Journal of pediatric rehabilitation medicine最新文献

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.

PurposeThe Glasgow Coma Scale (GCS) is the gold standard in assessing severity for traumatic brain injury (TBI). This study aimed to compare GCS-rated severity to caregiver-perceived severity. Researchers assessed levels of agreement and explored which factors explained any differences and predicted whether a GCS score was provided.MethodsCaregiver-perceived severity, demographic, and medical information was collected via electronic survey from 107 youth with TBI. GCS-rated severity was collected via medical-chart review.ResultsThe strength of agreement fluctuated by severity (mild/concussion k = 0.60, moderate k = 0.1, severe k = 0.64). Caregiver perceptions were more severe in 62% of cases. No medical or demographic variables explained discrepancies. GCS was documented in 38% of medical records. Binomial regression modeling found that participants seen in the emergency department were most likely to receive a GCS rating.ConclusionResults suggest that caregivers may be reliable evaluators of their child's TBI severity, particularly for those classified as mild or severe injuries with GCS ratings. Allowing caregiver-perceived severity ratings could increase inclusivity in research, so participation is not limited to children who go to the emergency department. More research is needed to determine if caregiver-perceived severity tracks with long-term outcomes or if caregivers base severity ratings on factors outside of the initial injury event.

Purpose: In 2022, the American Board of Physical Medicine and Rehabilitation (ABPMR) contracted with Professional Services Industries LLC to complete a Pediatric Rehabilitation Medicine (PRM) practice analysis. The goal was to develop an updated examination content outline that accurately depicts the knowledge and skills expected for a competent PRM physician following completion of training. The purpose of this paper is to describe the process of practice analysis and to present candidate perceptions of scope of practice and relevancy of content from the first two examinations in which the new outline was applied.

Methods: The practice analysis process was undertaken in four distinct stages: subject matter expert meetings to determine the tasks and knowledge areas; the development, issuance and analysis of a national survey; development of exam specifications; and results verification. Results were analyzed by a psychometrician and team to determine mean relative importance of task and knowledge items. A new outline was then created and used for the administration of the 2023 and 2024 ABPMR PRM Certification Examinations.

Results: All active board certified PRM physicians identified were sent surveys via e-mail. One hundred ninety six (61.1%) respondents completed the survey. The top five task statements in order of perceived importance were performing history and physical examinations, managing muscle and tone abnormalities, prescribing orthoses and equipment, prescribing therapy services, and making appropriate specialty care referrals. The top five knowledge statements in order of perceived importance were cerebral palsy, spinal cord injury, abnormal growth and development, neuromuscular disorders, and musculoskeletal conditions. The new PRM Examination content outline created included six domains and 22 subdomains of knowledge content areas. A higher percentage of initial certification candidates sitting for the 2023 and 2024 ABPMR PRM Certification Examinations selected "Strongly Agree" or "Agree" when responding to the examination content reflecting both scope of training and relevancy.

Conclusion: A practice analysis process was undertaken resulting in a new content outline for the ABPMR PRM Certification Examination. Following the implementation of the new content outline, initial certification candidate survey responses showed improved favorability regarding content reflecting scope of training and relevancy.

PurposeThis study examined hospital and emergency department (ED) experiences of adults with spina bifida (SB), medical traumatic stress (MTS) and participant characteristics including anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and resiliency scores.MethodsAdults with SB who had a hospital or ED encounter within the last five years were recruited from a medical home clinic and completed a structured interview and validated questionnaires. Narrative inquiry was used and descriptive analyses were conducted. MTS scores were reported per participant characteristics and emotional health questionnaire score counts and percentages.ResultsTwenty-five adults with SB representing 37% of eligible patients were recruited. Most participants were positive for at least one MTS symptom cluster. There was an increased number of MTS symptom clusters for participants with higher depression, anxiety, and PTSD scores, and decreased MTS symptom clusters for those with increased resilience. The narrative analysis yielded three distinct themes: a negative hospital environment, SB-related condition concerns and complications, and positive support when in the hospital.ConclusionFurther research with a larger study population is necessary to examine the extent to which MTS is present in individuals with SB of all ages, to understand how MTS symptoms may change with age and experience, and to identify risk and protective factors for emotional health in the presence of MTS. However, this study identified opportunities for improving healthcare experiences for this patient population, including facilitating communication, promoting self-advocacy, self-efficacy, resilience, and familial support which can be implemented for all age groups.

PurposeThe purpose of this study was to quantify quality of life (QOL), workplace bullying, discrimination and harassment among pediatric physiatrists.MethodsPediatric physiatrists (N = 389) were invited to participate in an online survey. Demographic data were collected as were the World Health Organization Quality of Life assessment (WHOQOL-BREF), the Negative Acts Questionnaire Revised (NAQ-22), and an adapted version of the Chronic Work Discrimination and Harassment Scale (aCWDHS). Means and standard deviations, one-sided t-tests, chi-squared and ANOVA tests were calculated with the p-value set a priori at 0.05.ResultsThe average WHOQOL-BREF score was 76.49/100. Seventeen percent of pediatric physiatrists met the threshold score of 33 for being bullied at least occasionally. The average score on the aCWDHS was 49.31. Disabled pediatric physiatrists reported statistically lower QOL scores (t = 2.356, p = .010), more workplace discrimination and harassment (t = 2.502, p = .010), and more workplace bullying (t = 2.139, p = .022). Low QOL scores were correlated with the scores on the aCWDHS and NAQ-22.ConclusionAddressing workplace bullying, discrimination, and harassment could potentially improve the QOL of pediatric physiatrists, especially those with disabilities who report a disproportionate amount of mistreatment.

For almost all Americans, having affordable access to quality health care in the United States requires health insurance. Inadequate insurance is more common among children with disabilities and complex health conditions than other children. For children, insurance is considered adequate if the benefits must usually or always meet the child's needs and usually or always allow the child to see needed providers and the family reports no out-of-pocket expenses or out-of-pocket expenses deemed usually or always reasonable. After the CEO of UnitedHealthcare was killed in front of a Manhattan hotel on his way to his annual investor conference in December 2024, there was an outpouring of stories on social media about how people felt their loved ones were harmed by health insurance companies denying care that their doctors recommended. While murder as a form of vigilante justice should not be condoned, this event highlighted how angry Americans are at health insurance companies. Pediatric rehabilitation medicine physicians are no strangers to the frustrations of insurance denials for their patients and feel the strain of having to work through prior authorizations and peer-to-peers just to get their patients what they deem important for their health and functioning. The national data confirms what pediatric rehabilitation medicine physicians knew from collective experience - millions of children with more complex health care needs have inadequate insurance.

PurposeThe growing interest among children in digital play provides new rehabilitation opportunities in hospital settings. There are, however, no published reviews on digital play interventions for the functional rehabilitation of children and adolescents across diagnoses and outcomes in hospital and rehabilitation settings. This scoping review aimed to identify and map the characteristics of digital play for functional rehabilitation in hospital and rehabilitation settings for children and adolescents to inform researchers and clinicians.MethodsStudies including participants aged ≤18 years investigating digital play and functional rehabilitation in hospital and rehabilitation settings were included. Reviews, text and opinion papers, conference papers, case studies, and studies with fewer than five participants were excluded. Five scientific databases were searched. The final search was conducted in October 2022. Four authors performed the study selection and data extraction.ResultsOf 13,663 references, 90 studies met the inclusion criteria. Digital play for rehabilitation was used in clinical settings, including hospitals, outpatient departments, and rehabilitation centres. Some interventions were conducted in human movement laboratories or at home. The relevant studies involved a wide range of disease categories, primarily neurological. A conceptual framework comprising five categories for gaming technologies utilizing digital play and rehabilitation was proposed: (1) traditional gaming platforms, (2) extended reality, (3) robotics and assistive technology, (4) sensors, and (5) rehabilitation systems. One hundred eighty different outcome measures used to evaluate the interventions were identified, almost one-third of which were unvalidated. The studies generally failed to report limitations and barriers to implementation.ConclusionThis scoping review gives a practical overview to assist and inspire healthcare professionals and researchers in digital play and rehabilitation, elucidating technology for rehabilitation within specific clinical contexts. In addition, this scoping review facilitates the exploration of implementation prospects associated with various technologies. Digital play and rehabilitation are primarily initiated in outpatient departments targeting children with neurological diseases. Future studies should investigate the potential of using digital play for the early rehabilitation of hospitalized children with various diseases.