Journal of pediatric rehabilitation medicine最新文献

Visual difficulties are common after brain tumors, despite a lack of visual complaints at diagnosis. These include difficulties with eye movements, visual coordination, vergence, accommodation, and photophobia, in addition to more obvious problems such as visual field defects. This case report presents the results of a thorough neuro-visual evaluation in a boy with sequelae after a brain tumor including intermittent double vision that was not explained by routine visual examination. Subjective complaints included poor reading perseverance, intermittent blurred and double vision, headache around the eyes when performing near activities, less efficient eye movement behavior in reading tasks, and increased sensitivity to visual motion. The patient participated in a multidisciplinary visual rehabilitation program that included reading glasses with prism compensation and tinted glasses, as well as training with the aim of improving eye teaming, near vision functions, and perseverance in eye movements. The patient responded quickly to the vision therapy program, with positive changes after just four weeks. Repeated neuro-visual evaluations over eight months showed remarkable improvements that were stable over time. This encouraging case report supports the notion that neuro-visual evaluation and rehabilitation should be included in the follow-up of patients after brain tumors.

The prevalence of cerebral palsy (CP) varies globally, with higher rates and burden of disease in low- and middle-income countries. CP is a lifelong condition with no cure, presenting diverse challenges such as motor impairment, epilepsy, and mental health disorders. Research progress has been made but more is needed, especially given consumer demands for faster advancements and improvements in the scientific evidence base for interventions. This paper explores three strategies to accelerate CP research: consumer engagement, global clinical trial networks, and adaptive designs. Consumer engagement involving individuals with lived experience enhances research outcomes. Global clinical trial networks provide efficiency through larger and more diverse participant pools. Adaptive designs, unlike traditional randomized controlled trials, allow real-time modifications based on interim analyses, potentially answering complex questions more efficiently. The establishment of a CP Global Clinical Trials Network, integrating consumer engagement, global collaboration, and adaptive designs, marks a paradigm shift. The Network aims to address consumer-set research priorities. While challenges like ethical considerations and capacity building exist, the potential benefits for consumers, clinicians, researchers, and funding bodies are substantial. This paper underscores the urgency of transforming CP research methodologies for quicker translation of novel treatments into clinical practice to improve quality of life for those with CP.

Conjoined twins are identical twins joined in utero and are a rare phenomenon. This report discusses a case of female thoraco-omphalo-ischiopagus tripus conjoined twins. The twins were separated at age two, and once medically stable, spent one month in inpatient rehabilitation to improve their sitting balance and gross motor skills. This was followed by outpatient physical therapy. The twins initially had customized ZipZac seats, which they were able to wheel independently. After six months of therapy, the girls began walking with posterior walkers and prostheses. The hemipelvectomy prosthesis included a customized thoracolumbosacral orthosis component and was directly attached to a non-articulated pylon. A manual-locking hip joint was added to accommodate sitting. An articulated ankle-foot orthosis was used for the intact leg. Care of formerly conjoined twins requires comprehensive care from a multidisciplinary team involving, but not limited to, a physiatrist, orthopaedic surgeon, physical therapist, and orthotist/prosthetist. Complex congenital limb deficiencies are often a major undertaking for the rehabilitation team as continuous treatment and management are needed throughout the patient's lifetime due to growth, development, and evolving physical demands. Anatomic variations must be examined on a case-by-case basis but often include limb deficiencies, orthopedic abnormalities, and organ comorbidities.

Purpose: There is no established clinical standard to evaluate ankle proprioception in children with cerebral palsy (CP). This study compared ankle position sense of children with CP to age-matched children who are typically developing (TD).

Methods: Children aged 6-17 years participated (15 CP, 58 TD). Using a custom-built device, the ankle was passively rotated to two positions for 25 trials. Using a psychophysical forced-choice paradigm, participants indicated which position was more plantarflexed. A psychometric function was fitted to the response data to determine the just noticeable difference (JND) threshold and the associated uncertainty (random error) for ankle position sense.

Results: Median JND thresholds for the CP group were elevated (CP: 4.3°, TD: 3.0°). Three children with CP exceeded the 95th percentile of TD. No differences in random error were found.

Conclusion: This method assessed ankle proprioception relative to norm data and identified position sense impairments in children with CP. Using this method can provide data on proprioceptive status in CP, augmenting the assessment of motor impairment.

Objective: Idiopathic toe-walking (ITW) is a diagnosis of exclusion. A relationship between ITW and decreased range of motion (ROM) is postulated. Treatments focus on increasing ankle dorsiflexion including serial casting. There is no consensus for duration of serial casting. This study aimed to determine ROM changes with cast change intervals of one vs. two weeks, and the rate of ITW recurrence.

Methods: This was a retrospective study of 86 patients, ages 0-9 years with ITW undergoing weekly casting (N = 29) and two-week casting (N = 57) at a children's hospital from 2014-2020. ROM at baseline, two weeks, four weeks, and final cast removal were collected. Statistical analyses included chi-squared tests, two-sample t-tests, and linear mixed regression. Outcome distributions were assessed for normality. P-values < 0.05 were considered statistically significant.

Results: After adjusting for baseline ROM, the mean change in ROM from baseline to two weeks was 10.6∘ vs 7.5∘ in the one-week vs. two-week casting interval, respectively (p < 0.001). The baseline to final measurement was 13.4∘ vs 9.8∘ in the one-week vs. two-week casting interval, respectively (p < 0.001). The rate of recurrence of ITW was similar between the two groups.

Conclusion: This study suggests greater improvement in ROM in the one-week vs. two-week casting interval group.

Purpose: Infants can have muscle hypertonia due to cerebral palsy, muscle strength imbalances due to brachial plexus palsy, refractory clubfoot, and torticollis. These muscle problems can cause significant development impairments. A child with severe sialorrhea and dysphagia from leukodystrophy can aspirate, causing respiratory problems. Botulinum toxin (BoNT) injections can improve these conditions but may lead to adverse effects from the toxin spreading to non-targeted muscles, potentially impacting breathing, swallowing, and overall strength. This is particularly concerning in infants. This study assessed the safety of BoNT injections in children less than one year of age.

Methods: This was a retrospective cohort study.

Results: Forty-seven patients (22 male, 25 female) received BoNT injections before one year of age (three to 12 months). Thirty-seven received one round of injections and 10 were injected on multiple occasions. Forty-five received onabotulinumtoxinA (15-100 units [U], 1.9-15.2 U/kg), one received abobotulinumtoxinA (70 U, 9.0 U/kg), and one received incobotulinumtoxinA (25 U, 3.5 U/kg). Lower extremities were treated in 15 patients, upper extremities in 38, the sternocleidomastoid in two, and the salivary glands in one. Forty-five patients had no reported complications. One experienced transient fever, vomiting, and diarrhea. The parent of another reported subjective weakness in one muscle.

Conclusion: BoNT injections in children less than one year of age appear to be safe.

Spinal muscular atrophy (SMA) is a neuromuscular ailment that leads to the deprivation of motor neurons in the spinal cord, producing denervation and muscle weakness. This case report explains how a patient with type 2 SMA used a therapeutic exercise rehabilitation program in a school environment. Motor functions were assessed by Gross Motor Function Measure-88 (GMFM-88), Manual Muscle Testing (MMT), and Hammersmith Functional Motor Scale (HFMS), which is validated and reliable. This study employed a repeated pre-test post-test measures design. During a year of treatment sessions, the child underwent twice weekly 45-minute physical therapy sessions for 48 weeks. The research was carried out between March 2022 and February 2023. The purpose of the intervention, which comprised a variety of therapeutic workouts, was to enhance physical function and gross motor abilities in an age-appropriate manner. The intervention utilized in this study led to improvements in GMFM-88, HFMS, and MMT total scores. The results of this case study showed that a child with type 2 SMA aged nine had successfully improved their gross motor skills and muscle strength.