PM&R最新文献

Background: Sensory and behavioral difficulties are frequently observed in children with cerebral palsy (CP), and these challenges may intensify when cerebral visual impairment (CVI) co-occurs. However, the extent and nature of these combined effects remain underexplored.

Objective: The aim of this study is to compare sensory processing skills and behavior of children with CP and CVI, CP without CVI, and typically development (TD) and to examine the relationship between sensory processing skills and behavior in children in these groups.

Design: Prospective, cross-sectional study with control group.

Setting: Special education and rehabilitation center.

Participants: A total of 120 children aged 3-6 years, consisting of three groups, were included in the study: 40 children with CP and CVI, 40 children with CP without CVI, and 40 children with TD.

Main outcomes measures: The Sensory Profile (SP) was used to assess sensory skills and the Child Behavior Rating Scale (CBRS) was used to assess behavior.

Results: There were significant differences in all pairwise comparisons between the three groups and between SP subdomains and CBRS scores (p < .05). Children with CP and CVI had the lowest median scores (SP: 7-78.5; CBRS: 26), followed by those with CP without CVI (SP: 9-95; CBRS: 33), whereas TD children had the highest scores (SP: 12-129; CBRS: 49). These findings suggest a trend toward worsening sensory and behavioral outcomes in the presence of CVI in addition to CP and in CP alone. Furthermore, moderate to strong positive correlations were observed between SP and CBRS scores in all groups (rho = 0.468-0.872; p < .001), suggesting that behavioral problems increase with decreased sensory processing skills.

Conclusions: This study reveals that children with CP have more problems in sensory processing and behavioral functioning compared to their peers with TD and that these problems are exacerbated in the presence of CVI accompanying CP. In addition, the significant relationship observed between the decrease in sensory processing skills and the increase in behavioral problems emphasizes the importance of evaluating these two areas together and adopting a holistic approach in intervention planning.

Objective: The goal of this study was to examine if differing platelet counts in platelet-rich plasma (PRP) formulations affected overall pain and function outcomes when compared to hyaluronic acid or placebo control saline injections.

Design/methods: We conducted a systematic review and meta-analysis (International Prospective Register of Systematic Reviews CRD42022340057) evaluating randomized controlled trials comparing injections of PRP to hyaluronic acid (HA) or saline (NS) control in patients with mild or moderate knee osteoarthritis. All studies used a validated outcome measure that examined pain, function, or overall patient global assessment. Study PRP interventions were subclassified as investigating the total number of platelets delivered in a low dose (1-5 billion total deliverable platelets), moderate dose (5-10 billion total deliverable platelets), or high dose (greater than 10 billion total deliverable platelets) injected into the joint.

Results: A total of 32 trials met inclusion criteria. All three PRP groups had significant improvements in validated patient-reported outcomes when compared to HA. Both the "low" and "high" platelet count groups resulted in a moderate effect size, respectively (standardized mean difference [SMD] = .47; 95% confidence interval [CI] .05-0.89, p < .01; SMD = .68; 95% CI .26-1.09, p < .01). Only the "moderate" (SMD = 1.48; 95% CI .71-2.58 p < .01) platelet count group resulted in large effect size on validated patient-reported outcomes. When compared to NS, all three PRP groups resulted in significant large effect sizes when examining pain reduction.

Conclusions: When compared to HA, PRP with platelet counts between 1 and 10 billion total deliverable platelets may result in a larger decrease in pain symptoms when compared to platelet counts greater than 10 billion at 6 months. In addition, platelet counts between 5 and 10 billion total deliverable platelets may be associated with greater improvement in functional outcomes.

Climate change has deleterious effects on stroke recovery, disproportionately affecting populations with increased stroke incidence. These effects start prior to the acute care hospitalization, precipitated by environmental etiologies and are sustained throughout the life course of stroke survivors. Health care practitioners play a critical role in identifying these concerns and mitigating their impact through effective strategies at the patient level, interventions at the community level, and advocacy at the state and federal level. As the experts on improvement in function, quality of life, and the mitigation of disability, physiatrists have the opportunity to lead efforts in this space for stroke survivors and their caregivers.

Background: Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized.

Objective: The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement.

Design: Pilot study.

Setting: Academic medical center.

Participants: N/A.

Interventions: N/A.

Outcome measures: Carbon emissions measured in CO₂ equivalents (CO₂ eq).

Methods: Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials.

Results: The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO₂ eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO₂ eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents.

Conclusion: Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization.

Background: The critical need for assistive technology (AT) for children with brain injury is recognized. Despite its importance, there is scant literature on how delays and denials in the provision of AT affect recovery and rehabilitation.

Objective: To examine the complex ecosystem of AT usage and barriers to access, drawing upon the perspectives of clinicians, vendors, and parents in an exploratory qualitative study.

Design: This is a companion study to a quantitative retrospective medical chart review using grounded theory methods. Two focus groups with clinical staff, one focus group with vendors, and six interviews with parents of children with brain injury were conducted. The narrative data were combined to maximize the triangulation of themes.

Setting: Pediatric rehabilitation hospital.

Participants: Multidisciplinary rehabilitation clinicians, vendors who provide AT, and parents of children with brain injury.

Results: Primary themes included coordinating with insurance, vendors, and funding; fostering age-appropriate independence; family's familiarity with AT; understanding the dynamic nature of development and recovery; impact on family relationships; costs/financial considerations; accepting role of AT; discovering new AT; accepting child's reality; and advocating for AT access.

Conclusion: The ethical implications of delays in access to AT, particularly in children with maturing and recovering brains, are far reaching and bring to the forefront concerns about the potential impact of disability stigma, social justice, and access to devices and information and the importance of maximizing self-determination and enabling independence and autonomy. Delays in access to AT preclude both a child's rights and capabilities, adversely affecting their recovery and maturation and limiting their integration into society under disability law.

Background: Health care outcomes for people with disability may be disproportionately affected by climate change through multiple interlinked factors, which are not well understood.

Objective: With use of scoping review methodology, this study aimed to model this intersectionality using socioecological (SE) levels to connect person-level rehabilitation diagnoses with systems/policy-level climate change and use this model to identify multilevel factors, rehabilitation outcomes, and responsive strategies from literature.

Methods: A scoping review of literature was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews methodology from three databases (PubMed Medline, Ovid Medline, CINAHL) using combinations of keywords (climate change), (rehabilitation), (disability), and (race). Logic and SE models were combined to model this intersectionality and create review forms that were used to abstract data. Common themes were collated (results), and additional experiential insight was added to provide contextual relevance (discussion).

Results: Of 32 deduplicated articles, 11 met inclusion criteria for qualitative analysis. Rehabilitation outcomes included physical, economic, mental, cognitive, and mortality (person level); rehabilitation services disruption, medical supply delay, emergency capacity overwhelmed (organizational level); and disabled environment (community level). Responsive strategies included education, backup supplies, planning, social support/utility registration (person level); competency assessment/training, physical medicine and rehabilitation physicians (PM&R) assisting patient in planning, providing pre-/postevent services, and establishing cross-coverage (interpersonal level); telerehabilitation, energy/resources conservation, PM&R inclusion in disaster mitigation planning (organization level); building accessible/resilient infrastructure, evidence-based practice guidelines through professional organizations (community level); and research funding, utility companies prioritizing power, and patients/providers included in planning (system/policy level).

Discussion: Climate change impact on rehabilitation diagnoses such as spinal cord injury and limb loss, as well as intersectionality with rehabilitation outcomes and identified responsive strategies, has been comprehensively modeled using SE levels. Race is not a commonly identified factor.

Conclusion: PM&R physicians can play a vital role in this intersectionality of disability, climate change, and rehabilitation outcomes.