Journal of pediatric rehabilitation medicine最新文献

Purpose: Quantitative muscle ultrasound (QMUS) is potentially valuable as a diagnostic tool in central neurological disorders, as it provides information about changes in muscle architecture. This study aimed to investigate whether ultrasound images of the submental and masticatory muscles in children with spastic cerebral palsy (CP) differ from those obtained in a reference group, and whether observed ultrasound abnormalities differ between subgroups of children with different Eating and Drinking Ability Classification System (EDACS) levels to support its construct validity.

Methods: A prospective cohort study was conducted in 25 children with spastic CP aged 3-18 years. QMUS of selected muscles was performed. Muscle thickness and echogenicity in the CP group were compared to previously collected reference values, and between different EDACS levels within the CP group.

Results: Median echogenicity of all muscles was significantly higher in children with CP than in healthy controls. The temporalis muscle was significantly thinner in the CP group. There were no differences in muscle thickness or echogenicity between EDACS levels.

Conclusion: QMUS is able to detect abnormal architecture of submental and masticatory muscles in children with spastic CP, but the interpretation of abnormalities in relation to the severity of mastication and swallowing problems needs further investigation.

PurposeThis study aimed to (1) examine the construct validity of the Zorowitz spasticity patient-reported outcome (PRO) scale in pediatric populations and (2) examine the scale's responsiveness to change in children to determine its clinical utility in guiding treatment of pediatric spasticity.MethodsRetrospective analysis of data collected at a large academic pediatric hospital system, including 505 patients who received injections for spasticity from pediatric physiatrists, was performed. Zorowitz scores, spasticity (Modified Ashworth Scale) scores, and Gross Motor Function Classification System levels were extracted.ResultsBaseline Zorowitz score (median 19, interquartile range 13-25) was not related to functional level (r = -0.088, p = 0.20) nor muscle tone (r = 0.006, p = 0.95), but patients with follow-up data reported reduced impact of spasticity post-injection (p < 0.0001). Higher baseline Zorowitz score was related to a greater decrease in Zorowitz score after injection (r = -0.39, p < 0.00001). Injection location, sex, number of muscles injected, and botulinum toxin dose were not related to Zorowitz change score.ConclusionThe Zorowitz scale may be responsive to spasticity treatment in children. However, construct validity to existing clinical measures was not observed, suggesting either that a clinical gold standard does not exist, that the scale measures a construct not otherwise captured clinically, or that it has limited validity in children.

PURPOSEA case report of a six-year and five-month-old female admitted with typical symptoms of Rubinstein-Taybi syndrome is presented. Clinical and rehabilitation settings where she acquired her reading, writing, and communication skills are described.METHODSBecause of her cognitive disabilities, a multidisciplinary and long-term intervention (2014-2020) was necessary. Treatment included orthoptic, psychomotor, logopedic, occupational, and neuropsychological care. Her family and school were involved.RESULTSIncreased attention led to decreased dysfunctional behaviors. Test results are still below average, but there has been significant improvement. Better communication skills resulted from increased phonetic range, improved articulation, lexical-semantic structure, comprehension, and production of sentences. Digital technologies played a significant role in enhancing her communication skills, not just in social interactions but also in school activities. The patient is oriented in time and space with the help of agendas and calendars. She can express her needs and compose concise narratives. As a result of acquiring functional skills, she is better equipped to handle real-life situations, which has led to increased social and family activities.CONCLUSIONThis case report highlights the importance of personalized rehabilitation programs. Obtaining an early genetic diagnosis is crucial for timely tailored rehabilitation, and any delays in this process can hinder progress.

Patients with spina bifida (SB) are highly susceptible to pressure injuries (PIs) due to limited mobility and sensory deficits, and they may occur during multiple surgical procedures. The article highlights that PIs, which significantly increase hospital costs and extend patient stays, can be prevented mainly through evidence-based interventions. One of the critical technologies used at this stage is pressure mapping to monitor and optimize pressure distribution on surfaces, whether lying or seated, particularly during prolonged medical procedures. Additionally, the article emphasizes the importance of educating families and caregivers about early signs of PIs, photography, using electronic health records for tracking, and effective home care strategies to prevent these injuries post-discharge. Future research should investigate how to enhance prevention methods in hospital settings, especially for patients undergoing surgeries or other lengthy procedures. Overall, the article underscores the critical role of early identification of risk, intervention, and technological support in reducing the incidence and impact of PIs in patients with SB.

Hydrocephalus is a common comorbidity associated with brain injuries, including cerebral palsy (CP). In CP, hydrocephalus typically presents in infancy or early childhood. This report describes a patient in their mid 20 s with mixed dyskinetic-spastic CP with adult-onset hydrocephalus of unknown cause initially presenting with new-onset bilateral lower extremity spasms. Multiple interventions were trialed, including ischial bursal steroid injections, botulinum toxin injections, trigger point injections, multiple oral medications, and physical and massage therapies without benefit. Given lack of treatment response, imaging of the neuraxis was obtained. Magnetic resonance imaging (MRI) of the brain demonstrated new diffuse moderate ventriculomegaly compared to prior MRI. Ophthalmologic evaluation demonstrated papilledema, and opening pressure on lumbar puncture was elevated to 44 mmHg H₂O. The patient underwent ventriculoperitoneal shunt placement with rapid and near-resolution of their spasms and pain. This patient represents a unique case of new-onset hydrocephalus in an adult with CP. To ensure appropriate and timely diagnosis and treatment, individuals with neurologic conditions such as CP should have ongoing surveillance and comprehensive evaluation for any neurologic or functional changes, including changes in baseline tone. Future research is needed to better understand if adults with CP are at higher risk for the development of hydrocephalus in adulthood.

PurposeThis study aimed to examine parents' perceptions and experiences navigating their child's chronic health condition diagnosis.MethodsResearchers used a qualitative research design, applying a phenomenological approach to interview 15 parents of children with a chronic health condition. Researchers analyzed verbatim transcripts to develop themes and report strategies that might inform care of the child and parents.ResultsParents described a fluid experience navigating their child's diagnosis that involved five interwoven elements: grief, anxiety, unknowing, responsibility, and positivity. Mediating processes of time and experience supported adaptation toward positivity. Experiences appeared to transcend child-specific diagnoses suggesting a common process of parent adaptation to a child's diagnosis.ConclusionFindings elucidate parents' lived experiences surrounding their child's diagnosis of a chronic health condition. Parents are inextricable from their child's care; thus, findings may garner knowledge supporting providers to employ strategies that support favorable outcomes for both children and parents.

CASE DESCRIPTIONA five-year-old male with spastic quadriplegia cerebral palsy and an expressive communication disorder presented because the family desired liberalization of diet. The diet consisted of pureed solids and no liquids due to deficits identified on bedside swallow evaluation; further dysphagia assessment had not been obtained due to significant procedural anxiety. Comprehensive approaches were taken involving premedication with buspirone, desensitization, distraction, and positive reinforcement. The fluoroscopic swallow study was successfully completed, and the patient's diet was upgraded to include moderately thickened liquids.DISCUSSIONProcedural anxiety management in special populations is not well-researched. The lack of definitive recommendations regarding these issues increases the difficulty of managing these patients. This case highlights one successful approach to addressing individual needs using widely-available pharmacologic and environmental techniques. Additionally, this case reinforces the need to identify underlying causes for procedural anxiety and involve an interdisciplinary team.CONCLUSIONSAttempts should be made to identify factors driving procedural anxiety. After discussing with the patient and family, relevant information should be relayed to staff with an open-ended invitation to propose ideas. While not all hospitals have equivalent resources, concerns related to unfamiliarity, underlying anxiety, and locus of control can be addressed with limited resource utilization, as demonstrated in this case.

PurposeThis study aimed to identify the perceptions of pediatric physical therapists, identifying barriers and facilitators to providing telehealth services during the COVID-19 pandemic.MethodsUsing a mixed methods design, an online, national survey gathered demographics and participants' perceptions.ResultsA total of 165 pediatric physical therapists participated in the study. Sixty-four percent of respondents rated their pre-pandemic perception of telehealth services as "somewhat" to "very" negative. After utilizing telehealth, 66% of therapists reported perceptions of telehealth as "somewhat" or "very" positive. Barriers were 1) poor patient and parent participation and 2) technology issues. Facilitators were 1) hands-on involvement, 2) ability to share information, and 3) ability to use items in the home. Predominate themes to open-ended responses further elucidated pre- and post-pandemic telehealth perceptions.ConclusionAfter implementing telehealth services during COVID- 19, most therapists indicated their perceptions of telehealth were somewhat or very positive.

PurposeThe goal was to elucidate and present the current landscape of bladder biosensor technology for urinary volume monitoring in the management of neurogenic bladder. The need for such technology in managing neurogenic bladder in the pediatric population is discussed, as well as the challenges researchers currently face in advancing individual technologies.MethodsA literature review including 43 articles discussing bladder biosensor and related technology for continuous urinary volume monitoring was conducted. Articles ranged from original research studies to systematic reviews.ResultsVarious continuous bladder urine volume monitoring devices have been proposed and evaluated. These devices utilize principles of ultrasound, electrical impedance tomography, near infrared spectroscopy, pressure biosensor implantation, microwave radar, and frequency modulated continuous wave radar. While several studies have shown promise in correlating device measurements to bladder urinary volume changes, ultimately researchers have not been able to surmount the challenges of optimizing configuration of device components and the impacts of dynamic position, posture, body habitus, bladder location, and urine biochemical properties that demonstrate high interpersonal variability.ConclusionThe need for developing bladder biosensor technology to provide continuous urine volume monitoring in patients with neurogenic bladder remains great. Transitioning from a time-based clean intermittent catheterization approach to a volume-based approach would possibly improve neurogenic bladder patients' quality of life. While technologies face limitations that have stalled translation to clinical practice, there is potential to build upon past work to address current challenges and meet this ever-pressing need.