Journal of pediatric rehabilitation medicine最新文献

PurposeDespite knowing that adolescents with disabilities face substantial barriers transitioning from pediatric to adult health care, little is known about how pediatricians experience transition-related tasks for their patients with disabilities.MethodsThe 2023 American Academy of Pediatrics (AAP) Periodic Survey utilized a cross-sectional random sample of post-trainee, non-retired, US-based AAP members to derive a nationally representative sample. Several questions related to transition services were compared. Data were weighted for non-response bias. Only AAP staff conducting the statistics had access to the non-anonymized data.ResultsOver half of the pediatricians reported discussing consent for care (56.3%), assisting with referrals to adult care (56.5%) and providing anticipatory guidance about sexual health and development (52.7%) to most or all adolescents with disabilities. In addition, 22.7% reported providing all four transition services to most or all of their adolescent patients with disabilities. A majority identified barriers that impeded successful transition of their patients with disabilities.ConclusionWhile many pediatricians engaged in a variety of transition-related activities for their adolescent patients with disabilities, they also identified numerous barriers. These findings underscore the importance of addressing both the practice and system level barriers that limit pediatricians' abilities to provide transition services for their patients with disabilities.

BackgroundChallenges in accessing comprehensive sexual and reproductive health (SRH) information and care leave many individuals with spina bifida (SB) vulnerable to unmet SRH needs, risking unfulfilling sexual experiences and increasing susceptibility to coercion and abuse. Accurate tools are essential to measure SRH knowledge and self-efficacy in adults with SB.ObjectiveThis study aimed to evaluate the internal consistency and construct validity of domains of a newly developed survey that assesses SRH knowledge and self-efficacy in partner and provider discussions among adults with SB.MethodsThe SRH survey, recently validated for content, was distributed via REDCap with support from the National Spina Bifida Association (SBA) through social media, including SBA's Facebook, and the Adult Advisory Committee. Responses were de-identified, and each participant received a unique survey ID. Internal consistency of the self-efficacy subscales was assessed using Cronbach's alpha and Kuder-Richardson Formula 20 (KR-20) was used for the knowledge scale. Principal component analysis (PCA) evaluated scale structures. Analyses were conducted using SPSS.ResultsNinety participants completed the SRH survey. Most respondents were female (75.5%). Participants' ages ranged from 18 to 77 years (mean = 40.47, SD = 12.897) and 85.6% identified as non-Hispanic White. Both the self-efficacy scale for partner discussions (α = 0.914, five items) and provider communication (α = 0.958, eight items) had excellent internal consistency. PCA supported construct validity, with a single-factor structure explaining 75.3% of variance for partner communication and 78.0% for provider communication, indicating that each set of items measures a cohesive underlying construct of self-efficacy within its respective communication domain. KR-20 indicated low internal consistency for the SRH knowledge scale (KR-20 = 0.426, 11 items), likely due to limited response variability.ConclusionThe SRH self-efficacy scales for partner and provider communication demonstrated excellent internal consistency (reliability) and construct validity among adults with SB. In contrast, limited variability in knowledge responses suggests that the current knowledge scale may require refinement to better capture differences in SRH knowledge across individuals.

PurposeThis study aimed to assess the acute effects of hippotherapy performed on different seating surfaces on sitting balance and walking speed in children with special needs.Materials and MethodsChildren aged 3-18 years with special needs were included. Participants were assigned to three groups: Group 1 (Saddle), Group 2 (No saddle, direct horse contact), and Group 3 (Saddle with additional texture material). Each group received a 30-min hippotherapy session in a riding arena. Sitting balance was measured with the BeCure balance system, and walking speed was assessed using the 10-meter walk test before and immediately after the session.ResultsNo significant improvement was found in sitting balance in any group after the intervention. However, Group 3 showed increased walking speed compared to Groups 1 and 2. Intergroup comparisons showed no statistically significant differences in sitting balance or walking speed.ConclusionDifferent texture materials used on saddles may provide more noticeable acute effects in hippotherapy. Future research should involve larger sample sizes and explore subacute and long-term outcomes.

PurposeThis study aimed to explore the feasibility and user experience of Grasp, a novel digital tool designed to register coping experiences during paediatric rehabilitation, and to examine perceived impact on reflection and sense of mastery.MethodsChildren and adolescents aged 8-16 years, their parents, and healthcare professionals in paediatric rehabilitation participated. Those participating were instructed to squeeze Grasp when experiencing mastery or coping during activities. Data were visualised and discussed during the end-of-stay summary meeting. A multi-method design was applied, integrating data logs, questionnaires, and semi-structured interviews to capture measurable indicators and in-depth perspectives.ResultsTwenty-three children and adolescents with parents and healthcare professionals were included. Recruitment rate was 100% and retention 96%. All participants used the device and software (median registrations 19, range 4-80). The majority found Grasp easy to use (71%), enjoyable (61%), and motivating (89%). Healthcare professionals reported that data provided valuable insights into children's coping experiences. Interviews identified two main themes: (a) coping registration with Grasp was feasible, and (b) Grasp seemed to facilitate self-efficacy and reflection.ConclusionRegistering coping experiences through Grasp was feasible and well-received in paediatric rehabilitation. For some, it appeared to strengthen reflection and sense of mastery, potentially enhancing self-efficacy.

Objective: The aim of this study was to investigate the effects of manual diaphragmatic relaxation combined with diaphragmatic breathing on respiratory muscle strength, pulmonary function, chest expansion, and sitting ability in children with diplegic cerebral palsy (CP).

Materials and methods: This randomized controlled study was conducted with 15 children with diplegic CP aged 5-15 years. Participants were randomly divided into two groups (control and intervention); both groups received conventional physiotherapy two days a week (45 minutes) for eight weeks. The intervention group additionally received manual diaphragm relaxation and diaphragmatic breathing exercises. The primary outcome was respiratory muscle strength (maximum inspiratory pressure and maximum respiratory pressure. Secondary outcomes were pulmonary function test (PFT), chest expansion and sitting dimension of the Gross Motor Functional Measurement (GMFM-B). (NCT05559346)Results:After eight weeks of intervention, the intervention group showed improvement in respiratory muscle strength, chest mobility, and GMFM-B score (p < 0.05). Respiratory muscle strength was significantly higher in the intervention group than in the control group (p < 0.05), but PFT parameters and GMFM-B scores were not significantly different between the two groups (p > 0.05)Conclusion:Adding manual diaphragmatic relaxation and diaphragmatic breathing exercises to the physiotherapy program in children with CP may contribute to the rehabilitation program.

PurposeMost children hospitalized with traumatic brain injury (TBI) acquire new impairments that impact function and health-related quality of life. However, there is a lack of standardized, multidisciplinary, longitudinal rehabilitative services for children with TBI.MethodsThis single center, retrospective study evaluated rehabilitative services during acute hospitalization and identified the frequency of unmet needs, defined as new or untreated impairments at the first acquired brain injury (ABI) clinic visit.ResultsAnalysis was conducted for 148 children hospitalized for TBI (mild/complicated mild [51%], moderate [14%], or severe [35%]) and evaluated at ABI clinic (median of 63 [43-122] days post-hospitalization). Eighty-two (55%) patients had at least one unmet need at initial clinic assessment. Executive function impairments were found in children with mild/complicated mild TBI (32%), despite only 5% of them receiving speech therapy (ST) prior to the clinic. Only 13% of children with severe TBI received outpatient ST at first clinic visit despite 26% and 20% identified as having executive function and communication impairments. Earlier consultation of physical therapy, occupational therapy, ST, and physiatry was associated with discharge home versus inpatient rehabilitation, all p < .05.ConclusionThis study demonstrates the importance of timely inpatient acute hospital rehabilitative care coordinated with longitudinal, multidisciplinary follow-up for children after TBI.

Purpose: Acquired brain injury (ABI) is prevalent among young people (4-25 years). When ABI-related problems persist, treatment in a rehabilitation center (RC) may be indicated. However, there is wide variability regarding the delivery of care across Dutch RCs, including assessments, interventions, and psychoeducational (PE) materials. The aim was to create a consensus-based framework with preferred assessments, interventions, and PE-materials to be used in pediatric ABI rehabilitation. A national framework could optimize the delivery of comparable care for this population.

Methods: For this three-round Delphi study, healthcare professionals (physiatrists, psychologists, social workers, physical/occupational/speech/language therapists) from RCs providing care for young people with ABI were invited to participate. In the first two (online) rounds, currently used assessments/interventions/PE-materials were collected, stepwise-prioritized, subsequently listed per discipline, and classified per International Classification of Functioning (ICF) domain. Results from rounds one/two were discussed in a consensus meeting (in person), aiming to reach agreement on assessments/interventions/PE-materials in the national framework and how to use them in current practice.

Results: Seventy-four healthcare professionals from 12 RCs participated. After Delphi round one, 163 assessments, 39 interventions, and 64 PE-materials were collected. After round two, the selection was narrowed down to n = 51/n = 34/n = 28, respectively. After round three, consensus was reached on 37 assessments, 25 interventions (divided over all disciplines/classified per ICF domain), 27 PE-materials, as well as on the use of the framework by all participating RC to enhance clinical reasoning in current practice.

Conclusion: A consensus-based national framework in ABI rehabilitation has been developed and is now available to optimize the delivery of care for young people with ABI across Dutch RCs.

PurposeThe purpose of this matched cohort study was to determine the impact of intensive, multidisciplinary neurorehabilitation on functional independence following pediatric acquired brain injury.MethodsCohorts receiving lower-intensity (n = 19) and higher-intensity multidisciplinary neurorehabilitation (n = 19) were matched on age, injury characteristics, and admission functional status. Intensity was measured by time in physical, occupational (OT), and speech therapy over length of stay (LOS). Outcome measures included WeeFIM efficiency, WeeFIM developmental functional quotients (DFQs), and LOS.ResultsThere were no significant between-cohort findings in 1) WeeFIM efficiency, 2) WeeFIM DFQs or 3) LOS. There was a significant difference between admission and discharge WeeFIM DFQs for all participants (p < 0.001), demonstrating significant functional recovery regardless of intensity. Hierarchical linear regressions were significant for OT intensity and discharge WeeFIM DFQs (p = .003, ΔR² = .22). Total admission WeeFIM DFQs significantly predicted LOS in the lower-intensity (p = 0.016, R² = 0.29) and higher-intensity (p < 0.001, R² = 0.51) cohorts, indicating a greater variance explained with increased intensity.ConclusionWhile significant functional outcomes were not correlated with intensity, OT intensity did significantly predict variations in functional independence. Investigation into definitive parameters for intensive treatment, including the amount and context of therapeutic interventions, is needed.

Children with severe traumatic brain injury (TBI) experience medical complications including paroxysmal sympathetic hyperactivity, disorders of consciousness, mood disruption, agitation, and upper motor neuron syndrome. This review article examines the pharmacologic agents used in management of complications of pediatric TBI and the evidence supporting the use of these medications. Much of the literature to support medications used in pediatric TBI comes from adult literature; therefore, more research is needed to examine the impact of these agents in pediatric patients.