Physical & Occupational Therapy in Pediatrics最新文献

Aims: To explore the psychometric properties of the Vietnamese Pediatric Evaluation of Disability Inventory (vPEDI) using Rasch analysis.

Methods: 403 Vietnamese children aged 0.5 to 7.5 years with typical development were evaluated by the vPEDI. The Andrich Rating Scale model (RSM) using WINSTEPS was utilized to analyze the construct validity, internal consistency, and precision of the vPEDI, particularly the Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS) subscales. A keyform ability map was generated to illustrate an example of the item-level hierarchy of the self-care domain in the FSS.

Results: The vPEDI showed strong item-level psychometric properties for both the FSS and CAS under RSM. Ninety-five to 98.5% of items fit the three domains in the FSS, and 87.5 to 100% of items fit the three domains in the CAS. A keyform ability map for a child with a middle self-care ability in the FSS showed a clear pattern, where the child's transition between capable and unable items represented their ability level.

Conclusion: The vPEDI provided a valid, reliable, and precise measure of the functional capacity and performance for typically developing children in Vietnam, with few misfitting items.

Aim: To estimate the effectiveness of Constraint-Induced Movement Therapy (CIMT) vs. conventional therapy in improving the frequency, quality, and spontaneity of the affected arm usage and acquiring new motor programs in children with Obstetrical Brachial Plexus Palsy (OBPP).

Methods: Pilot, randomized, and controlled clinical trial with a blind evaluator. Twenty (N = 20) children with OBPP diagnoses were divided into Intervention Group (CIMT protocol, 5x/week, 3h/day, 3 wk) and Control Group (conventional Physiotherapy/Occupational Therapy 2x/week, 40 min/day, 3 wk). Pediatric Mal Activity Log - Revised (PMAL-R) was used for quality and frequency measures; Pediatric Arm Function Test (PAFT) was used to measure the spontaneous use of the affected upper limb; Inventory of New Motor Activities and Programs (INMAP) was used for the acquisition of new motor programs. All the evaluations were applied pre and post treatment.

Results: CIMT was superior compared to control in terms of frequency (mean change= 1.58; 95% CI 0.83 to 2.33; p < 0.001) and quality of movement (mean change= 1.53; 95% CI 0.78 to 2.28; p < 0.001), in spontaneity of use in unimanual tasks in PAFT (mean change= 2.9; 95% CI 1.29 to 4.5; p = 0.022) and in the INMAP (mean change= 1.4; 95% CI 0.70-2.10; p < 0.001). All the effect sizes for the differences were large, and MCID showed large effects for PMAL-R and PAFT.

Conclusion: CIMT is favored over standard care, with gains in terms of quality and frequency of movement, spontaneity of use, and acquisition of motor programs.

Background: Despite advances in neonatal care, preterm birth remains associated with high rates of subsequent motor impairment. Preschool-age children born very preterm show poorer motor outcomes and face various motor challenges compared with their term peers.

Aim: To examine associations between the Alberta Infant Motor Scale (AIMS) at 12 months and motor and gait outcomes at 4-5 years in children born <30 weeks' gestation.

Methods: Prospective cohort study of 149 infants born at <30 weeks' gestation, assessed at 12 months using the AIMS. Assessments at 4-5 years included the Movement Assessment Battery for Children, second edition (MABC-2), and the GAITRite system.

Results: Lower AIMS total scores were associated with lower balance skills on the MABC-2 (coefficient 0.14 score, 95% confidence interval (CI) 0.07, 0.22), a wider base of support in tandem gait (coefficient -0.05 cm, 95% CI -0.09, -0.001), and higher rates of motor impairment (odds ratio 2.51, 95% CI 2.36, 2.69) at 4-5 years. AIMS scores at or below the 5th centile were associated with lower balance skills (mean difference -1.34 score; 95% CI -2.27, -0.41) and shorter double support in tandem (mean difference -1.93%; 95% CI -3.77%, -0.08).

Conclusion: AIMS at 12 months may help identify infants at risk of poorer balance and gait challenges, enabling early interventions in children born preterm.

Aim: To compare social functioning components (social skills, behavioral challenges, and social participation) of preschool children with and without sensory modulation disorder (SMD) and to examine whether social skills and behavioral challenges mediate the relationship between sensory processing difficulties and social participation.

Methods: Parents of 77 preschool children aged 3-6, with (n = 38) and without (n = 39) SMD, completed questionnaires on their child's Sensory Profile, social skills and behaviors, and social participation.

Results: Children with SMD demonstrated lower social skills and social participation and more behavioral challenges compared to typical peers. Both the social skills and behavioral challenges levels mediated the relationship between sensory processing difficulties and social participation.

Conclusion: The findings support an indirect association between sensory processing and social participation, occurring through the associations of sensory processing differences with social skills and behavioral challenges. The findings underscore the importance of assessment and intervention of children with SMD during early childhood to identify and mitigate social skills and behavioral difficulties that may limit social participation.

Aim: To contrast parents' and pediatric therapists' beliefs regarding infant container use (e.g. car seats, strollers, swings, and jumpers), compare parents' container use with therapists' recommendations, and understand how therapists educate parents about infant containers.

Methods: Two anonymous surveys were distributed to parents of infants younger than 19 months of age and pediatric therapists. Participants rated their beliefs about the developmental impact of 10 types of infant containers, as well as appropriate durations and reasons for using each type of container. Parents also reported their daily use of the containers. Differences between parents' and therapists' beliefs were evaluated.

Results: Overall, pediatric therapists (n = 341) held more negative beliefs about containers and recommended shorter durations of use than parents (n = 250). Parents' average daily use of containers was more than double the longest duration recommended by therapists. Parent education regarding containers varied among therapists, with most recommending that parents limit container use to a specific amount of time.

Conclusion: Therapists and parents differ in their beliefs regarding the influence of containers on child development, as well as how and why containers should be used. Pediatric therapists should consider each family's beliefs and needs when educating parents about infant containers.

Aim: Children diagnosed with autism spectrum disorder (ASD) require timely access to occupational therapy (OT) to support their developmental and functional needs, yet children of minority races and ethnicities may experience barriers to accessing care. This study aimed to assess racial and ethnic differences in OT access during the initial five years post-ASD diagnosis.

Methods: This retrospective study utilized electronic health records from a large pediatric health system encompassing 13 outpatient sites in the Northeastern United States. Data on OT access from 2014 to 2019 (the most recent five-year period uninterrupted by the COVID-19 pandemic), comorbid diagnoses, and social determinants of health were collected.

Results: The sample comprised 1181 children diagnosed with ASD in 2014 (diagnosis age: M = 5.0 years, SD = 3.2). No differences in odds of OT receipt were found between racial/ethnic groups. However, children of minority race/ethnicity had lower OT intensity, with Hispanic, Black, and Asian and Pacific Islander children receiving 0.6 (95% CI = [0.44, 0.82]), 0.54 [0.36, 0.81], and 0.55 [0.32, 0.96] times the number of OT visits received by non-Hispanic White children over five years post-diagnosis.

Conclusion: Children of minority race/ethnicity may receive lower OT intensity, suggesting potential barriers in continued access to therapy following ASD diagnosis.

Aims: Functional neurological disorder (FND) etiology is multifactorial. This study aimed to examine: (1) generalized joint hypermobility (GJH) prevalence in children diagnosed with FND and (2) the association between GJH and FND severity, activity level, and participation.

Methods: Participated in this study 53 children with FND (mean age 14.2 ± 2.7 years; 73.6% female). GJH was assessed using the Beighton score. FND severity was evaluated with the 24-item Children's Somatic Symptoms Inventory (CSSI-24), number of limbs affected, and pain following the six-minute walk test (6MWT).

Results: GJH was identified in 43% (Beighton ≥4) and 24% (Beighton ≥6) of participants. Elbow hyperextension was the most common feature (56.6%). The total Beighton score was independently associated with CSSI-24 (R²=.25, p<.01) and with the number of limbs involved (R²=.15, p<.01). A positive association was observed between Beighton score and pain post-6MWT.

Conclusion: Regardless of the Beighton cutoff used, GJH prevalence remained high, with at least 1 in 4 participants presenting GJH even at the strictest threshold (≥6). GJH was associated with increased CSSI-24 and motor involvement. These findings suggest that GJH may represent a somatic vulnerability factor within the biopsychosocial model of FND. Routine assessment could help identify meaningful subgroups and guide individualized treatment.

Aims: To describe mobility outcomes for youth with cerebral palsy (CP) who received inpatient rehabilitation (IPR) following multilevel surgery (MLS) and surgical and patient factors associated with mobility outcomes.

Methods: Data for 58 youth (mean age 13.5 years; Gross Motor Function Classification System [GMFCS] level II-53%; III-47%) who underwent high-burden MLS were retrospectively reviewed. 81% received IPR following MLS; average length of stay (LOS) was 4.3 wk. The Functional Independence Measure for Children (WeeFIM) was administered at admission and discharge from IPR. The Pediatric Outcomes Data Collection Instrument Transfer and Basic Mobility score (PODCI-TBM), Gait Deviation Index (GDI), and Gross Motor Function Measure Section D (GMFM-D) were administered preoperatively and at 18 months following MLS.

Results: Youth made significant gains in acute mobility function (p < 0.0001); for youth classified at GMFCS III, length of stay was significantly longer (p = 0.03). Lower WeeFIM cognitive scores and lower GMFM-D scores preoperatively correlated with fewer mobility gains during IPR (r = 0.48, p = 0.0007). For all patients, at 18 months postoperatively, GDI improved significantly (p < 0.01); GMFM-D and PODCI-TBM did not (p > 0.05).

Conclusion: Youth had improved mobility acutely after MLS that was associated with cognition and preoperative gross motor function. IPR did not influence 18-month mobility improvements.

Aims: To co-design an intervention model for 4-year-old children with mild developmental delay, in particular, mild motor delay, in the childcare setting.

Methods: An exploratory sequential mixed-methods design via a three-stage co-design approach was used with qualitative and quantitative methods of data collection and analysis. Stage 1: a rapid literature review and collaborating with educators, parents, and physical therapists, to identify considerations and preferences for an intervention model. Stage 2: a national cross-sectional online survey collected feedback on intervention from a wider national sample of educators, physical therapists and parents/carers. Stage 3: survey feedback allowed development of the final intervention model.

Results: Studies evaluating interventions on non-typically developing 4-year-old children with mild motor delay in the childcare setting varied. Seventy stakeholders completed the survey most of whom were physical therapists (n = 57). Stakeholders preferred: a combined treatment approach by multiple professionals within the childcare setting using existing equipment, an intervention to include all children, to alternate between individual and group-based, and to be frequent (30 min, 2-3 times per week, 8-10 weeks long).

Conclusions: This co-designed intervention model involves a combined approach, two-to-three 30-min group and individual-based sessions per week over 8-to-10 weeks delivered by health professionals and educators.

Background: This randomized controlled trial examined the effects of deep breathing exercises (DBEs) and transcutaneous auricular vagus nerve stimulation (VNS) on psychosocial and autonomic outcomes in mothers of children with cerebral palsy.

Methods: Thirty-nine participants were randomly assigned to the DBE (n = 20) or VNS (n = 19) group and received three sessions per week for three weeks. The outcomes included the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Zarit Burden Interview (ZBI), Composite Autonomic Symptom Score-31 (COMPASS-31), heart rate variability (HRV), and the Nordic Musculoskeletal Questionnaire-Extended Version (NMQ-E).

Results: Both interventions produced significant within-group improvements in sleep quality, depressive symptoms, caregiver burden, and autonomic symptom burden (p < .05). In contrast, the HRV parameters showed no significant within-group changes (p > .05). Between-group analyses indicated a greater reduction in BDI scores in the VNS group (d = 0.74), whereas improvements in the PSQI (d = 0.43), ZBI (d = 0.08), and COMPASS-31 (d = 1.19) scores were comparable between the two groups. NMQ-E pain scores decreased in six regions of the DBE group and seven areas of the VNS group, with small-to-moderate between-group effect sizes across body regions; however, none of these differences reached statistical significance (p > .05).

Conclusion: Both interventions were effective, with VNS demonstrating more substantial antidepressant effects and broader pain reduction, whereas DBE remains a simple, low-cost, and scalable option for caregiver support.