardized instruments, as well as a chart review of medical progress. RESULTS: Thirty-one children with AFM treated at…our institution in the study time period were identified. Of these, seventeen received inpatient treatment, and fourteen received solely outpatient interventions. Their medical and functional outcomes are described with use of standardized measures when available. CONCLUSIONS: Children with flaccid paralysis due to AFM undergoing structured, comprehensive rehabilitation interventions, even when these are initiated long after paralysis onset, can make significant neurologic and functional gains. Recovery of function and prevention of comorbidities are the main therapeutic targets for interventions in this population.
Abstract: A 9-year old male patient with a past medical history of congenital cytomegalovirus (CMV) infection and spastic quadriplegic cerebral palsy with an intrathecal baclofen pump was admitted to a tertiary care hospital with respiratory depression and unresponsiveness for approximately two days. He had a recent two-week hospital stay for respiratory failure due to pneumonia. After being prescribed antibiotics and being sent home, he had developed copious diarrhea. On readmission, he was found to be dehydrated and in acute renal failure. A physical exam revealed hypotonia throughout, in a patient who typically had spasticity with contractures. The Pediatric Rehabilitation Medicine service…was consulted for possible baclofen toxicity. Some signs and symptoms of baclofen toxicity include respiratory depression, seizures, CNS depression, hypotonia, hypotension, absent deep tendon reflexes, lethargy, ataxia, and cardiac arrhythmias. His intrathecal baclofen (ITB) dose was reduced, and signs/symptoms of ITB overdose began to resolve. As renal function improved, spasticity returned, necessitating increase in ITB dosing toward the premorbid dose.
Abstract: Conventional knee-ankle-foot orthoses (KAFOs) are generally prescribed for children with lower limb muscle weakness and joint instabilities. The main function of KAFOs is to provide stability during gait by locking the knee in full extension. However, walking with the knee joint in a fully extended position requires excessive energy consumption, leading to early fatigue and inducing non-physiological gait patterns. A new generation of KAFOs was developed to allow free knee flexion during the swing phase and to lock the knee joint during the stance phase to provide the required stability. These are commonly labeled as stance-control knee-ankle-foot orthoses (SCKAFOs). Nevertheless,…commercial SCKAFOs are not available for the pediatric population. Especially in early ages, children must frequently replace the orthosis due to their growth. Hence, the proposed design presents a solution for a SCKAFO with adjustable length adaptable to children’s dimensions ranging from two to six years old.
Keywords: Design, stance-control knee-ankle-foot orthosis, assistive technology, pediatric population