Journal of pediatric rehabilitation medicine最新文献

PurposeThe objective of this article was to explore the prevalence, pathophysiology, diagnosis, and management of sleep-related breathing disorders (SRBDs) in children with spina bifida and specifically myelomeningocele (MMC).SummarySRBDs, including obstructive and central sleep apnea, hypoventilation, and hypoxia, are prevalent in children with spina bifida, particularly those with MMC. This high prevalence, ranging from 40% to 80%, is often attributed to brainstem abnormalities, upper airway dysfunction, and restrictive lung disease. Despite the general efficacy of treatments like adenotonsillectomy in typical pediatric populations, these interventions show lower success rates in children with spina bifida. Comprehensive polysomnography is crucial for accurate diagnosis due to the atypical presentation of symptoms. Management strategies include surgical interventions, supplemental oxygen, noninvasive ventilation, and, in severe cases, tracheostomy. A multidisciplinary approach involving various specialties is essential for optimal care and improved outcomes.ConclusionEarly diagnosis through polysomnography and a multidisciplinary management strategy are critical for effectively treating SRBDs in children with spina bifida, aiming to mitigate associated comorbidities and enhance overall quality of life.

Purpose: This paper describes the development and characteristics of a multi-disciplinary spina bifida clinic in Qatar considering the recently revised and globally available Guidelines for the Care of People with Spina Bifida (GCPSB).

Methods: A retrospective chart review was performed on individuals in Sidra's multidisciplinary spina bifida clinic database from January 2019 to June 2020. Their electronic health records were reviewed for demographics, as well as neurosurgical, urologic, rehabilitation, and orthopedic interventions.

Results: There were 127 patients in the database; 117 met inclusion criteria for diagnoses of myelomeningocele, meningocele, sacral agenesis/caudal regression, and/or spinal lipoma. Generally, Qatar is following GCPSB recommendations for multidisciplinary care. Consanguineous relationships, difficulties with access to urological and rehabilitation supplies and equipment, school access, and variable timing of neurosurgical closure were areas that demonstrated differences from GCPSB recommendations due to barriers in implementation.

Conclusion: The GCPSB recommendations are applicable in an international setting such as Qatar. Despite a few barriers in implementing some of the recommendations, this new multi-disciplinary spina bifida clinic demonstrates alignment with many of the GCPSB guidelines.

Pediatric spinal cord injury (SCI) most commonly affects the cervical region. Central cord syndrome most often occurs in the lower cervical injury due to hyperextension injury, while anterior cord syndrome is primarily due to vascular infarction after hyperextension injury. An unusual case of a pediatric patient who physically presented with central cord syndrome but radiologically had evidence of anterior spinal artery syndrome is described.A two-year-old male presented after a fall from three feet with flaccid upper extremities and dysesthesias but maintained functional strength in bilateral lower extremities. Although his clinical presentation was that of central cord syndrome, he was found to have an anterior spinal artery infarct spanning from C2-T3 with a ligamentous injury at C3 and an incidental finding of Chiari I malformation on MRI. Given the negative evaluation for a cardiac or hematologic source of embolus and normal angiography, it was theorized that compression of vertebral arteries by previously undiagnosed Chiari I malformation in the setting of trauma could have made the patient more vulnerable to this complication. During inpatient rehabilitation, he regained scapular movement and shoulder flexion. However, he regained distal movement in supination, wrist extension, and finger flexion instead of the more usual proximal-to-distal motor recovery observed in SCI. While he had a relative sparing of strength in his legs, he had impaired proprioception and balance, leading to gait impairment.This case highlights the complexity of pediatric cervical SCI diagnosis and prognostication. While classic SCI subtypes are well described, many pediatric and adult patients will present and recover in unexpected ways. All with SCI should be evaluated thoroughly for common etiologies and transitioned to rehabilitation therapies to assist in recovery.

Virtual reality (VR) is an innovative technology with the potential to enhance treatment for children with chronic pain and functional symptoms. Currently, little is known about patients' experiences of VR in the setting of intensive interdisciplinary pain treatment (IIPT). This study aimed to better understand how patients engage with and benefit from VR. This case report focuses on a 12-year-old female with amplified musculoskeletal pain syndrome and comorbid functional neurological disorder receiving treatment in inpatient IIPT. VR was incorporated into physical/occupational and recreational therapy sessions. A semi-structured interview was completed one-month post-discharge. Qualitative analysis revealed three major themes: Process of Change (VR was unique/immersive, reduced pain focus, challenged skepticism, and changed pain perception), Efficacy (VR increased movement, supported transitioning from a wheelchair to walking independently, and increased confidence, excitement, and surprise), and Engagement (VR aided in acknowledging progress, increased camaraderie, was fun, and challenged patient to extend treatment goals made in VR to real life). Therapist observations of the benefits and barriers to using VR in treatment are described. Overall, this report indicates that VR may be a helpful tool to use with existing IIPT interventions to enhance patient engagement in treatment and improve functionaloutcomes.

Purpose: The purpose of this study was to compare the clinical efficacy of a virtual reality rehabilitation-based training (VRT) with balance-specific training (BST) and conventional training (CT) on the balance and gross motor functions (GMF) of children with cerebral palsy (CwCP).

Methods: This study was a double blinded, randomized controlled trial. Participants were recruited from different CP rehabilitation centers and clinics and were then randomly allocated using the block randomization method into three groups: (1) group 1 (VRT using a set of Xbox 360 games that triggered balance), (2) group 2 (BST applying a protocol of 13 exercises to enhance balance in different conditions), and (3) control group 3 (CT using traditional physiotherapy techniques). All groups received 18 sessions over six weeks, three sessions per week, each lasting 60 minutes. Participants were assessed at three timepoints (baseline, post-treatment, and follow-up) using the Pediatric Balance Scale (PBS), the Gross Motor Function Measure (GMFM D & E), the Five Times Sit-To-Stand Test, and upper and lower segments' center of mass (COM) displacement (U_COM and L_COM).

Results: A total of 46 CwCP participated in this study. The repeated measures ANOVA revealed a statistically significant difference between groups in the dependent variables, except for the GMFM (D & E) and the PBS (p < 0.05 and partial η² = 0.473). The post-hoc test showed a statistically significant difference in favor of the VRT group compared to other groups in terms of right UCOM (p < 0.05) with a large effect size of the time*group interaction (partial η² = 0.87). Moreover, there was a statistically significant effect of time (i.e., baseline to post-treatment and baseline to follow-up) with F (18, 23) = 59.954, p < 0.05, Wilks' lambda = 0.021, partial η² = 0.979.

Conclusion: The findings revealed that VRT was not superior to BST in the rehabilitation of balance and GMF in CwCP aged four to 12 years. However, when compared to CT, better results were reported. Furthermore, it appears that customized programs lead to greater improvements in balance than commercial programs. Future studies are needed to assess the physiological effects of the three types of rehabilitation interventions using more advanced measurement tools, such as functional magnetic resonance imaging, following VRT protocols.

Purpose: The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP).

Methods: Participants (N = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion.

Results: Pain intensity was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, β = - .28, p = .047, while pain catastrophizing was associated with baseline gross motor abilities, β = - .28, p = .032.

Conclusion: Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain.

Purpose: This study aimed to A) evaluate changes in pain and function following an outpatient interdisciplinary pain management program (IPMP) for children with different chronic pain conditions and B) explore differences in pain and function at baseline and discharge for different diagnoses.

Methods: A retrospective chart review was performed for 488 children who participated in an outpatient IPMP. Children's pain and physical, social, and emotional functioning were assessed at initial evaluation, discharge, and one-to-two-month follow-up. Patients were stratified by diagnosis (complex regional pain syndrome [CRPS], headache, musculoskeletal pain, visceral pain, and widespread pain) to evaluate differences in pain and functioning at baseline and discharge.

Results: Children's pain and function improved from initial evaluation to discharge. Those with headache and musculoskeletal pain exhibited better baseline physical and emotional functioning than other diagnostic groups (p = 0.03; p = 0.005; p = 0.002; p = 0.04). Children with CRPS displayed the worst baseline physical functioning (p = 0.003). Those with widespread pain exhibited the worst baseline emotional functioning at both initial evaluation and discharge (p = 0.009; p = 0.007).

Conclusion: Children with CRPS, visceral pain, and widespread pain undergoing treatment in an IPMP exhibited the most impaired baseline functioning, while those with musculoskeletal pain and headache were least impaired. All exhibited improvements in pain and function following the IPMP.

Purpose: Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine.

Methods: This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame.

Results: Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X² = 69.7, p = 0.002), treatments (X²: 23.6-43.8, p: <  0.001-0.003), and referrals (X² = 132, p <  0.001) were for shin injuries. Larger proportions of nutrition assessments (X² = 40.7, p <  0.001), interventions (X² = 26.8, p = 0.003), and referrals (X² = 27.5, p = 0.002) were performed in or after the year 2015.

Conclusion: Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.