Physical & Occupational Therapy in Pediatrics最新文献

Aims: To describe the teaching strategies that physiotherapists currently employ in individual therapy sessions for children with DCD using the OPTIMAL theory for motor learning as a framework, focused on (1) autonomy (supporting autonomy vs. therapist-controlled), (2) expectancies (enhancing vs. lowering expectancies), and (3) attention (promoting an internal vs. an external focus of attention).

Methods: Eighteen physiotherapy sessions were videotaped and analyzed with Noldus The Observer XT using the OPTIMAL Strategies Observational Tool (OSOT). Relative duration (% of session time) and frequency were extracted for teaching strategies related to autonomy, expectancies, and attention.

Results: Physiotherapists mostly applied strategies to support autonomy and enhance expectancies in contrast to therapist-controlled strategies, and lowering expectancies. Strategies to promote either an internal or an external focus of attention were used to a similar extent. Furthermore, strategies were frequently combined; physiotherapists often employed more than one teaching strategy at a time.

Conclusions: The insight into current physiotherapy teaching practice that this study provides can help inform research and application regarding effective motor teaching for children with DCD. Follow up studies are needed to further investigate how child and task characteristics influence teaching strategy employment and to examine physiotherapists' reasoning behind their choice of strategies.

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.

Aims: The calf raise test (CRT) assesses plantarflexor strength and endurance, but normative data for children are scarce. Furthermore, contradictions exist on which factors are associated with total repetitions, with repetitions being the only metric considered. We quantified three of the main CRT outcomes (repetitions, total work, and peak height) in children 10-17 years and explored their relationship with various factors.

Methods: Healthy children (n = 165, 50.3% female) completed single-legged calf raises on a 10° incline, once on each leg. Test outcomes were extracted using the valid and reliable Calf Raise application.

Results: CRT outcomes were not significantly different between legs (p ≥ .19). The only covariates significantly associated with outcomes based on stepwise quantile regressions were body mass index centile for repetitions, meeting physical activity recommendations for total work and peak height, and age for total work. Outcomes did not significantly differ based on sex or maturation. Median values were around 26 for repetitions, 640-1460 J for total work (age dependent), and 10.1 cm for peak height for children meeting physical activity recommendations.

Conclusion: Children who were older, had lower body mass indices, and were more active exhibited superior CRT outcomes. Meeting physical activity recommendations appears beneficial for plantarflexor function and should continue to be prioritized in children.

Aims: To explore the feasibility, acceptability, and tolerability of an augmented reality intervention for children with and without movement impairments. Preliminary mechanisms of effect for motor learning were also assessed.

Methods: This non-randomized feasibility study included 33 participants between the ages of six and twelve (mean age 9.54, SD 1.60), with a range of motor abilities. Experimental sessions comprised of i) the Movement Assessment Battery for Children, 2nd Edition assessment, ii) a testing session with Intervention X, and iii) a questionnaire examining their experience. A supporting clinician who observed all sessions provided feedback on the delivery of Intervention X.

Results: Participants spent 895 min playing Intervention X. Most participants (92.2%) reported they had 'fun' using the intervention, and they would play at home (84.2%), and with friends (86.1%). Disengagement occurred in 16.7% of participants. Intervention X demonstrated evidence of a potential mechanism of effect for motor learning principles.

Conclusion: Intervention X was feasible, acceptable, and tolerable for children across a range of motor abilities in a school and clinic environment, supporting potential therapeutic benefits. Future studies should provide rigorous testing with children with movement impairments, such as developmental coordination disorder, to determine the long-term effectiveness of Intervention X.

Aims: To examine the correlation between a newly developed Fine Motor Test for the School-aged (FMTS) and the Movement Assessment Battery for Children-Second Edition (MABC-2), and to explore the FMTS's ability to identify children with suspected developmental coordination disorder (DCD) compared to the MABC-2.

Methods: Fifty-one children aged 7-14 years in Hong Kong participated. Each child was assessed with both the MABC-2 and FMTS, and their parents completed the revised Developmental Coordination Disorder Questionnaire (DCDQ-R). Suspected DCD was identified using the 15th percentile for the MABC-2 and the 5th percentile for the FMTS using DCDQ-R cutoffs. Spearman's rho correlation analyses were performed.

Results: Moderate-to-strong correlations (rho = .41-.70, p = .011 to p < .001) between the FMTS and MABC-2, except for the aiming and catching subtest, among children aged 7-10 years. The FMTS identified 20 children with suspected DCD, of whom 18 scored below DCDQ-R cutoffs, while the MABC-2 identified seven children with suspected DCD.

Conclusions: The FMTS demonstrates convergent validity and shows potential for aiding in the identification of DCD specifically related to fine motor difficulties in Hong Kong children. As the FMTS focuses solely on fine motor skills, combining it with gross motor assessments in clinical use is recommended.

Aims: Sensory differences are associated with disruption to daily occupations for both children and families. A one-to-one coaching approach with mothers is effective in increasing performance and satisfaction in children's daily occupations, and in reducing maternal stress. The study aimed to pilot a brief online group coaching intervention for mothers of children with sensory differences.

Methods: Eleven mothers participated in a brief online group coaching intervention of four x 90-minute sessions, based on Occupational Performance Coaching (OPC). Mothers gave both quantitative and qualitative feedback on their experience in the group. Mothers reported child occupational goals, maternal stress, and maternal sense of competence pre and post intervention.

Results: Statistically significant improvement in child occupations and aspects of maternal stress were observed. Maternal sense of competence showed improvement but did not reach statistical significance. They valued the sensory focus and found the group safe and supportive; they also gave feedback on how groups could be improved.

Conclusions: For mothers of children with sensory differences and associated occupational concerns, a brief online group coaching intervention, based on OPC, has the potential to support child occupational performance and reduce maternal stress.

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.

Aim: To investigate the feasibility, acceptability, and relevance of the Youth Engaging Transition (YET) instrument.

Methods: In this observational study, nine youth (16-21 years) with motor disabilities, their parents, and school physical therapists completed the YET, then triad members gave feedback about the experience (n = 27).

Results: Parents and PTs agreed that both sections (S1: Future Plans and S2: Self-Assessment and Goal Planning) were feasible. Three triads questioned the youth's understanding of the YET. Parents agreed that S1 and S2 were acceptable. Three PTs disagreed that S2 was an appropriate scope/depth. Five triads questioned the YET's length and repetitiveness. Youth and PTs reported that the YET was relevant. Perhaps due to previous transition planning experience, some parents reported not learning new information by completing the YET. Parents' and PTs' ratings were aligned, suggesting a common experience using the YET.

Conclusions: Results of this pilot study suggest that the YET has promise as a feasible, acceptable, and relevant transition planning instrument. Larger studies investigating the validity and reliability of the YET should include modifications to the YET, involve other transition team members, and ascertain the team's previous involvement in the planning process. Future YET iterations will include enhanced cognitive accessibility and shortened length.

Aim: Describes the development and implementation of the Applied Coaching Tool (ACT), and training protocol, to build coaching competency in therapists supporting parents of young children.

Methods: The ACT was developed using literature review, draft tool creation, expert review and refinement. A training protocol for therapists to learn how to coach was developed using principles of adult learning, coaching and instructional design to increase learner competence and confidence.

Results: The ACT framework includes five coaching events to support therapists to implement coaching practices including self-directed goals, learner-focused interventions with meaningful reflection, practice and feedback. Within the ACT, behaviors associated with coaching events were defined as overt therapist actions and elaborations - examples of interactional behaviors. The training plan for therapists consisted of a workshop, intentional practice with coaching feedback over a period of five months, and assessment of competence. Pilot implementation demonstrated evidence of acceptability, appropriateness, adoption and fidelity of the ACT.

Conclusion: Use of the ACT, and the training plan, provides practical clinical behaviors for therapists to coach families to be active participants in rehabilitation which may contribute to improvements in self-efficacy and motivation in therapy. Furthermore, it provides a reliable standard amongst therapists coaching in pediatric rehabilitation.

Aims: To measure the quality of life in children with impaired walking who receive a mobility assistance dog (MAD).

Methods: The parents of ten children who received a MAD completed the cerebral palsy quality of life questionnaire, before receiving their dog and at one, three, and six-month follow-up. Data were analyzed to assess changes for each participant and to the group.

Results: The group showed a positive change in the domains of social well-being and acceptance, feelings about functioning, and emotional well-being and self-esteem after six months. Children with less impairment (GMFCS I-II) showed a change in social-wellbeing and acceptance, feelings about functioning, participation, physical health, and emotional-wellbeing and self-esteem after six months. Children with more impairment (GMFCS III-IV) showed no change at any timepoint measured.

Conclusions: This novel therapeutic area of receiving a MAD demonstrated some positive quality of life changes after six months for a small group of children with impaired walking. These are preliminary findings in a small sample and this intervention would benefit from further study.