Journal of pediatric rehabilitation medicine最新文献

PurposeChildren with disabilities benefit from physical, occupational, and speech therapy, but families identify unmet needs for these services. The purpose of this study was to audit access to therapy services in a tri-state region. It was hypothesized that children who were publicly insured and children from minoritized identity groups would face greater access barriers and longer wait times than children covered by private insurance and non-minoritized White children.MethodsThis prospective audit study utilized callers who posed as mothers seeking outpatient therapy services for their child. Access difficulties were identified based on the number of phone calls required to obtain an appointment or determine if services would be obtained at all, as well as the number of days to the earliest available appointment.ResultsTherapy appointment access was a problem for 47.4% of simulated families. After 251 phone calls, 91 simulated families were able to schedule appointments in 76 clinics. Black and Hispanic simulated families had a harder time getting appointments, but days to appointment did not differ by telegraphed minoritized identity (F(3,88) = 1.474, p = .227).ConclusionSimulated families experienced substantial barriers to arranging therapy appointments with Black and Hispanic families experiencing more barriers than their White and Muslim peers.

PurposeLimited data are available on the cardiorespiratory and muscle fitness of children with acute lymphoblastic leukemia (ALL) during chemotherapy. This pilot study evaluated the safety of testing the cardiorespiratory and muscle fitness of two children with ALL at different risk levels in early chem treatment.MethodsTwo girls with low- and high-risk B-cell ALL (DFCI-16-001) took part in two test sessions: T1 (induction, consolidation 1A/C) and T2 (consolidation 2). Each testing session included a maximal oxygen uptake ($\dot{V}$O₂max) exercise test, muscular strength tests, physical activity and quality of life questionnaires, and a semi-structured interview. The parents agreed to these assessments at the start of chemotherapy treatment.ResultsThe participants experienced no significant adverse effects from undertaking the cardiorespiratory and muscular tests, and there was no impact on their chemotherapy treatment schedule. At their post-test interview, both participants reported that thigh pain and fatigue were the most difficult part of the $\dot{V}$O₂max exercise test. Regarding physical performance outcomes, both participants exhibited low scores compared to their gender, weight- and age-predicted $\dot{V}$O₂max and on most strength test values.ConclusionThe physical tests were safely and successfully conducted with these two participants during early chemotherapy.

PurposeTwenty percent of childhood cancer survivors experience physical function impairments, and ∼75% develop a chronic health condition. Physical and occupational therapists (PT/OTs) can mitigate these late effects, yet few children receive cancer rehabilitation (CR). This research aimed to identify provider attitudes and perspectives towards CR services for children across inpatient and outpatient settings at a cancer center.MethodsThree cardiac rehabilitation instruments were adapted to evaluate knowledge, attitudes, and perceptions regarding CR delivery. Descriptive statistics were used to summarize participant survey results.ResultsTwenty administrators, 20 physicians/advanced practice providers (APPs), and 20 PT/OTs completed surveys. All disciplines strongly agreed on the value of CR for patient outcomes and care quality. Barriers to CR access included insurance models that disincentivize healthcare systems from providing CR, lack of a standardized screening and referral process, and inconsistent patient participation. Physicians/APPs (81%) endorsed clinical practice guidelines (CPGs) to promote CR referrals, and 90% of PT/OTs agreed hybrid CR delivery, which includes both supervised and unsupervised exercise, would increase patient participation.ConclusionThis study identified opportunities to increase CR access for childhood cancer survivors, including CPGs, streamlining referral processes, hybrid CR delivery, and closing insurance gaps. Future research should address these factors to improve CR access and ultimately improve outcomes for pediatric survivors.

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.

Purpose: Sports-related concussion (SRC) cases have increased among children in the last decade. Differences in concussion symptoms, presentation, and follow-up care exist when comparing demographics. The aim of this study was to explore SRC within the pediatric population.

Methods: A retrospective chart review of patients ≤18 years old diagnosed with SRC at a New Orleans stand-alone children's hospital from January 2007 to December 2021 was performed. T-test and Fisher's exact test were used for relationship between outcomes and sports, demographics, setting, insurance, and follow-up care.

Results: Children who sustained SRC at practice were more likely to be male (p = 0.0311) and younger (p < 0.0001). Cheerleading was more likely to have injuries during practice (p < 0.0001). Medicaid/uninsured patients were more likely to be referred from the emergency department (ED) (p = 0.001), have longer length of follow-ups (p = 0.0489), and have more missed appointments (p = 0.0062). However, the total number of follow-ups between insurance types did not differ (p = 0.3084).

Conclusion: SRC incidence is situation and time dependent. Medicaid/uninsured patients are more likely to be evaluated at the ED, miss appointments, and have a longer length of follow-up to attain the same number of appointments. Exploring the nuances of SRC within this population will improve management and outcomes.

PurposeFollowing the Global Health Symposium at the Spina Bifida World Congress in 2023, the purpose of this work is to provide a historical overview and a state-of-the-art update on the current global practice of myelomeningocele (MMC) closure and to highlight the importance of care coordination and outcomes reporting to mitigate care fragmentation through a multidisciplinary approach.MethodsPanelists from the Spina Bifida World Congress Global Health Symposium reviewed their institutions' history and experience with risk for fragmentation of care following prenatal repair and proposed solutions to address fragmentation of care.ResultsNew and rapidly evolving in-utero approaches to MMC repair are increasingly accessible for patients worldwide but bring more complexity to follow-up care. There is a consensus that unifying multidisciplinary practices and evaluations across institutions and countries will help make care coordination more comprehensive and longitudinal, and that meeting these standards may decrease care fragmentation.ConclusionRegardless of the open spina bifida repair technique, longitudinal follow-up must be established after fetal surgery, not only for the optimal care of individual patients but also to mitigate care fragmentation, transparently evaluate and compare techniques (for example, through the North American Fetal Therapy Network, the National Spina Bifida Patient Registry, etc.), engage health care professionals, and provide evidence-based multidisciplinary care.

PurposeDance is a leisure time physical activity (LTPA) known to improve motor, cognitive, and psychosocial functions in youth with cerebral palsy (CP). Online exercise or tele-programs are promising in overcoming the environmental barriers of accessibility to LTPA. To ensure successful implementation, it is necessary to identify limitations specific to dance in a pediatric population. The aim was to explore the perspectives of the main stakeholders, i.e., dance instructors and youth, to implement such a program.MethodsIn a mixed-method design, feasibility indicators were assessed by participation and retention rates, the Physical Activity Enjoyment Scale (PACES), and the Children's Effort Rating Table (CERT). Semi-structured interviews were conducted before and after the intervention with youth with CP [n = 15] and dance instructors [n = 3]. Interviews were analyzed with an inductive approach.ResultsParticipation and retention rates were 86.7% ± 10.7 and 100%, and the PACES and CERT average scores were 91% ± 11 and 3.7 ± 1.3, respectively. Four themes emerged from the interviews: 1) Technology; 2) Pedagogical Approach; 3) Participant's Environment; and 4) Social Relations.ConclusionThe teledance program is feasible and enjoyable, requiring minimal equipment and travel. However, there is a need to consider and provoke social interaction, to enhance the social and relational dimension of dance.

Multiple sclerosis (MS) is a chronic autoimmune condition causing damage to the protective covering of nerves in the central nervous system. Pediatric multiple sclerosis is a rare form of the disease that affects 3-5% of individuals with multiple sclerosis. Pediatric Onset Multiple Sclerosis (POMS) has a rather different clinical profile from the more prevalent adult multiple sclerosis. Alongside the classic symptoms of multiple sclerosis, children tend to present with various atypical symptoms that can impact motor milestones, speech development, and cognitive functions. This review aims to explore the pathogenesis, clinical features, diagnosis and progression of Pediatric Onset Multiple Sclerosis into adulthood, address the challenges accompanying this transition and identify strategies and therapies to overcome them. Pediatric multiple sclerosis patients transitioning into adulthood face many challenges, such as difficulty in school and social life, and dealing with uncertainties especially due to changes in healthcare providers from pediatric to adult settings. These challenges can be overcome by an emphasis on a well-structured transition plan, early planning, personalized care, proper counselling of the patient as well as the family and caretakers, a multidisciplinary approach with good communication and coordination between all healthcare personnel a robust support network with a gradual transition rather than an abrupt one. Proper care during the transition period is crucial to enhance patient adherence and deepen the understanding of the disease for both patients and their families. This will empower them to seek timely assistance when needed, reduce loss to follow-up, and ultimately improve overall quality of life.

FOXP1 syndrome is a neurodevelopmental disorder caused by mutations or deletions in the Forkhead Box Protein 1 (FOXP1) gene. It is characterized by intellectual disabilities, language difficulties, autism spectrum disorder, congenital anomalies and motor impairments.Walking difficulties have been reported, but specific gait impairments have not previously been described. In this case series, specific gait abnormalities, and how they were managed, are reported in three children with FOXP1 syndrome. The most prominent clinical abnormalities in their gait and gait analysis were toe walking with increased plantar flexion, and knee and hip flexion in midstance. All children had premature activation of the calf muscles. In two of the three children, spasticity in the calf muscles and contractures of ankles and knees were found, which could explain these abnormalities in their gait.