Journal of pediatric rehabilitation medicine最新文献

PurposeUnderstanding the level of fatigue experienced by adolescents and adults with cerebral palsy (CP) in low- and middle-income countries is crucial, as it can inform healthcare workers in the assessment, prevention, and management of fatigue for these individuals, similar to the approach taken in high-income countries. This study aimed to determine self-perceived fatigue and the level of accomplishments and satisfaction of activities and participation in daily life in adolescents and adults with CP compared with typically developing (TD) peers living in urban South Africa. The study also examined whether the outcome measures were associated within the CP cohort.MethodsThis case-control study included 31 adolescents and 30 adults with CP and TD peers matched for age, sex, and socio-economic status. Participants completed the Fatigue Severity Scale and Life-Habits Questionnaire.ResultsSelf-perceived fatigue was reported in 14/31 adolescents with CP, 6/31 TD adolescents, 9/30 adults with CP, and 8/30 TD peers. No differences in fatigue were observed between adults or adolescents with CP and TD peers. However, accomplishment and satisfaction scores were lower for adolescents (p < 0.001 and p = 0.016, respectively) and adults with CP (both p < 0.001) compared to TD peers.ConclusionsIndividuals with CP living in urban South Africa reported similar levels of fatigue as TD peers. Despite limitations in accomplishing life habits, adolescents and adults with CP reported to be independent in their daily activities and satisfied with their community participation, which was unrelated to fatigue.

PurposeTo explore convergent validity of the Physical and Neurological Examination of Subtle Signs Gaits and Stations completion scores (PANESS G/S) with Bruininks-Oseretsky Test of Motor Proficiency, Second Edition balance score - (BOT-2) and Activities-specific Balance Confidence Scale - (ABC) in typically developing youth with and without a history of concussion.MethodCross-sectional data obtained from 79 youth (32 with history of concussion) aged 10-17 years. First, between-group differences in balance measures were explored. Then, correlations were explored between demographic variables and balance measures to identify control variables for subsequent correlations between balance measures.ResultsGiven no between-group differences on PANESS G/S, BOT-2, or ABC, correlations were examined across all participants. PANESS G/S was correlated with age. BOT-2 balance score was correlated with Full Scale Intelligence Quotient (FSIQ). Controlling for age and FSIQ, PANESS G/S was associated with better BOT-2 performance. PANESS G/S and ABC were not correlated.ConclusionThis work adds to the literature characterizing the use of PANESS in adolescents, including those post-mTBI. Correlation between PANESS G/S and BOT-2 balance supports overlapping constructs. Lack of PANESS G/S correlation with ABC may reflect the lack of balance concerns in generally healthy youth and known discordance between performance and self-report measures.

PurposeLower extremity spasticity can cause pain and limit function. This study examined the safety and efficacy of hyperselective neurectomy (HSN) of the gastrocnemius-soleus complex (GSC) in addressing spastic equinus deformities in pediatric patients.MethodsPediatric patients that underwent HSN of the GSC by a single surgeon were retrospectively reviewed. Preoperative and postoperative Modified Ashworth Score and passive ankle dorsiflexion (°) were compared using Wilcoxon signed-rank test and Student's paired two-tailed t-test, respectively.ResultsTen lower extremities in seven patients with a mean age of 10 years were reviewed. Mean follow-up was 15 months. All extremities demonstrated improvement in spasticity. All exhibited improved passive ankle dorsiflexion range of motion with the knee in extension (mean change +17°, SD = 8°, p = 0.000). Five patients demonstrated improved passive dorsiflexion with the knee in flexion while two remained unchanged from preoperative assessment (mean change +13°, SD = 9°, p = 0.002). One complication, wound dehiscence, was noted and managed conservatively. No patients reported loss of strength or sensation. Four patients underwent subsequent staged surgery on the ipsilateral extremity for concomitant contractures.ConclusionHSN of the GSC is safe in pediatric patients and effectively reduces spastic equinus deformity and improves ankle passive dorsiflexion in short-term follow-up.

Purpose: In Argentina, there is no consensus on the functional assessment of children with cerebral palsy (CP). The International Classification of Functioning, Disability and Health (ICF) Core Sets for children with CP are tools that standardize clinical functional assessments. The aim was to build functioning profiles of children with CP aged 2 to 18 years in eight Argentine cities, to identify their functional needs and contribute to improving assessment processes.

Methods: Cross-sectional study, developed in stages. This article describes the last stage, the creation of the functional profile of a sample surveyed in eight cities. Twenty-five categories established in the common abbreviated core set of CP were evaluated through the application of a protocol called PC-CIFuncional (previously created). This protocol consists of scales or culturally sensitive instruments, assessed through clinical evaluations and questionnaires for children and families.

Results: One hundred thirty-three functioning profiles were built using the previously developed PC-CIFuncional protocol. Of the participants, 52.7% had severe motor compromise with Gross Motor Function Classification System (GMFCS) levels IV and V. In children at GMFCS level IV-V, most categories in activities and participation-including recreation, communication and physical activity-showed severe limitations and restrictions, compared with their peers. The use of technology for daily living and mobility in children with less motor compromise (GMFCS level I-III) was neither a facilitator nor a barrier, but in children with greater compromise it was a complete facilitator.

Conclusions: Differences in functional needs were identified in children with CP according to motor involvement. This project standardizes the identification of functional needs and therapeutic goals based on ICF language, creating novel functioning profiles in Argentina.

PurposeThis study aimed to explore therapists' experiences of providing early intervention therapy services for infants with or at risk of cerebral palsy (CP), and, in particular, therapy services that promote infants' hand function.MethodsEleven semi-structured small group interviews and one individual interview were conducted with 26 therapists working with infants, either in hospital or in the municipality. Interview transcripts were analyzed using qualitative content analysis.ResultsProviding early intervention therapy services for infants with or at risk of CP was influenced by factors such as inadequate coordination and communication between hospital and municipalities, varying use of motor assessment tools to detect risk of CP, more focus on gross motor function than hand function in early age, impact of usual clinical practice, requirements for acting in a variable therapeutic role when providing guidance for parents, and challenges obtaining therapeutic training and specialization in a decentralized organization.ConclusionChallenges caused by a complex practice and a high level of requirement for therapeutic skill may have an impact on evidence-based practice and need to be addressed when incorporating new research knowledge about early CP-specific interventions into a family-centered clinical practice.

PurposeThis study aimed to understand and describe the rehabilitation and care complexity needs of adults with cerebral palsy (CP) receiving care in a pediatric healthcare setting.MethodsThis was an exploratory sequential mixed-methods study. Qualitative data included 20 semi-structured interviews with adults with CP and caregivers. Quantitative data included electronic health record data from adults with CP who were active pediatric rehabilitation medicine (PRM) patients over a two-year period at a pediatric health system (N = 280). Results from analyses were mixed and merged through narrative and joint display approaches.ResultsThree qualitative themes were identified: 1) Wide range of equipment and orthotic needs that change over time; 2) Various roles of therapies in adulthood; and 3) High levels of rehabilitation and subspecialty care utilization. Quantitatively, n = 150 (53.8%) had equipment prescription(s), n = 79 (28.2%) had orthotic prescription(s), and n = 162 (57.9%) were actively engaged in at least one type of therapy. Participants cumulatively saw over 30 types of specialists. Only n = 21 (7.7%) had documented transition efforts during their PRM visits.ConclusionWhile the rehabilitation needs of individuals with CP evolve over time, adults with CP have high rehabilitation and overall healthcare utilization needs. This can complicate the transition to adult-based care and underscores the importance of comprehensive and longitudinal transition processes.

Purpose: This study aimed to highlight the structural and functional musculoskeletal changes and associated treatment strategies in paediatric patients with spinal cord disorders (SCD).

Methods: A systematic scoping review was conducted whereby PubMed, Excerpta Medica Database and MEDLINE Ovid databases, and grey literature were searched for articles published between January 2000 and June 2024. Study criteria included at least 50% of participant cohort being children aged under 18 years at time of SCD diagnosis, investigating the musculoskeletal effects of SCD in children, and related management or interventional strategies. Reports in which paediatric or SCD participants were less than 50% of the cohort were included if results were appropriately stratified. Included reports underwent descriptive analysis.

Results: Forty-five reports were eligible for inclusion. Physiological Parameters, Musculoskeletal Complications, and Interventions were the main themes identified. It was observed that musculoskeletal changes following SCD can differ in children compared to their adult-injured counterparts, but the mechanisms underlying these differences are not known. Intervention studies that have been performed are important, but underpowered, and cannot yet be translated into routine care.

Conclusion: Monitoring and treatment guidelines for musculoskeletal health in this population are scarce. Comprehensive research efforts are required to facilitate guideline development, which will be imperative in improving musculoskeletal outcomes following paediatric SCD.

Spina bifida (SB) is a broad term encompassing several subgroups of neural tube defects including myelomeningocele, meningocele, and lipomyelomeningocele. Myelomeningocele is the most common form of open SB, accounting for approximately 80% of all SB. For a significant subpopulation of historically underserved individuals, precursors to poor condition-specific outcomes may be best conceptualized through a "three-hit" model. Whereas the first two "hits" are experienced prenatally (i.e., neural tube lesion and its environmental exposure to amniotic fluid), the third "hit" may involve combinations of additional genetic and/or ecological exposures, such as unfavorable social drivers of health. Promisingly, life expectancy for people living with SB has improved significantly due to continued development in medical technology. However, there are also notable differences in the health systems that take care of children when compared to adults, and many individuals struggle with this transition. In response, The Spina Bifida Association's Guidelines for the Care of People with Spina Bifida outlined how to support independence and access to adult-centered care. As the care for SB has evolved over the years, so has the Journal of Pediatric Rehabilitation Medicine (JPRM). The journal has developed new formats to showcase current clinical and innovative practice, advocacy, and research. To this end, the journal has established both collections and tracks to best organize publications. JPRM's collection on SB care has recently included a broad array of works conducted and written by a diverse number of professionals - from surgeons to public health advocates - from numerous institutions across the globe. Thus, from fetal surgery to adult medicine, the investigational journey of SB traverses many fields, technologies, and service models; yet a constant remains - the crucial need for a patient-centered evidence-based care philosophy in the midst of adverse social drivers and an aging population facing many challenges. Opportunely, through a new format of collections, JPRM is poised to continue to be a resource for the global community of clinicians, advocates, and investigators caring for individuals with SB across the lifespan.

PurposeThis study aimed to test a robotic supine gait training (RSGT) device's safety when treating children and adolescents with a variety of diagnoses, to ensure their safety and the standardization of clinical practices.MethodsThis retrospective observational study included 280 patients who underwent one or more treatment sessions with a RSGT device (DPA Med^®) at the Nantes Regional Children's and Adolescent Health Care Center. These patients' medical files, indexed in the digital medical file manager program, were examined in search of evidence of adverse events presumably associated with the treatment. The search also included when the adverse events took place, their severity, the required treatment, and the clinical outcomes.ResultsFrom January 2, 2019, to June 1, 2021 (a 2.5-year period), no adverse events were logged, presumed, or definitively linked to the treatment, for any of the 280 patients included in this study (100% of the sample). Patients underwent an average of 5.71 (standard deviation = 7.06) treatment sessions, for a total of 1598 sessions during that period.ConclusionNo adverse events linked to RSGT were registered for the children and adolescents treated with the device in this preliminary study.