Physical & Occupational Therapy in Pediatrics最新文献

Introduction: Non-nutritive sucking (NNS) is commonly employed to assist in the development of preterm infants facing feeding challenges. The effectiveness of NNS interventions on sucking performance (suction and expression/compression component of sucking) in this population has not yet to be systematically explored.

Aims: To review the literature on the effects of NNS on sucking performance in preterm infants.

Methods: A comprehensive search was conducted across five databases, encompassing publications from the inception of these databases until July 2024. The studies included only randomized controlled trials (RCTs) involving preterm infants born before 37 wk with feeding problems, who were tube-fed. The experimental group received exclusive NNS intervention, while the control group received routine care or no intervention. Data extraction focused on one primary outcome (sucking performance) and two secondary outcomes (physiological characteristics and weight gain at discharge). The quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale, while the Cochrane risk-of-bias tool for randomized trials was employed to evaluate the risk of bias. The findings were summarized using a narrative synthesis approach.

Results: Nine RCTs involving a total of 575 preterm infants were incorporated. The methodological quality scores of the included studies ranged from 5 to 8. Compared to standard care, the use of NNS had positive influences on the Lower Anchors and Tethers for Children (LATCH) scale, aspects of sucking parameters (the percentage of milk taken and number of sucks per burst), and physiological characteristics. However, NNS produced variable results on the Preterm Infant Breastfeeding Behavior Scale (PIBBS), weight gain at discharge, and four sucking parameters-volume of milk intake at the first 5 min, rate of milk transfer, overall milk intake, and feeding time. Notably, insignificant association was found between NNS and other sucking parameters, including overall frequency, suction amplitude, and expression amplitude.

Conclusions: The effectiveness of NNS intervention on sucking performance, weight at discharge yielded inconsistent results. However, the existing evidence that elucidated the impact mechanism of NNS and its effects on sucking performance was constrained. Additional trials characterized by robust methodological quality should be employed to further elucidate and clarify the potential impact mechanism of NNS on sucking performance.

Aim: To assess the effectiveness of family-centered care (FCC) interventions on motor and neurobehavior development of very preterm infants.

Method: Randomized and quasi-randomized trials assessing the effect of FCC on motor and neurobehavioral outcomes in very preterm infants (28-32 wk gestation) were included. Five electronic databases and grey literature were searched from January 2010 to August 2022. Two reviewers independently screened the titles/abstracts and full texts, assessed the risk of bias, and extracted data. The Cochrane Risk of Bias 2.0 Tool and GRADE were used for risk and evidence certainty assessments. Meta-analysis or narrative synthesis was performed based on data availability and heterogeneity.

Results: Seventeen trials with 21 publications were included. GRADE showed low to moderate evidence. At 24 months, FCC interventions improved motor development (Mean Difference (MD):5.00, 95% CI: 2.58-7.42), cognitive development (MD: 3.64, 95% CI: 1.15-6.12), and behavior development (MD: -2.40, 95% CI: -4.32, -0.48) compared to control groups. Further, the FCC showed minimal or inconclusive effects on language, communication, and personal social development measured anytime between newborn and 24 months of age.

Conclusions: Early initiated FCC interventions can be a promising approach to improve motor, cognition, and behavioral development in very preterm infants.

Aims: To describe participation patterns and identify factors associated with participation of young Brazilian children with myelomeningocele (MMC) in their home, daycare/preschool, and community settings.

Methods: The participants were parents/caregivers of 70 children with MMC, averaging 26.7 (±17.3) months in age. Participation was measured by the Young Children's Participation and Environment Measure (YC-PEM) completed by interview. Simple and stepwise multiple linear egression models were used to examine factors associated with participation.

Results: On average children participated in home activities a few times a week, community activities once a month to a few times in the last month, and daycare or preschool activities once to a few times in the past four months. Age was associated with participation frequency (R² = 0.32; p < .0001) and number of activities (R² = 0.27; p < .02) in daycare/preschool and in the number of activities in the community (R² = 0.30; p < .0001). Number of environmental facilitators was associated with the desire for change in participation in daycare/preschool (R² = 0.21; p < .04). Mobility performance was associated with children's level of involvement (R² = 0.10; p = .006) and caregivers' desire for change in community participation (R² = 0.11; p = .006).

Conclusion: Knowledge of participation and factors that influence participation can help in designing interventions to improve participation opportunities for young children with MMC.

Aims: To evaluate attendance rates, daily therapy engagement, parents' perceptions regarding feasibility, acceptability, family-centeredness, and individualized outcomes of a collaborative telehealth-based physical therapy intervention for children with disabilities.

Method: Mixed-method design involving 15 families and 17 children with disabilities (range age 4-90 months). Parents recorded time spent on home activities. Family-centeredness was assessed using the Measure of Processes of Care-20-item (MPOC-20). The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to measure individualized outcomes. Interviews were conducted on families' perceptions of the telehealth service.

Results: Parents attended an average of 8.29 out of 9 scheduled telehealth sessions and spent an average of 1.32 (±0.58) hours per day on therapy activities. Parents rated the services as family-centered "to a fairly great extent" or "to a great extent". On average, children achieved individualized goals. Parents identified therapists' collaborative behaviors and information sharing as facilitators, beliefs about their abilities and technical issues as barriers, and empowerment and active engagement as benefits of the telehealth sessions.

Conclusion: The family-professional collaborative telehealth physical therapy was perceived by parents as acceptable and feasible to address their children needs. Children achieved individualized goals and participating families actively engaged in the intervention process.

Aims: Autism Spectrum Disorder (ASD) may exhibit early motor delay, and long-term motor impairments in addition to social and communicative problems. This pilot study aimed to describe (i) the early motor repertoire using General Movements Assessment (GMA) of infants later diagnosed with ASD, (ii) the developmental outcomes in these children between 24- and 42-months, and (iii) the relationship between GMA and developmental outcomes.

Methods: Ten children diagnosed with ASD were included. All infants were assessed using Motor Optimality Score for 3- to 5-month-old Infants-Revised score sheet for GMA, and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) for developmental functioning aged between 24- and 42-months.

Results: The median Motor Optimality Score-Revised (MOS-R) was 10 (range: 6-28), considered reduced optimal, and 80% of children had less than optimal MOS-R. 60% of the children had aberrant fidgety movements and abnormal postural patterns, and 80% had abnormal but not cramped-synchronized movement character. The mean composite scores of all subdomains in Bayley-III were below 69 (extremely low) in all children.

Conclusions: This study highlighted the importance of early motor repertoire and longitudinal developmental assessments in children with ASD. Further research is needed to explore the potential of this assessment as a screening tool.

Aims: Children in foster care (CFC) have prevalent developmental health needs. Comprehensive health assessments (CHA) that include development evaluation are recommended for CFC. The impact of adding occupational therapy (OT) to multidisciplinary CHA teams is unknown. We aimed to describe findings from OT evaluations performed as part of CHA for CFC and determine if OT evaluation influences developmental health recommendations.

Methods: Retrospective study at a clinic for CFC that included 335 children with OT evaluation during their CHA and 217 without OT evaluation due to limited availability. OTs performed developmental components of CHA using observation and standardized testing. We used descriptive statistics, and chi-square and Fisher's exact tests to compare developmental health recommendations between patients with and without OT assessment.

Results: Median age was 8.3 years (range 0, 19). At least one aspect of development was delayed in 230/335 (69%) children evaluated by OT. OTs provided strategies to strengthen development to 74% of evaluated youth. Children seen by OT received significantly more developmental referrals compared to controls (38% versus 58%, p<.001).

Conclusions: Our findings suggest rehabilitation specialists such as OTs can enhance detection of developmental needs and provide strategies to strengthen development when included in CHA for CFC.

Aims: Well-designed score reports can support therapists to accurately interpret assessments. We piloted a score report for the Pediatric Evaluation Disability Inventory-Patient Reported Outcome (PEDI-PRO) and evaluated: 1) To what extent can occupational and physical therapists (OT, PT) accurately interpret item-response theory (IRT)-based PEDI-PRO assessment results? 2) What is the perceived clinical utility of the pilot score report?

Methods: Exploratory, sequential mixed methods design. Focus groups with OT and PTs (n = 20) informed the development of the final score report; revisions were made in response to feedback. Next, OTs and PTs (n = 33) reviewed score reports from two fictional clients and answered survey questions about the interpretation of the PEDI-PRO results. Additional questions evaluated clinical utility.

Results: Focus groups: Visual cues supported score interpretation, but therapists requested additional explanations for advanced IRT measurement concepts. Survey: Therapists accurately interpreted foundational IRT concepts (e.g. identifying most/least difficult items, highest scores), but were less accurate when interpreting advanced concepts (e.g. fit, unexpected responses). Therapists anticipated sharing different components of the score report with family members, clinicians, and payers to support their clinical practice.

Conclusions: The pilot PEDI-PRO score report was highly endorsed by therapists, but therapists may need additional training to interpret advanced IRT concepts.

Aim: To compare bimanual coordination in children with bilateral cerebral palsy (BCP) with that of children with typical development (TD) and correlate bimanual coordination with clinical measures of hand function.

Methods: 3-D kinematic data were collected from 14 children with BCP (mean age 13 years 1 month; range 7.3-17.2 years, 5 females) and 14 age-matched children with TD (mean age 13 years 1 month, range 7.0-16.0 years, 7 females) as they opened a drawer with one hand and activated a switch inside it with the other hand at self-paced and as-fast-as-possible speeds. Hand roles varied in each condition. Participants' hand function levels were classified using the Manual Ability Classification System. Unimanual dexterity and bimanual performance were evaluated using the Box and Blocks Test and Both Hands Assessment respectively.

Results: Participants with BCP performed the bimanual task more slowly (p < 0.001) and sequentially, as evidenced by greater time differences between the two hands achieving the end goal (p = 0.01). Faster speeds, particularly when the less affected hand opened the drawer, facilitated time-related measures of bimanual coordination (p < 0.05). Bimanual coordination correlated with all clinical measures of hand function (p < 0.05).

Conclusion: For children with BCP, speed and hand used for each subcomponent of the task influence bimanual coordination. Better bimanual coordination is associated with less impairment of both hands.

Aims: The aims of this study were to: (1) synthesize existing evidence regarding the integration of students with osteogenesis imperfecta (OI) into the school setting, (2) tabulate existing school integration tools for OI, and (3) create an individualized school plan to facilitate school integration.

Methods: Guided by the process of developing evidence-informed guidelines, an international, interprofessional, expert task force was convened. The process entailed: (1) reviewing of the literature, (2) developing recommendations, and (3) creating a clinically meaningful, person-focused plan to facilitate the integration and promotion of school inclusivity. The 13-member task force relied on empirical studies, grey literature, and their experiential knowledge (from clinical, teaching or patient experiences) to devise the plan.

Results: Over a series of eight meetings and five drafts, the Task Force prioritized 14 core items for inclusion. These items consisted of general student information, fracture response protocol, student inclusion recommendations, mobility considerations, transfer considerations, toileting protocol, physical education recommendations, fieldtrip information, transportation considerations, evacuation plan, environmental and scholarly considerations, consent and authorization, and an annual renewal document.

Conclusion: Further research is recommended to pilot the plan, solicit ongoing feedback, implement and evaluate the plan into routine education and health care practices.