Journal of Pediatric Rehabilitation Medicine - Volume Pre-press, issue Pre-press
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The Journal of Pediatric Rehabilitation Medicine (JPRM): An Interdisciplinary Approach Throughout the Lifespan is designed to parallel the multidisciplinary teams caring for children, adolescents and adults with childhood-onset physical disabilities and complex care needs worldwide. Published quarterly, topics include, and are not limited to, cerebral palsy, traumatic brain injury, spinal cord injury, spina bifida, limb deficiency, muscular dystrophy, stroke, cancer, developmental delays, and rare disorders. Furthermore, the journal welcomes papers dedicated to pediatric rehabilitation from a global health perspective.
The aim of JPRM is to engage a diverse group of international experts with the goal of providing readers with comprehensive information regarding children and adolescents requiring rehabilitation. JPRM brings together specialists from medicine, nursing, psychology, social work, nutrition, child life, family centered care, and occupational, physical, and speech therapy. For manuscript submissions, authorship involving at least two different specialties is encouraged, although not required, to facilitate a transdisciplinary and collaborative approach. Manuscripts are blinded and peer reviewed including biostatistical analysis. Authors are invited to submit original research, systematic and scoping reviews, guidelines, protocols, care pathways, case reports, book reviews, commentaries, editorials, and dates for future conferences.
Abstract: CASE DESCRIPTION: A 2-month-old child required a bilateral limb amputation, right transtibial, and left transfemoral after a deep burn compromising one-third of the body surface area. Traumatic amputations of lower limbs at such an early age are uncommon and underreported in the literature, especially in middle-income countries. OBJECTIVE: To describe the long-term follow-up of the prosthetization process after traumatic bilateral amputation of a 2-month-old patient. TREATMENT: The process started with compensatory prostheses for independent sitting, followed by exoskeletal devices with SACH feet, and finally introduced dynamic feet and knee to achieve progressively independent gait.…OUTCOMES: The patient achieved functionality, autonomy, and social interaction for his age. The habilitation process continues to improve his independent gait and support upcoming life changes. CONCLUSION: Through a multidisciplinary approach, family support, and timely changes of device components according to the child’s development, this patient has been able to achieve a normal life.
Abstract: Social media represents a significant source of health information for the public, especially during the COVID-19 pandemic where gatherings are limited. It is important for pediatric physical medicine and rehabilitation physicians to understand how their patients use these platforms in order to educate the public and provide sound medical advice on social media. Given the lack of current guidelines on medical education through social media, the purpose of this paper is to provide an overview of various online social media platforms and describe how they can be utilized to enhance pediatric patient education. It is necessary to understand the different…educational functions and limitations of the various social media platforms. This text provides a comprehensive overview of different social media platforms, their educational uses, limitations, and sample accounts. Relevant to the COVID-19 pandemic, social media can improve the efficiency of educational delivery and clinic workflow. Although social media is not meant to replace physician-patient relationships, it can be used as a surrogate for health information and improve— even start— physician-patient relationships. Despite the benefits of social media, pediatric physiatrists may be hesitant to utilize these platforms for several reasons. This text provides an overview of common barriers to social media usage by physicians and recommendations to overcome them. Given that the pandemic has led to increased social media usage, physicians should be aware of its implications on patient care and how they can be used to enhance the practice of pediatric physical medicine and rehabilitation. As social media usage by both patients and physicians grows, more research is needed to create recommendations on how pediatric physiatrists can best utilize social media to educate the public in an enjoyable manner while maintaining a professional image.
Keywords: Social media, physical medicine and rehabilitation, physiatry, YouTube
Abstract: PURPOSE: The Measure of Processes of Care for Service Providers (MPOC-SP) is a valid and reliable instrument to measure the professionals’ perception of the extent to which they apply the principles of family-centered services in care for children with disabilities. This study aimed to evaluate the validity and reliability of the Korean translation of the MPOC-SP (Korean MPOC-SP). METHODS: The Korean MPOC-SP was completed by 132 rehabilitation service providers in 5 provinces in South Korea. Analyses for internal consistency, construct validity, and test-retest reliability were performed. RESULTS: The estimates of internal consistency (Cronbach’s alpha) of the…four scales of the Korean MPOC-SP ranged from 0.67 to 0.92. All the scales correlated highly with the other scales (r ranging from 0.61 to 0.77). In addition, all the items exhibited high item-total correlations (r s ranging from 0.40 to 0.83). Three scales had moderate to good reliability with ICCs ranging from 0.57 to 0.78; the ‘providing general information (PGI)’ scale showed low reliability (ICC 0.22). CONCLUSION: The Korean MPOC-SP can be considered a valid instrument for group-level research purposes with acceptable internal consistency, but caution is warranted regarding the low test-retest reliability of the PGI scale.
Keywords: Family-centered care, pediatric rehabilitation, psychometric assessment, processes of care, self-assessment
Abstract: PURPOSE: Adolescent idiopathic scoliosis (AIS) is associated with perturbation of orthostatic postural control. In humans, orthostatic postural control is organized around the gravitational vertical (GV). Perception of the GV involves a bottom-up process (central integration of multisensorial information) and a top-down process that uses cognitive mechanisms relying on body image. This study hypothesized that AIS would be associated with an erroneous central representation of verticality. The objective was to demonstrate an altered top-down process of sense of verticality in AIS. METHODS: This multicenter, single-blind, case-control study evaluated 63 adolescent girls with AIS divided into two groups (major AIS…(n = 31) and minor AIS (n = 32)) and 30 matched non-scoliotic adolescents. Participants scored their perception of trunk appearance in an upright position using a pictographic scale. The outcome measure was the difference between perception score and real trunk deformity. RESULTS: Participants with major AIS presented with misperception of their trunk appearance in an upright position when compared with those with minor AIS or controls. CONCLUSION: Adolescents with major AIS underestimate their trunk deformity in an upright position. This suggests an altered representation of body image, affecting top-down control of sense of verticality.
Keywords: Adolescent idiopathic scoliosis, postural control, verticality perception, body image
Abstract: PURPOSE: The current study’s aims were to (1) examine long-distance walking ability (6-minute walking test [6MWT]) and walking hemodynamic responses (i.e., heart rate) among youth with functional neurological symptom disorder (FNSD) before and after an integrative pediatric rehabilitation (IPR) program; and (2) explore factors predicting improvement in walking ability. METHODS: Thirty-one youth with FNSD participating in an IPR program were recruited. The IPR program was activated biweekly in an ambulatory format. Study measures included the 6MWT, hemodynamic characteristics, rate of perceived exertion (RPE), pain-intensity perception, and Child’s Somatization Inventory-24 (CSI-24). All measures were conducted upon admission to the…IPR and discharge. RESULTS: Findings indicated a significant increase in 6MWT distance, as well as decreases in heart rate, RPE, and pain-intensity perception from admission to discharge. At admission, CSI-24 and pain intensity predicted 6MWT distance (adjusted R2 = 0.68). Pain intensity predicted discharge 6MWT distance (adjusted R2 = 0.18). Initial 6MWT predicted changes in 6MWT distance from admission to discharge (adjusted R2 = 0.33). CONCLUSION: Using an integrative rehabilitation approach increases walking distance and decreases pain-related symptoms in youth with FNSD, emphasizing the need for collaboration between physical therapists and pediatric psychologists. Moreover, changes in walking ability may increase participation and thus should be the focus of IPR.
Abstract: PURPOSE: Objectives included identifying programs that provide pediatric inpatient rehabilitation services (IPRs) across the United States (US), describing differences in location, admission criteria, available resources, personnel and staffing, and populations served between pediatric rehabilitation programs with the overall goal to evaluate rehabilitation needs in geographical areas with limited access for targeted program development. METHODS: Online survey emailed to pediatric physiatrists who worked or directed IPRs and completed between December 2018 to March 2019. RESULTS: Fifty respondents completed the survey of the seventy-one distributed. Fifty percent of pediatric inpatient rehabilitation services are within a free-standing pediatric hospital…with an average of 14 beds. Twenty-eight programs provide acute services with almost half providing accredited specialized programming. All respondents reported that inpatient rehabilitation treatment teams included pediatric physiatry, nursing, social work, and core therapy disciplines. CONCLUSION: Although characteristics of pediatric inpatient rehabilitation services vary, similarities exist with respect to team composition, clinical coverage, admission or documentation criteria, and outcome measures. The geographic distribution of pediatric IPRs including available specialty programming reveals resource-limited areas. Results from this study emphasize how practice standards or fiscal limitations impact program structure, resources, and ultimately short- and long-term healthcare outcomes among the population of pediatric rehabilitation patients.
Abstract: PURPOSE: This initiative aimed to assess adherence to Scottish Rite for Children’s serial casting protocol for children with idiopathic toe walking (ITW), factors related to adherence, and outcomes after education regarding the protocol. METHODS: 60 patients aged 7.1±2.7 years who completed serial casting were examined at baseline phase (n = 30) and post-education phase (n = 30). Protocols include weekly serial casting for 4 to 6 weeks to achieve 10° of ankle dorsiflexion (ADF) passive range of motion (PROM) with knees extended (KE), assessing the foot posture index (FPI-6) and single leg stance (SLS). Baseline phase evaluated adherence to protocols.…Education phase evaluated factors related to adherence and education regarding serial casting findings. Post-education phase evaluated the impact of the education phase. RESULTS: Serial casting averaged 4.8±1.5 weeks (n = 60). ADF PROM was measured with 100% adherence. ADF PROM KE averaged –10.7° pre-cast and significantly improved to +6.5° post-cast (n = 60), and it significantly improved post-cast post-education (p = 0.04). FPI-6 and SLS adherence significantly improved post-cast post-education. FPI-6 total score averaged +5.3 at baseline and +5.8 post-cast (n = 35). CONCLUSION: Education of staff in serial casting protocols improved adherence and patient outcomes. Patients with ITW and ADF PROM KE –10° benefit from serial casting to improve PROM and to allow for orthotic use post-casting.
Abstract: PURPOSE: The purpose of this study was to examine the reliability, and discriminant validity of the Quantitative Timed up and Go (QTUG) in typically developing (TD) children and children with cerebral palsy (CP). METHODS: Twenty-eight TD children and 8 with CP (GMFCS I-II) completed 3 TUG trials while wearing QTUG sensors. Test-retest reliability and discriminative ability were examined for the 57 constituent parameters of the TUG. Relationships between age and these parameters were also examined. RESULTS: Forty-four of the parameters demonstrated moderate to excellent test-retest reliability, with measures of angular velocity being the most reliable. Twenty-six…parameters were different between TD children and those with CP, and twenty-eight gait parameters demonstrated correlations with age, further supporting its discriminative ability. CONCLUSION: The QTUG is a clinically feasible tool that is capable of both reliably measuring and discriminating many of the movement parameters with the TUG mobility task in TD children and those with CP GMFCS I-II. The results of the present study provide preliminary evidence that the QTUG can discriminate between children on several of the gait parameters within the TUG.
Keywords: Cerebral palsy, children, children, gait, inertial sensors, QTUG, quantitative timed up and go, reliability
Abstract: PURPOSE: This pooled analysis of data from three Phase 3 studies investigated the effects of incobotulinumtoxinA on spasticity-related pain (SRP) in children/adolescents with uni-/bilateral cerebral palsy (CP). METHODS: Children/adolescents (ambulant and non-ambulant) were evaluated for SRP on increasingly difficult activities/tasks 4 weeks after each of four incobotulinumtoxinA injection cycles (ICs) using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to lower limb [LL] or upper limb [UL] spasticity and respondent type [child/adolescent, interviewer, or parent/caregiver]). IncobotulinumtoxinA doses were personalized, with all doses pooled for analysis. RESULTS: QPS key item responses were available from…331 and 155 children/adolescents with LL- and UL-spasticity, respectively, and 841/444 (LL/UL) of their parents/caregivers. IncobotulinumtoxinA efficacy was evident with the first IC. Efficacy was sustained and became more robust with further subsequent ICs. By week 4 of the last (i.e. fourth) IC, 33.8–53.3% of children/adolescents reported complete SRP relief from their baseline pain for respective QPS items. Children/adolescents reported reductions in mean LL SRP intensity at levels that surpassed clinically meaningful thresholds. Similarly, parents/caregivers observed complete SRP relief and less frequent SRP with incobotulinumtoxinA. Similar results were found for UL SRP. CONCLUSION: These findings indicate that incobotulinumtoxinA could bring considerable benefit to children/adolescents with spasticity by reducing SRP, even during strenuous activities.
Keywords: Botulinum toxin, muscle spasticity, all movement disorders, all pediatric, cerebral palsy, pain
Abstract: PURPOSE: Collaboration between physical therapists and caregivers of children who receive physical therapy is integral to providing family-centered care. Successful collaboration depends upon the therapeutic relationship built within the caregiver-therapist dyad. However, the nature of these relationships is not well understood. The purpose of this study was to explore the caregiver-pediatric physical therapist relationship from the perspectives of the caregiver and pediatric physical therapist. METHODS: A qualitative multiple case study methodology was used; a caregiver and pediatric physical therapist represented a bounded case. Each caregiver and therapist engaged in separate, semi-structured, in-depth interviews. RESULTS: Through within-…and cross-case coding, three themes were identified: physical therapist as a guide, the caregiver-pediatric physical therapist connection, and professional qualities and performance. CONCLUSION: These themes help to provide an understanding of the therapeutic relationships that can occur between caregivers and pediatric physical therapists, which can help support effective collaboration as part of providing family-centered care.