Physical & Occupational Therapy in Pediatrics最新文献

Aims: To determine the potential of low-end high-intensity home-based hand-arm bimanual intensive therapy (H-HABIT) in mitigating post-modified constraint-induced movement therapy (mCIMT) regression in children with unilateral cerebral palsy (UCP).

Methods: Twenty-two children (aged 4-12 years) with UCP were assigned to either the experimental (n = 12) or control group (n = 10). Both groups completed 30 h of mCIMT for three weeks, followed by 30 h of H-HABIT for five weeks in the experimental group and none in the control group. Assessments, including the assisting hand assessment (AHA) and other standardized measures, were performed at baseline, post-mCIMT, and post-H-HABIT. Triaxial accelerometers were worn on both wrists during each phase to monitor the activity.

Results: The experimental group showed AHA scores from baseline to post-H-HABIT, with a significant time × group interaction (p = 0.001, ƞ² = 0.29) indicating distinct trajectories from the control. In contrast, actigraphy-based measures of the upper limb remained stable over time. Caregiver feedback for H-HABIT showed that 83.33% found the guidelines easy to follow, and 91.67% rated therapist interactions as helpful.

Conclusions: H-HABIT may help prevent post-mCIMT regression. Further research should refine task selection and explore advanced assessment methods to better capture real-world function.

Purpose: Children with cerebral palsy (CP) struggle in dual task (DT) situations, where interference may decrease performance when executing two simultaneous tasks. Dual task training (DTT) improves primary motor performance in individuals with typical development and neurological conditions, and emerging research also suggests benefits for DT performance. Its potential in children with CP, however, remains unexplored. This scoping review aims to (1) identify; (2) describe; and (3) synthesize the current evidence for DTT interventions in children with CP, and (4) evaluating its effects on mobility-based impairment, activity, and participation level outcomes.

Methods: Five electronic databases were searched. Studies were included if they were in English, included children with CP, used a motor-motor or motor-cognitive DTT intervention, detailed the intervention, and reported results.

Results: The six studies included 117 children with CP (F: 50, M: 67) and used motor-motor (n = 2) and motor-cognitive (n = 4) DTT paradigms. Training ranged from 480 to 1800 min, and all studies showed improved primary motor task performance.

Conclusion: Despite the study heterogeneity, the results provide early, yet promising, evidence that DTT may enhance primary motor task performance in children with CP. Robust and rigorous research is needed to explore the effects of exercise prescription, training regimens, and optimal dosing on motor and cognitive outcomes.

Objective: To explore the assessment practices and identification of movement difficulties in autistic children aged 12 months to 6 years by physiotherapists in Australia.

Methods: Registered physiotherapists providing services to autistic children ages 12 months - 6 years completed a survey. The survey was distributed via closed physiotherapy social media (Facebook) pages in Australia from March to June 2022. The survey included 8 items on strategies/approaches to assessment, 47 items on measurement, and 23 items on movement difficulties.

Results: 85 physiotherapists completed the survey. Findings indicated that parent reports, observations, and movement analyses were the most commonly used assessment strategies employed 100% of time, followed by musculoskeletal assessments (80%) and standardized assessments (50%). Of standardized assessments used, Alberta Infant Motor Scale (AIMS) was used most, by over 69% of physiotherapists, with multiple versions of five other standardized assessments used by over 52% of physiotherapists, namely Movement Assessment Battery for Children, Neurological Sensory Motor Developmental Assessment, Bruininks-Oseretsky Test of Motor Proficiency, Developmental Coordination Disorder Questionnaire and Test of Gross Motor Development. A range of movement difficulties were frequently identified in developmental delays (86% of time), gross motor (85%), coordination (82%), motor planning (81%), and hypotonia (80%).

Conclusions: Physiotherapists in Australia use a variety of methods to examine movement difficulties in young autistic children, suggesting that this frequently occurs prior to autism diagnosis.

Aims: The most used assessment tool to measure family-centered care and the perception of the care process is the Measure of Processes of Care questionnaire. This study aimed to evaluate the psychometric properties of the Spanish version of the MPOC-SP, specifically by assessing the reliability of its item scores, testing whether its factor structure aligns with the original version, and examining differences in scores across professional profiles.

Methods: The Spanish-adapted MPOC-SP questionnaire was completed by 278 early childhood service professionals across Spain. Analyses assessed internal consistency, construct validity through confirmatory factor analysis, and differences in scores across professional profiles.

Results: The Spanish MPOC-SP demonstrated strong psychometric properties, with Cronbach's Alpha values above 0.70 for total and dimensional scores. Confirmatory factor analysis supported the alignment of the data with the specified model. No significant differences in scores were found across professional profiles, indicating consistency in its application.

Conclusion: The Spanish version of the MPOC-SP is a reliable and valid instrument for assessing family-centered care. It provides valuable insights for evaluating and improving family-centered practices in early childhood services, thereby contributing to the enhancement of care quality.

Aims: Mother-Child Health Centers in Israel offer comprehensive health-care services, including unique screening programs that serve as important preventive services for families of lower socioeconomic status. This study aimed to explore the service quality regarding family-centered care and professionalism from the perspectives of parents, providers, and observers.

Methods: Eighty-nine Arabic-speaking parents of children (M = 17.4, SD = 11.7) from East Jerusalem completed socio-demographic, self-efficacy, care, and child development questionnaires. Five providers completed demographic-professional and care questionnaires; two occupational therapists completed observation forms.

Results: Most parents reported moderate self-efficacy, and half of the children had suspected/detected developmental delays. Parents rated enabling, partnership and respectful care highly, with low scores for providing information. Observations indicated higher scores for professional referrals and listening to parents, but lower scores for providing adapted-written information. Content analysis revealed two main categories knowledge provision and parent-provider interaction with sub-categories.

Conclusion: This study highlights the value of assessing early intervention services from multiple perspectives, confirming that high-quality interaction between recipients and providers is essential for successful family-centered services, while emphasizing the need for socio-cultural adjustments. Further research involving large samples of providers and diverse at-risk populations, and long-term assessment is recommended to refine and enhance these services.

Introduction: Sickle cell disease (SCD) affects 1 in every 350 newborns in the United States. Children with SCD are at risk for impaired postural control. The purpose of this study was to explore if children with SCD have impaired postural control as compared to age- and sex-matched controls.

Methods: Twenty-eight children between the ages of 6 and 17 years were recruited for the study including children with SCD and age- and sex-matched controls. Posturography measures included Limits of Stability (LOS) and Modified Clinical Test of Sensory Interaction in Balance (mCTSIB) testing and balance was measured using the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition (BOT-2).

Results: There were no between-group differences in posturography measures. Children with SCD had significantly poorer BOT-2 balance performance as compared to age- and sex-matched controls (p < 0.001).

Conclusion: This sample of children with SCD does not demonstrate impairments in posturography as measured by limits of stability and sensory integration despite having significantly impaired balance compared to peers. Additional research is necessary to determine why children with SCD demonstrate gross balance impairments without concurrent impairments in postural control.

Aim: The aim of this study was to determine the amount of displacement of the Center of Pressure (CoP) during movement of the affected limb in children with Neonatal Brachial Plexus Palsy (NBPP) and to compare it with the unaffected side.

Method: Forty-six children (6.63 ± 1.97 years) with NBPP who met the inclusion criteria were enrolled in this cross-sectional descriptive study. The amount of CoP displacement was measured using the Bertec BP5046 force plate while performing Modified Mallet Movement Scale (MMMS) subtests.

Results: When performing the MMMS subtests, maximum CoP displacements were greater for movements performed with the affected side (p < 0,05). The CoP displacements at the end of the movement were also greater for the affected side movements for global external rotation, hand to spine, hand to mouth and internal rotation (p < 0,05).

Conclusions: In children with NBPP, the difference in the amount of CoP displacement during the affected and unaffected side movements does not necessarily indicate pathology. It may instead reflect a specific postural control strategy. However, since the difference in the amount of trunk perturbation caused by limb movements can result in an asymmetric loading, it is crucial to include trunk control in rehabilitation protocols.

Background: Children with autism spectrum disorders (ASD) can have difficulty adapting to environmental changes and motor-tasks demands.

Objective: to investigate the effectiveness of non-immersive virtual reality (VR) combined with traditional physiotherapy versus traditional physiotherapy alone on static and functional balance in children with ASD, aged from 7 to 12 years.

Methods: Fifty-three children with ASD were randomly assigned to either the VR group, received virtual reality training combined with traditional physical therapy, or the control group, received traditional physical therapy alone. The Biodex balance system and the pediatric balance scale were used to evaluate the balance control before and after the 12-week treatment program.

Results: MANOVA results showed significant improvements in the pediatric balance scale scores for both the VR and control groups compared to the pre-intervention, and that the post-intervention results were significantly lower than the pre-intervention in terms of the overall sway index and all Biodex tested conditions (p < 0.05). However, post-intervention between-group comparisons showed that these significant improvements in all outcome measures were in the favor of the VR group (p < 0.05).

Conclusion: This study suggests that virtual reality training could be an effective adjunct to traditional physical therapy for improving postural control in children with ASD.

Aim: To understand caregivers' experiences of implementing sleep systems for children with complex neurodisability. This knowledge would help develop and refine the evidence base to inform clinical practice to improve care and support increased engagement and adherence to this approach.

Methods: Semi-structured interviews were conducted with nine caregivers (7 mothers, 2 fathers) of eight children aged 4-17 years (mean age 7.7 years) with complex neurodisability. Interviews were audio-recorded and transcribed. Interpretive Description methodology and inductive analysis based on Morse's four-step framework were employed to analyze the data.

Results: Three themes were developed: (1) It's a complex night; (2) This is what I know, incorporating subthemes "What I know about my child" and "What I know about sleep systems"; and (3) Support me to support my child. Sleep system interventions that account for nighttime health complexity and address caregivers' priorities of sleep and comfort for their child were perceived as more sustainable and successful by caregivers.

Conclusion: Embedding principles of family-centered care in sleep system assessment, prioritizing caregivers' goals of sleep and comfort, and fostering hope and trust through the co-production of postural care solutions are critical components of care. A shift in focus from "future prevention" of deformity to "protection and comfort" may advance the quality of care and uptake of sleep systems.

Aims: To evaluate the effects of telerehabilitation (TG) compared with an unsupervised home exercise training program (HG) on muscle function, physical activity (PA), and sleep in children with cystic fibrosis (CF).

Methods: Thirty children with CF (mean age = 10.2 ± 1.9 years) were randomly allocated to TG or HG. The exercise protocol was applied thrice a week for six weeks in the TG via Skype. The same exercises were sent in an exercise booklet to the HG, and phone contact was made once a week. Muscle function (one-minute sit-to-stand (1-min STS), sit-up, pushup, squat, and plank tests)), PA (Physical Activity Questionnaire for Older Children), and sleep (Epworth Sleepiness Scale (ESS) and Pediatric Sleep Questionnaire (PSQ)) were assessed before and after the 6-week study period.

Results: The 1-min STS significantly improved in the TG compared with the HG (p ≤ .001, η_p² = 0.474). The sit-up (p = .005, η_p² = 0.247), pushup (p = .002, η_p² = 0.180), squat (p = .002, η_p² = 0.284), and plank (p < .001, η_p² = 0.360) test scores were significantly improved in the TG compared to the HG. No significant changes between groups were seen for PA (p = .261, η_p² = 0.045), ESS (p = .160, η_p² = 0.069), or PSQ (p = .763, η_p² = 0.003).

Conclusion: Children who received TG improved muscle function more than children who received an HG. The effectiveness of longer term TG programs should be investigated in children with CF.