Journal of pediatric rehabilitation medicine最新文献

PurposeThis study aimed to translate the English version of the Mini-Eating and Drinking Ability Classification System (Mini-EDACS) into Dutch and assess its psychometric properties and applicability among preschool-aged children with cerebral palsy (CP) in the Netherlands.MethodsForty-eight children with CP (18-36 months) were included. Inter-rater reliability of the Dutch version of the Mini-EDACS was assessed between two speech and language therapists (SLTs) and between two SLTs and parents. Construct validity was established by hypothesis testing regarding the expected strength of the correlation between Mini-EDACS level and sum score of (a) the Pediatric Eating Assessment Tool (PEDI-EAT-10) and (b) the Montreal Children's Hospital Feeding Scale (MCH-FS).ResultsThe level of agreement for Mini-EDACS level was almost perfect between SLTs (weighted kappa (k_w) = 0.83) and substantial between parents and SLTs (parents vs SLT-1: k_w= 0.77; parents vs SLT-2: k_w= 0.70).Kendall's tau-b correlation between Mini-EDACS and PEDI-EAT-10 was 0.66 (p < 0.001), slightly lower than hypothesized, and 0.52 (p < 0.001) between Mini-EDACS and MCH-FS, aligning with the hypothesis. Applicability was found to be good.ConclusionThe Dutch version of the Mini-EDACS showed sufficient inter-rater reliability, construct validity and applicability and can be used in clinical care in the Netherlands to promote unambiguous communication between healthcare professionals and parents.

Recently, the National Institutes of Health (NIH) announced possible restructuring of indirect and administrative costs for funded research. Many entities have raised concern about the impacts that such funding restructuring may have on the future progress of biomedical investigation. The NIH has historically played a key role in research on relevant chronic conditions, including spina bifida and cerebral palsy. Such research funds have not only provided occasion for basic science investigational opportunities but also have allowed for enquiry into clinical, social, and environmental factors that impact disability-specific health outcomes, including those present in some of the world's most vulnerable communities. However, the journal's editorial board is nonetheless encouraged to see the growth and change of Journal of Pediatric Rehabilitation Medicine (JPRM), as the journal evolves from a special issue format to a collections format. The collections will serve as ever-growing "homes" for the latest research on childhood-onset physical disabilities and complex care needs, with the added benefit of greater accessibility and improved user interface. Furthermore, as reflected in this issue, JPRM will continue to offer a platform for research in multidisciplinary care of childhood disability throughout the lifespan as we weather the changes of time together as a committed global community of clinicians and investigators.

PurposeThis study aimed to evaluate long-term functional and radiological outcomes as well as parents' perception of change and overall satisfaction following hip reconstructive surgery in children with cerebral palsy (CP).MethodsMedical charts of children between three and 18 years of age with CP who had surgery between 1993 and 2014 by the same surgeon were reviewed. The study sample consisted of 44 children (Gross Motor Function Classification System levels I-V) aged 2-18 years representing 60 hips. Mean follow-up was 8.4 years [1.8-17.5]. A final follow-up evaluation was held to obtain post-operative anteroposterior pelvic radiographs and administer patient-reported outcomes to the caregivers.ResultsCare and Comfort Hypertonicity Questionnaire scores showed that 74-79% of caregivers reported no difficulty post-surgery in terms of child's pain or discomfort during position changes, when participating in general activities, or during sleep. The Lower Extremity Parent-Rated Change Form showed that 58-76% of caregivers reported a better status in their child's overall health, leg function, activity level, and pain post-surgery. Seventy-six percent of the caregivers indicated satisfaction with the overall changes since the surgery. For the 45 hips with both pre-operative and follow-up radiological outcomes, migration percentage improved significantly (p < 0.001) by 36.7%, and there was a 62.2% increase in the number of hips that were located post-operatively compared to pre-operatively. Acetabular coverage improved significantly (p < 0.001) from non-covered to covered in 46.7% of the hips and Shenton's line improved significantly (p < 0.001) from non-intact to intact in 66.7% of the hips.ConclusionHip reconstructive surgery improved long-term functional and radiological outcomes, as well as quality of life for children and caregivers, while changes were perceived as satisfactory to the families. Evaluating pain, function, and satisfaction is important to measure the impact of hip reconstructive surgery on daily life.

PurposePatients who have undergone lower limb surgery require rehabilitation to regain movement and function in the affected leg. Unfortunately, physical rehabilitation can be painful, reducing compliance and recovery. This feasibility study aimed to demonstrate that immersive virtual reality (IVR) applications can provide potential benefits of anxiety reduction and pain distraction for children during gait rehabilitation, increased engagement and enjoyment, and improved perceived walking quality.MethodsThis study included 15 children aged 11-16 who required weight-bearing rehabilitation following lower limb surgery. A mixed methods (quantitative and qualitative) approach and a multidirectional perspective (patients, parents and physiotherapists) were adopted to measure. Changes in anxiety (General Anxiety Disorder-7) and pain (visual analogue scale) before and after the intervention were assessed. Qualitative data were collected through interviews with children, their parents, and physiotherapists, focusing on their experiences, satisfaction, perceived effectiveness, and acceptability of the IVR intervention.ResultsResults demonstrated that IVR for rehabilitation after lower limb surgery in children (1) reduced anticipatory anxiety; (2) reduced the level of pain experienced during gait rehabilitation; (3) improved rehabilitation, such that children were walking more than expected and with better quality; (4) increased confidence; (5) made rehabilitation more enjoyable; and (6) was delivered via a system that was easy to learn and accept.ConclusionThis rehabilitation IVR is the first product of its class for paediatric lower limb postoperative rehabilitation. These preliminary results will inform improvements to the system in a future multi-site study with a large calculated sample size to demonstrate its clinical effectiveness and safety in acquiring medical device markings and adoption.

PurposeRocking in a rocking chair may facilitate trunk muscle activation in children with spinal cord injury (SCI). To assess this, children with SCI and typically developing (TD) children were evaluated for increases in trunk muscle activation, muscle activation patterns, and correlation of trunk muscle activation with trunk control during rocking.MethodsEleven children with SCI and 10 TD children aged 1-12 years rocked while surface electromyography activity in arm, leg, and trunk muscles was captured. Mean muscle activity during rocking and at baseline were compared for each muscle. Temporal activation patterns of SCI and TD groups were compared using cluster analysis. Correlation of trunk control and trunk muscle activation was assessed.ResultsSignificantly higher muscle activity was found during rocking versus quiet sitting for each muscle (p < 0.05). Cluster analysis of temporal muscle activation patterns revealed two disparate SCI groups; one SCI group's muscle activation timing was similar to the TD group. Correlation analysis indicated greater trunk muscle activation in lower trunk muscles for participants with better trunk control.ConclusionRocking activates the neuromuscular system and is feasible for children with trunk impairment due to SCI, suggesting its potential as a home-based activity for extending practice beyond the clinic.

PurposeThis retrospective cohort study sought to examine participant skill and functional progression in an adaptive snow sports program for children and young adults with disabilities.MethodsOne hundred twelve individuals, majority male, who participated in at least 2 adapted ski or snowboard sessions were evaluated by trained adaptive instructors. The primary outcome measure was standardized skill level ranging from 1-novice to 9-expert. Secondary outcome measures of cognitive, emotional, social, physical, and independence scores, were rated on a scale from 1-5, with 5 being the highest.ResultsThe median number of sessions per participant was 4 (range 2-65 sessions) and median participation duration was 2 years (range 2-10 years). A Wilcoxon-rank sum test demonstrated an improvement in final skill level compared to baseline (p < 0.0001), with an average increase of 1.2 skill levels per participant and an average increase of 0.48 skill levels per year of involvement. There were also improvements from initial session to final session in all secondary outcomes: social (p = 0.002), emotional (p = 0.018), physical (p < 0.0001), and independence (p < 0.0001) scores.ConclusionOverall, there were improvements in all measured domains. This uses objective and functional measures to validate ongoing engagement with this adaptive skiing program at the athlete, volunteer, and organizational levels.

Purpose: Quantitative muscle ultrasound (QMUS) is potentially valuable as a diagnostic tool in central neurological disorders, as it provides information about changes in muscle architecture. This study aimed to investigate whether ultrasound images of the submental and masticatory muscles in children with spastic cerebral palsy (CP) differ from those obtained in a reference group, and whether observed ultrasound abnormalities differ between subgroups of children with different Eating and Drinking Ability Classification System (EDACS) levels to support its construct validity.

Methods: A prospective cohort study was conducted in 25 children with spastic CP aged 3-18 years. QMUS of selected muscles was performed. Muscle thickness and echogenicity in the CP group were compared to previously collected reference values, and between different EDACS levels within the CP group.

Results: Median echogenicity of all muscles was significantly higher in children with CP than in healthy controls. The temporalis muscle was significantly thinner in the CP group. There were no differences in muscle thickness or echogenicity between EDACS levels.

Conclusion: QMUS is able to detect abnormal architecture of submental and masticatory muscles in children with spastic CP, but the interpretation of abnormalities in relation to the severity of mastication and swallowing problems needs further investigation.

PurposeThis study aimed to (1) examine the construct validity of the Zorowitz spasticity patient-reported outcome (PRO) scale in pediatric populations and (2) examine the scale's responsiveness to change in children to determine its clinical utility in guiding treatment of pediatric spasticity.MethodsRetrospective analysis of data collected at a large academic pediatric hospital system, including 505 patients who received injections for spasticity from pediatric physiatrists, was performed. Zorowitz scores, spasticity (Modified Ashworth Scale) scores, and Gross Motor Function Classification System levels were extracted.ResultsBaseline Zorowitz score (median 19, interquartile range 13-25) was not related to functional level (r = -0.088, p = 0.20) nor muscle tone (r = 0.006, p = 0.95), but patients with follow-up data reported reduced impact of spasticity post-injection (p < 0.0001). Higher baseline Zorowitz score was related to a greater decrease in Zorowitz score after injection (r = -0.39, p < 0.00001). Injection location, sex, number of muscles injected, and botulinum toxin dose were not related to Zorowitz change score.ConclusionThe Zorowitz scale may be responsive to spasticity treatment in children. However, construct validity to existing clinical measures was not observed, suggesting either that a clinical gold standard does not exist, that the scale measures a construct not otherwise captured clinically, or that it has limited validity in children.

PURPOSEA case report of a six-year and five-month-old female admitted with typical symptoms of Rubinstein-Taybi syndrome is presented. Clinical and rehabilitation settings where she acquired her reading, writing, and communication skills are described.METHODSBecause of her cognitive disabilities, a multidisciplinary and long-term intervention (2014-2020) was necessary. Treatment included orthoptic, psychomotor, logopedic, occupational, and neuropsychological care. Her family and school were involved.RESULTSIncreased attention led to decreased dysfunctional behaviors. Test results are still below average, but there has been significant improvement. Better communication skills resulted from increased phonetic range, improved articulation, lexical-semantic structure, comprehension, and production of sentences. Digital technologies played a significant role in enhancing her communication skills, not just in social interactions but also in school activities. The patient is oriented in time and space with the help of agendas and calendars. She can express her needs and compose concise narratives. As a result of acquiring functional skills, she is better equipped to handle real-life situations, which has led to increased social and family activities.CONCLUSIONThis case report highlights the importance of personalized rehabilitation programs. Obtaining an early genetic diagnosis is crucial for timely tailored rehabilitation, and any delays in this process can hinder progress.