Journal of Pediatric Rehabilitation Medicine - Volume 7, issue 3

Article Type: Other

DOI: 10.3233/PRM-140298

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 195-196, 2014

Authors: Banez, Gerard A. | Frazier, Thomas W. | Wojtowicz, Andrea A. | Buchannan, Kristen | Henry, Douglas E. | Benore, Ethan

Article Type: Research Article

Abstract: PURPOSE: The purpose of this research was to describe 24–42 month outcomes of a combined inpatient/day hospital interdisciplinary pain rehabilitation program for children and adolescents with chronic pain and functional disability. METHODS: One-hundred-seventy-three children and adolescents (mean age=15.1 years, SD=2.5) were treated in the three-week program. Mixed effects regression models (MERM) examined changes over time in pain ratings (0–10), school days missed by children and work days missed by parents in …the preceding week, and the number of days hospitalized in the preceding month. RESULTS: Participants reported a significant decline in pain from admission to 24–42 month follow-up. The largest declines in pain occurred from discharge to 1-month follow-up (6.20 vs. 4.81 on a 0–10 numerical rating scale) and from 12 months to 24–42 month follow-up (4.90 vs. 3.56). Two distinct trajectories of treatment response were identified using growth mixture modeling: children with initially high pain ratings exhibited large reductions in pain ratings, while those with lower pain ratings at admission showed minimal reductions. Treatment resulted in significant reductions in school and work days missed and the number of days hospitalized (all p's < 0.001), with reductions evident at 1-month follow-up and maintained through 24–42 month follow-up. CONCLUSIONS: These results suggest that interdisciplinary pain rehabilitation is a promising approach to chronic pain and associated disability in children, with enduring improvements found 24–42 months following program completion. Distinct trajectories of treatment response were identified. Show more

Keywords: Adolescents, pain, interdisciplinary health team, rehabilitation, outcomes assessment

DOI: 10.3233/PRM-140289

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 197-206, 2014

Authors: McPherson, Amy C. | Leo, Jennifer | Church, Paige | Lyons, Julia | Chen, Lorry | Swift, Judy

Article Type: Research Article

Abstract: Childhood obesity is a global health concern, but children with spina bifida in particular have unique interacting risk factors for increased weight. PURPOSE: To identify and explore current clinical practices around weight assessment and management in pediatric spina bifida clinics. METHODS: An online, self-report survey of healthcare professionals (HCPs) was conducted in all pediatric spina bifida clinics across Canada (15 clinics). Summary and descriptive statistics were calculated and descriptive thematic analysis was …performed on free text responses. RESULTS: 52 responses across all 15 clinics indicated that weight and height were assessed and recorded most of the time using a wide variety of methods, although some HCPs questioned their suitability for children with spina bifida. Weight and height information was not routinely communicated to patients and their families and HCPS identified considerable barriers to discussing weight-related information in consultations. CONCLUSION: Despite weight and height reportedly being measured regularly, HCPs expressed concern over the lack of appropriate assessment and classification tools. Communication across multi-disciplinary team members is required to ensure that children with weight-related issues do not inadvertently get overlooked. Specific skill training around weight-related issues and optimizing consultation time should be explored further for HCPs working with this population. Show more

Keywords: Rehabilitation, children, disability, spina bifida, obesity

DOI: 10.3233/PRM-140290

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 207-217, 2014

Authors: Coker-Bolt, Patty | Woodbury, Michelle L. | Perkel, Jessica | Moreau, Noelle G. | Hope, Kathryn | Brown, Truman | Ramakrishnan, Viswanathan | Mulvihill, Denise | Jenkins, Dorothea

Article Type: Research Article

Abstract: PURPOSE: To determine specific motor skills in premature infants, match those that correlate with standards tests of motor performance, and MRS measures of abnormal brain biochemistry. METHODS: Prospective cohort study of preterm infants (n=22). Infant motor assessments were completed at term and 12 weeks corrected gestational age (CGA) using the Test of Infant Motor Performance (TIMP) and Bayley Scales of Infant and Toddler Development-III at 12 months CGA. Infants (n=12) received MRS scans at …term CGA. Rasch analysis and MRS findings investigated TIMP items well targeted to high and low risk infants. RESULTS: A 10 item subset of motor skill items correlated strongly with full 42-item TIMP at term and 12 week testing (r> 0.90, p< 0.001 for both), and with Bayley gross motor scores. MRS metabolites in basal ganglia correlated significantly with both TIMP and 10 item motor tests at term, while frontal white matter metabolites correlated with TIMP and 10 item tests at 12 weeks and Bayley motor scores. CONCLUSION: A short motor skill assessment may be representative of a longer standardized test and relate to brain metabolic function in key areas for motor movement and development. Validation of a shortened assessment may improve early identification of high-risk preterm infants. Show more

Keywords: Cerebral palsy, motor delays, MRS

DOI: 10.3233/PRM-140291

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 219-232, 2014

Authors: O'Neil, Margaret E. | Fragala-Pinkham, Maria A. | Forman, Jeffrey L. | Trost, Stewart G.

Article Type: Research Article

Abstract: PURPOSE: The purposes of this study were to: 1) establish inter-instrument reliability between left and right hip accelerometer placement; 2) examine procedural reliability of a walking protocol used to measure physical activity (PA); and 3) confirm concurrent validity of accelerometers in measuring PA intensity as compared to the gold standard of oxygen consumption measured by indirect calorimetry. METHODS: Eight children (mean age: 11.9; SD: 3.2, 75% male) with CP (GMFCS levels I–III) wore ActiGraph …GT3X accelerometers on each hip and the Cosmed K4b^{2} portable indirect calorimeter during two measurement sessions in which they performed the six minute walk test (6MWT) at three self-selected speeds (comfortable/slow, brisk, fast). Oxygen consumption (VO2) and accelerometer step and activity count data were recorded. RESULTS: Inter-instrument reliability of ActiGraph GT3X accelerometers placed on left and right hips was excellent (ICC=0.96–0.99, CI_{95} : 0.81–0.99). Reproducibility of the protocol was good/excellent (ICC=0.75–0.95, CI_{95} : 0.75–0.98). Concurrent validity of accelerometer count data and VO2 was fair/good (rho=0.67, p< 0.001). The correlation between step count and VO2 was not significant (rho=0.29, p=0.2). CONCLUSION: This preliminary research suggests that ActiGraph GT3X accelerometers are reliable and valid devices to monitor PA during walking in children with CP and may be appropriate in rehabilitation research and clinical practice. ActiGraph GTX3 step counts were not valid for this sample and further research is warranted. Show more

Keywords: Physical activity measurement, accelerometry, cerebral palsy

DOI: 10.3233/PRM-140292

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 233-240, 2014

Authors: Rashid, Marghalara | Goez, Helly R. | Mabood, Neelam | Damanhoury, Samah | Yager, Jerome Y. | Joyce, Anthony S. | Newton, Amanda S.

Article Type: Research Article

Abstract: PURPOSE: To explore the impact moderate to severe traumatic brain injury (TBI) in a child has on family functioning. METHODS: The search was conducted using 9 bibliographic databases for articles published between 1980 and 2013. Two reviewers independently screened for inclusion and assessed study quality. Two reviewers extracted study data and a third checked for completeness and accuracy. Findings are presented by three domains: injury-related burden and stress, family adaptability, and family cohesion. RESULTS: Nine observational studies …were included. Across the studies, differences between study groups for family functioning varied, but there was a trend for more dysfunction in families whose child had a severe TBI as compared to families whose child had a moderate TBI or orthopedic injury. In three studies, injury-associated burden was persistent post-injury and was highest in families whose child had a severe TBI followed by families with a child who had a moderate TBI. One study found fathers reported more family dysfunction caused by their child's injury compared to mothers. Two studies found that mothers' adaptability depended on social support and stress levels while fathers' adaptability was independent of these factors and injury severity. CONCLUSION: Moderate to severe TBI has a significant, long-standing impact on family functioning. Factors associated with family adaptability vary by parental role. Show more

Keywords: Family function, family dysfunction, family burden, traumatic brain injury, TBI, head injury

DOI: 10.3233/PRM-140293

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 241-254, 2014

Authors: Jones, Harrison N. | Crisp, Kelly D. | Moss, Tronda | Strollo, Katherine | Robey, Randy | Sank, Jeffrey | Canfield, Michelle | Case, Laura E. | Mahler, Leslie | Kravitz, Richard M. | Kishnani, Priya S.

Article Type: Research Article

Abstract: PURPOSE: Respiratory muscle weakness is a primary therapeutic challenge for patients with infantile Pompe disease. We previously described the clinical implementation of a respiratory muscle training (RMT) regimen in two adults with late-onset Pompe disease; both demonstrated marked increases in inspiratory and expiratory muscle strength in response to RMT. However, the use of RMT in pediatric survivors of infantile Pompe disease has not been previously reported. METHOD: We report the effects of an intensive …RMT program on maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) using A-B-A (baseline-treatment-posttest) single subject experimental design in two pediatric survivors of infantile Pompe disease. Both subjects had persistent respiratory muscle weakness despite long-term treatment with alglucosidase alfa. RESULTS: Subject 1 demonstrated negligible to modest increases in MIP/MEP (6% increase in MIP, d=0.25; 19% increase in MEP, d=0.87), while Subject 2 demonstrated very large increases in MIP/MEP (45% increase in MIP, d=2.38; 81% increase in MEP, d=4.31). Following three-month RMT withdrawal, both subjects maintained these strength increases and demonstrated maximal MIP and MEP values at follow-up. CONCLUSION: Intensive RMT may be a beneficial treatment for respiratory muscle weakness in pediatric survivors of infantile Pompe disease. Show more

Keywords: Glycogen storage disease type II, muscle, skeletal, neuromuscular diseases, rehabilitation, breathing exercises

DOI: 10.3233/PRM-140294

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 255-265, 2014

Authors: Korupolu, Radha | Ngo, Thien | Hack, Nawaz | Escott, Edward | Salles, Sara

Article Type: Research Article

Abstract: A 5-year old female presented with acute tetraparesis and areflexia. Initial imaging and cerebrospinal fluid analysis were suggestive of acute disseminated encephalomyelitis (ADEM). Minimal clinical response with intravenous steroids prompted further work up. Limited nerve conduction studies suggested possible acute motor-sensory axonal neuropathy, a rare variant of Guillain-Barré syndrome (GBS). Repeat imaging was compatible with polyradiculopathy indicating concomitance of ADEM and GBS. The patient suffered severe motor deficits and neuropathic pain. Slow …but significant functional recovery was noted after intensive inpatient rehabilitation followed by continued rehabilitation via home health services. Show more

Keywords: Encephalomyelitis, Guillain-Barre syndrome, pediatrics, rehabilitation

DOI: 10.3233/PRM-140295

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 267-272, 2014

Authors: Salem, Yasser | Elokda, Ahmed

Article Type: Research Article

Abstract: Children who are critically ill are frequently viewed as "too sick" to tolerate physical activity. As a result, these children often fail to develop strength or cardiovascular endurance as compared to typically developing children. Previous reports have shown that early participation in physical activity in is safe and feasible for patients who are critically ill and may result in a shorter length of stay and improved functional outcomes. The use of the virtual reality gaming systems …has become a popular form of therapy for children with disabilities and has been supported by a growing body of evidence substantiating its effectiveness with this population. The use of the virtual reality gaming systems in pediatric rehabilitation provides the children with opportunity to participate in an exercise program that is fun, enjoyable, playful, and at the same time beneficial. The integration of those systems in rehabilitation of children who are critically ill is appealing and has the potential to offer the possibility of enhancing physical activities. The lack of training studies involving children who are critically ill makes it difficult to set guidelines on the recommended physical activities and virtual reality gaming systems that is needed to confer health benefits. Several considerations should be taken into account before recommended virtual reality gaming systems as a training program for children who are critically ill. This article highlighted guidelines, limitations and challenges that need to be considered when designing exercise program using virtual reality gaming systems for critically ill children. This information is helpful given the popular use of virtual reality gaming systems in rehabilitation, particularly in children who are critically ill. Show more

Keywords: Exercises, video gaming, pediatric rehabilitation

DOI: 10.3233/PRM-140296

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 273-276, 2014

Article Type: Other

DOI: 10.3233/PRM-140297

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 7, no. 3, pp. 277-278, 2014