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Benefit of enteral baclofen in the management of spasticity in cerebral palsy. 肠内巴氯芬治疗脑瘫痉挛的益处。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-230005
Rajashree Srinivasan
Spasticity is a movement disorder that is commonly associated with cerebral palsy (CP) and can be managed by various treatment options. It can be increased or worsened by any noxious stimulus like infection, constipation, gastroesophageal reflux disease (GERD), tight clothes, and growth spurts. Indications to treat spasticity include decreasing muscle spasms, improving posture, improving mobility, decreasing pain, improving use and tolerability of adequate braces, decreasing risk of pressure ulcers, preventing or decreasing the rate of contracture formation, and improving quality of life [1]. There are several pharmacologic treatment options used to treat spasticity which include chemodenervation with botulinum toxin injections; chemoneurolysis with phenol or alcohol; oral medications like diazepam, baclofen, tizanidine, and dantrolene; and intrathecal baclofen (ITB) [1]. Baclofen has been
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引用次数: 0
Attitudes and practices of specialty physicians regarding the return to school process after pediatric acquired brain injury. 专科医生对儿童获得性脑损伤后返校过程的态度和做法。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-210130
Bethany L Johnson-Kerner, Kathleen Colao, Nathan K Evanson, J Michael Taylor

Purpose: More than 50,000 children are hospitalized yearly in the U.S. for acquired brain injury (ABI) with no established standards or protocols for school re-entry and limited resources for hospital-school communication. While ultimately the school has autonomy over curricula and services, specialty physicians were asked about their participation and perception of barriers in the school re-entry process.

Methods: Approximately 545 specialty physicians were sent an electronic survey.

Results: 84 responses (43% neurologists and 37% physiatrists) were obtained with a response rate of ∼15%. Thirty-five percent reported that specialty clinicians currently make the plan for school re-entry. The biggest challenge for school re-entry noted by physicians was cognitive difficulties (63%). The biggest gaps perceived by physicians were a lack of hospital-school liaisons to help design and implement a school re-entry plan (27%), schools' inability to implement a school re-entry plan (26%), and an evidence-based cognitive rehab curriculum (26%). Forty-seven percent of physicians reported that they did not have adequate medical personnel to support school re-entry. The most commonly used outcome measure was family satisfaction. Ideal outcome measures included satisfaction (33%) and formal assessment of quality of life (26%).

Conclusion: These data suggest that specialty physicians identify a lack of school liaisons in the medical setting as an important gap in hospital-school communication. Satisfaction and formal assessment of quality of life are meaningful outcomes for this provider group.

目的:美国每年有5万多名儿童因获得性脑损伤(ABI)住院治疗,但没有既定的重返校园标准或协议,医院与学校沟通的资源有限。虽然学校最终对课程和服务拥有自主权,但专科医生被问及他们在重返学校过程中的参与程度和对障碍的看法。方法:向大约545名专科医生发送了一份电子调查。结果:获得84个应答(43%的神经科医生和37%的物理科医生),应答率为~15%。35%的人报告说,专业临床医生目前正在制定重返校园的计划。医生指出,重新入学面临的最大挑战是认知困难(63%)。医生认为最大的差距是缺乏医院与学校的联系来帮助设计和实施重返校园计划(27%),学校无法实施重返学校计划(26%),以及循证认知康复课程(26%)。47%的医生报告说,他们没有足够的医务人员来支持重新入学。最常用的结果衡量标准是家庭满意度。理想的结果指标包括满意度(33%)和对生活质量的正式评估(26%)。结论:这些数据表明,专科医生认为,在医疗环境中缺乏学校联系是医院与学校沟通的一个重要差距。满意度和对生活质量的正式评估对这一提供者群体来说是有意义的结果。
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引用次数: 0
JPRM cerebral palsy special issue 2023. JPRM 脑瘫特刊 2023。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-239002
Heakyung Kim, Rachel Byrne, Michael Green
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引用次数: 0
Reliability of the Wii Balance Board for measurement of steady state balance in children aged 6-9 years. Wii平衡板测量6-9岁儿童稳态平衡的可靠性。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-210106
Hemant Juneja, Christian Frandsen, Nina Odgaard Nielsen, Kim Larsen, Jeanette Praestegaard

Purpose: The Wii Balance Board (WBB) can be used for assessment of steady state balance (SSB), but its reliability has not been studied in children aged 6-9 years. This study aimed to determine the test-retest reliability of the WBB for measuring SSB in this population. A secondary aim was to determine the minimum detectable change (MDC) and standard error of measurement (SEM) of the WBB in children aged 6-9 years.

Methods: 52 children between 6-9 years of age participated. "One leg stand balance" was used to assess center of pressure velocity (COPV) and center of pressure area (COPA) on three occasions by the same tester. Two tests were conducted on the same day (Day 1) and the third test was performed on another day (Day 2), with a period of 5-13 days between the two test days. Intraclass correlation coefficient (ICC 3,1), SEMs, and MDC were calculated.

Results: Intra-day test-retest reliability of COPA was found to be good (ICC3,1 =0.86; 95% confidence interval [CI]: 0.75, 0.92) and that of COPV was also found to be good (ICC3,1 =0.87; 95% CI: 0.77, 0.92). Inter-day test-retest reliability was found to be good for COPA (ICC3,1 = 0.87; 95% CI: 0.75, 0.93) and COPV (ICC3,1 = 0.89; 95% CI: 0.81, 0.94). SEM for COPA in intra-day testing was 18.90 mm2 (15.78%), and in inter-day testing it was 16.44 mm2 (13.61%). SEM for COPV in intra-day testing was 1.12 mm/s (7.6%), and in inter-day testing it was 1.01 mm/s (6.9%). MDC for COPA in intra-day testing was 52.41mm2 (42.75%), and in inter-day testing was 45.58 mm2 (35.75%). MDC for COPV in intra-day testing was 3.11 mm/s (21.2%), and in inter-day testing it was 2.80 mm/s (18.9%).

Conclusion: The WBB has good test-retest reliability for assessing SSB of children between 6-9 years. COPA measurements appear to be less sensitive to clinical changes in SSB when compared to COPV. Assessment of validity of the WBB in this age group is recommended before it can be considered as a potential balance assessment tool in children.

目的:Wii平衡板(WBB)可用于评估稳态平衡(SSB),但其在6-9岁儿童中的可靠性尚未研究。本研究旨在确定WBB在该人群中测量SSB的重测信度。第二个目的是确定6-9岁儿童WBB的最小可检测变化(MDC)和测量标准误差(SEM)。方法:52名6-9岁儿童参与。采用“单腿站立平衡法”对压力中心速度(COPV)和压力中心面积(COPA)进行了三次评估。在同一天(第1天)进行两次试验,在另一天(第2天)进行第三次试验,两次试验之间间隔5-13天。计算类内相关系数(ICC 3,1)、sem和MDC。结果:COPA的日内重测信度较好(ICC3,1 =0.86;95%可信区间[CI]: 0.75, 0.92), COPV的预后也较好(ICC3,1 =0.87;95% ci: 0.77, 0.92)。COPA的日间重测信度较好(ICC3,1 = 0.87;95% CI: 0.75, 0.93)和COPV (ICC3,1 = 0.89;95% ci: 0.81, 0.94)。白天检测时COPA的SEM为18.90 mm2(15.78%),白天检测时为16.44 mm2(13.61%)。白天检测时,COPV的扫描电镜为1.12 mm/s(7.6%),白天检测时为1.01 mm/s(6.9%)。COPA在日间检测的MDC为52.41mm2(42.75%),日间检测的MDC为45.58 mm2(35.75%)。COPV在日间检测中的MDC为3.11 mm/s(21.2%),在日间检测中的MDC为2.80 mm/s(18.9%)。结论:WBB评价6 ~ 9岁儿童SSB具有较好的重测信度。与COPV相比,COPA测量对SSB的临床变化似乎不太敏感。在将WBB作为儿童潜在的平衡评估工具之前,建议对该年龄组的WBB进行效度评估。
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引用次数: 0
Frequency, facilitators, and barriers for range of motion to prevent shoulder contracture in brachial plexus birth injury: A pilot study. 为预防臂丛神经产伤患者肩部挛缩而进行活动幅度训练的频率、促进因素和障碍:一项试点研究。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-220090
Jennifer Wingrat, Matthew J Elrick

Purpose: This pilot study investigated the efficacy of passive range of motion (PROM) during the first year of life to prevent development of shoulder contractures in children with brachial plexus birth injury (BPBI) and identified facilitators and barriers to caregiver adherence with daily PROM.

Methods: Five caregivers of children with upper trunk BPBI participated in retrospective interviews about the frequency with which they performed PROM during their child's first year of life including facilitators and barriers to daily adherence. Medical records were reviewed for documentation of caregiver-reported adherence and documented evidence of shoulder contracture by age one.

Results: Three of the five children had documented shoulder contractures; all three had delayed initiation or inconsistent PROM in the first year of life. Two without shoulder contractures received consistent PROM throughout the first year of life. Making PROM part of the daily routine was a facilitator to adherence while family contextual factors were barriers.

Conclusion: Absence of shoulder contracture may be related to consistent PROM throughout the first year of life; decreased frequency of PROM after the first month of life did not increase the risk of shoulder contracture. Consideration of family routines and context may facilitate adherence with PROM.

目的:本试验性研究调查了臂丛神经先天性损伤(BPBI)患儿出生后第一年内被动活动范围(PROM)对预防肩部挛缩发展的有效性,并确定了护理人员坚持每天进行PROM的促进因素和障碍:五名上躯干 BPBI 患儿的护理人员参加了回顾性访谈,了解他们在患儿出生后第一年内进行 PROM 的频率,包括坚持每天进行 PROM 的促进因素和障碍。我们还查阅了医疗记录,以了解护理人员报告的坚持情况和一岁前肩部挛缩的记录证据:结果:五名儿童中有三名患有有记录的肩部挛缩,这三名儿童在出生后的第一年里都延迟了PROM的启动或PROM不一致。两名没有肩部挛缩的患儿在出生后的第一年里一直接受了PROM。将PROM作为日常生活的一部分是坚持PROM的促进因素,而家庭环境因素则是障碍:没有肩部挛缩可能与在婴儿出生后的第一年中始终坚持实施PROM有关;婴儿出生一个月后减少实施PROM的频率并不会增加肩部挛缩的风险。对家庭常规和环境的考虑可能有助于坚持实施PROM。
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引用次数: 0
Review of If I Betray These Words by Wendy Dean with Simon Talbot. 温迪·迪恩与西蒙·塔尔博特的《如果我打赌这些话》评论。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-230023
Stephen R Skinner
This is a book about physician burnout [1]. Drs. Dean and Talbot prefer the term “moral injury” to “burnout” when discussing the affliction which affects so many physicians today. Since I represent a classic case of burnout, I was eager to read this book. As I read each chapter, I wanted to engage the author in conversation. My mind was filled with anecdotes from my own practice. I had arguments and comments that I longed to share with her. This, I think, is the main value of the book. It is a fantastic stimulus for dialogue about a topic that is crucial to healthcare in our world today. Most of us enter medical school feeling a calling to serve others, to comfort and heal those who are sick. We think of medicine as a noble calling, a moral life. We expect to make sacrifices that include grueling hours of training and interrupted family life. The personal price, we believe, will be more than balanced by the satisfaction of grateful patients restored to health. Unselfish humanitarianism is the core of our role as physicians. On the other hand, the modern American healthcare system operates, to an overwhelming extent, as a business. Success is measured in dollars. Healthcare is no longer mission-driven with humanitarian goals.
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引用次数: 0
Medicine shouldn't be this hard: The intersection of physician moral injury and patient healthcare experience in pediatric complex care. 医学不应该这么难:在儿科复杂护理中,医生道德伤害和患者医疗经验的交叉点。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-230027
Erika Erlandson, Carrie Ramirez, Wendy Dean

Dr. Jay Neufeld's story in If I Betray These Words is a detailed account of one physician's catastrophic journey through moral injury when caring for pediatric patients with complex medical conditions [1]. Many clinicians may recognize Jay's journey in their own experiences, but what deserves parallel consideration are the journeys of patients and families when they are accompanied by physicians at risk of moral injury. This case study illustrates the tight link between drivers of physician moral injury and patients' negative healthcare experiences. These include (1) decisions directed by health insurance regulations and prior authorizations; (2) the electronic medical record (EMR); and (3) healthcare systems focused on revenue generation.

Jay Neufeld博士在《如果我怀疑这些话》中的故事详细描述了一位医生在照顾患有复杂疾病的儿科患者时经历的道德伤害的灾难性旅程[1]。许多临床医生可能在自己的经历中认识到周的旅程,但值得同时考虑的是,当患者和家人在有道德伤害风险的医生陪同下的旅程。这项案例研究说明了医生道德伤害的驱动因素与患者的负面医疗体验之间的紧密联系。其中包括(1)根据健康保险条例和事先授权作出的决定;(2) 电子病历(EMR);以及(3)注重创收的医疗保健系统。
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引用次数: 0
Open Topic. 打开主题。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01
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引用次数: 0
Feasibility of temperature monitoring smart socks in adolescents and young adults with spina bifida. 脊柱裂青少年体温监测智能袜的可行性。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-230030
Melissa A Bent, Abigail N Padilla, Sam P Wimmer, Kelleen Lopez, Veronica Beltran, Tishya A L Wren

Purpose: The purpose of the study was to determine if the use of continuous temperature monitoring smart socks is feasible in adolescents with spina bifida (SB) by obtaining user feedback on comfort.

Methods: Participants were provided temperature monitoring socks and a 4 G hub. Follow-up phone calls were performed to answer questions or discuss barriers. Sock temperatures were monitored throughout four weeks. Following sock wear, participants were asked to complete a satisfaction survey.

Results: Seventeen of the 33 participants enrolled (eight males, nine females) with a mean age of 14.8 years completed the study. Average sock wear was 8.0 hours per day for four weeks. The mean temperature was 83.4°F with a mean temperature differential between feet of -0.74°F (left-right). The duration of sock wear varied from 14.6 to 595.9 hours over the four-week period. Lastly, eleven participants (84.6%) reported that the socks were comfortable and very easy to put on.

Conclusion: Continuous temperature monitoring smart socks are an option for monitoring risk for developing pressure injuries in adolescents with SB. Future directions would include increasing sample size, obtaining normative data for temperature ranges in this population, and correlating to clinical outcomes.

目的:本研究旨在通过获取用户对舒适度的反馈,确定脊柱裂(SB)青少年使用连续体温监测智能袜是否可行:方法:向参与者提供体温监测袜和 4 G 集线器。方法:向参与者提供体温监测袜和 4 G 集线器,并通过后续电话回答问题或讨论障碍。对袜子的温度进行了为期四周的监测。穿袜子后,参与者被要求完成满意度调查:33 名参与者中有 17 人(8 男 9 女)完成了研究,他们的平均年龄为 14.8 岁。平均每天穿袜 8.0 小时,持续四周。平均气温为 83.4°F,双脚之间的平均温差为 -0.74°F(左右)。在四周的时间里,穿袜时间从 14.6 小时到 595.9 小时不等。最后,11 名参与者(84.6%)表示袜子穿着舒适,非常容易穿戴:连续体温监测智能袜是监测患有 SB 的青少年发生压力伤害风险的一种选择。未来的研究方向将包括增加样本量、获得该人群温度范围的标准数据以及与临床结果相关联。
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引用次数: 0
Six-minute walk test and factors affecting exercise capacity in children with cystic fibrosis. 囊性纤维化儿童6分钟步行试验及影响运动能力的因素。
IF 1.9 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.3233/PRM-210089
Vahideh Toopchizadeh, Elaheh Nezamoleslami, Mandana Rafeey, Fatemeh Jahanjoo, Mohammad Sadegh Khabbaz, Amir Hossein Jafari-Rouhi

Purpose: This study aimed to compare the result of the six-minute walk test (6MWT) in patients with cystic fibrosis (CF) aged < 20 years old and individuals without CF.

Methods: In this cross-sectional study, 50 children and adolescents with CF and 20 children and adolescents without CF underwent the 6MWT. Vital signs before and immediately after the 6MWT and six-minute walk distance (6MWD) were evaluated.

Results: The mean change in heart rate, percentage of peripheral oxygen saturation (SpO2%), systolic blood pressure, respiratory rate, and dyspnea severity during the 6MWT was significantly higher in patients with CF. In the case group, 6MWD was associated with regular chest physical therapy (CPT) and forced expiratory volume (FEV)> 80%. Patients with CF receiving regular CPT or mechanical vibration and with FEV in the first second > 80% showed better physical capacity during the 6MWT (smaller Sp02% decline and lower dyspnea perception).

Conclusion: Children and adolescents with CF have lower physical capacity compared to individuals without CF. CPT and mechanical vibration could be used to increase physical capacity in this population.

目的:本研究旨在比较老年囊性纤维化(CF)患者6分钟步行试验(6MWT)的结果 方法:在这项横断面研究中,50名患有CF的儿童和青少年以及20名没有CF的儿童或青少年接受了6MWT。评估6MWT和6分钟步行距离(6MWD)前后的生命体征。结果:CF患者在6MWT期间心率、外周血氧饱和度百分比(SpO2%)、收缩压、呼吸频率和呼吸困难严重程度的平均变化显著较高。在病例组中,6MWD与常规胸部物理治疗(CPT)和用力呼气量(FEV)> 80%。CF患者接受常规CPT或机械振动,并在第一秒内出现FEV > 80%的患者在6MWT期间表现出更好的体力(Sp02%下降较小,呼吸困难感较低)。结论:患有慢性疲劳的儿童和青少年的体能比没有慢性疲劳的人低。CPT和机械振动可用于提高该人群的体能。
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引用次数: 0
期刊
Journal of pediatric rehabilitation medicine
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