Physical & Occupational Therapy in Pediatrics最新文献

Aims: The aims of this study were to explore perceptions of school-based physical therapists (SBPTs) about professional development and effective practice and to create a conceptual framework to help understand how SBPTs become effective practitioners who continue to learn and grow professionally as clinicians in an educational setting.

Methods: Twenty school-based physical therapists completed a demographic questionnaire and a semi-structured interview. Guiding interview questions focused on SBPTs' perceptions of roles and responsibilities, professional development, barriers, and recommendations.

Results: Participants identified roles and personal qualities of effective SBPTs. Three concepts for the process of professional development were developed: educational context and culture, barriers to effective practice, and strategies for professional development.

Conclusion: The development of effective practice for SBPTs is a multifaceted, iterative process involving a unique set of knowledge, skills, and behaviors that allow them to fulfill their roles. The process takes time and effort to understand the self within the educational context and culture, recognize barriers to effective practice, and develop strategies for success. A conceptual framework was developed to assist SBPTs in implementing a plan for professional development that leads to effectively providing services to students and functioning as essential members of the educational team.

Aims: to map and synthesize the results from studies that assessed whether individuals diagnosed with cerebral palsy (CP) have abnormal masseter and temporal muscles activation during the masticatory cycle.

Methods: Six databases were searched for comparative observational studies assessing masticatory muscles activation in individuals with CP through electromyography analysis. Methodological quality was evaluated using the Joanna Briggs Critical Appraisal Checklist. Outcome data were combined in meta-analysis using the Review Manager software.

Results: We included five cross-sectional studies with an overall low risk of bias. Meta-analyses showed no difference between CP and healthy individuals regarding maximum voluntary isometric contraction: right masseter (Standard mean difference [SMD] - 0.95; 95% CI -2.03 to 0.13); left masseter (SMD -0.92; 95% CI -1.93 to 0.09); right temporal (SMD -0.72; 95% CI -1.63 to 0.18); and left temporal (SMD -0.68; 95% CI -1.76 to 0.40). Electrical activity amplitude in the inactive period was superior in the CP group, and maximum bite pressure presented higher values in the control group (Mean difference [MD] - 17.38; CI 95% -26.62 to -10.15).

Conclusions: Based on observational studies with a lower level of evidence, individuals with CP seem to present difficulties activating masticatory muscles. Future prospective cohort studies with rigorous methodology are still necessary to support these findings. PROSPERO register CRD42020208444.

Aim: To determine the level of evidence for the effectiveness of telerehabilitation against comparison interventions in improving child- and parent-related outcomes in children and youth with developmental disabilities.

Method: A systematic approach, comprised of a comprehensive search; transparent study selection, data extraction, quality assessment by independent reviewers; and synthesis of sufficiently similar data (per diagnostic group, health profession, and overall level of evidence for each outcome) was undertaken.

Results: Fifty-five studies (29 randomized trials) were included across six diagnostic groups and ten health professions. Common telerehabilitation targets varied across diagnostic groups and included motor function, behavior, language, and parental self-efficacy. Telerehabilitation was found to be either more effective or as effective versus comparison intervention in improving 46.9% or 53.1% of outcomes, respectively. It was never found to be detrimental or less effective. Strong to moderate, limited, and insufficient levels of evidence were found for 36.5%, 24.5%, and 38.6% of the outcomes, respectively.

Conclusion: There is sufficient evidence suggesting that telerehabilitation is a promising alternative when face-to-face care is limited. It is comparable to usual care and is more effective than no treatment. Blending in-person and telerehabilitation approaches could be beneficial for the post-pandemic future of rehabilitation in pediatric care.

Aims: This case series was completed to determine the effectiveness of an interdisciplinary (occupational and physical therapy) approach to treating constipation and fecal incontinence in children. Non-pharmacological therapies for treating constipation and incontinence are showing potential benefits, especially for children not responding to standard medical treatment, which involves oral laxatives for fecal dis-impaction (cleanout) and maintenance dosing to prevent further impaction.

Methods: A retrospective chart review, surface electromyography (sEMG) biofeedback, and parent and child reports of progress was completed for two children ages 4 and 10 years old. Progress toward goals was measured using a therapy plan of care and progress updates every 60 days. Focus of goals included, pelvic floor muscle coordination and activation, education of anatomy and physiology of digestive system, emotional regulation, functional training in the bathroom, and hygiene.

Results: Notable improvements in pelvic floor function, emotional regulation, and defecation dynamics contributed to decreased constipation and fecal incontinence as well as improved emotional regulation and confidence in both participants over a 6-month period.

Conclusion: A coordinated physical therapy and occupational therapy approach to treating children with constipation and fecal incontinence can be successful in reaching full continence and support children have not responded to standard medical treatment.

Aims: To refine a cardiac rehabilitation pathway for pediatric heart transplant recipients; assess clinician knowledge and adherence to the program; and evaluate patient outcomes.

Methods: The center has utilized a rehabilitation pathway for pediatric heart transplant recipients. Challenges in practice include access to centers, lack of data tracing, and adherence to the pathway. The quality initiative focused on program refinements: implementation of text templates to improve data collection, collection of the Pediatric Cardiac Quality of Life Inventory (PCQLI), Functional Independence Measure (WeeFIM) and Child Occupational Self-Assessment (COSA), development of an outreach program, and creation of an educational program for therapists to increase content knowledge and improve clinician satisfaction.

Results: In the evaluation of rehabilitation follow-up post-transplant, there was no statistical significance between the pre- and post-implementation groups. After the implementation of the refined pathway, there was an increase in the completion of the six-minute walk test post-transplant (p = 0.048). Clinicians' responses post educational session noted familiarity with the pathway (88%), documentation (78.8%), and outcome measures (97%). Results of outcomes noted improvement in six-minute walk distances and a decrease in the rate of perceived exertion post-transplant. To ensure future pathway adherence, clinical support should be implemented, and key players identified to maintain sustainability.

Aims: Children with disabilities and rare or undiagnosed conditions and their families have faced numerous hardships of living during the COVID-19 pandemic. For those with undiagnosed conditions, the diagnostic odyssey can be long, expensive, and marked by uncertainty. We, therefore, sought to understand whether and how COVID-19 impacted the trajectory of children's care.

Methods: We conducted semi-structured qualitative interviews with 25 caregivers who, prior to the pandemic, were on a diagnostic odyssey for their children.

Results: Most caregivers did not report any interruptions to their child's diagnostic odyssey. The greatest impact was access to therapy services, including the suspension or loss of their child's in-person therapeutic care and difficulties with virtual therapies. This therapy gap caused caregivers to fear that their children were not making progress.

Conclusion: Although much has been written about the challenges of diagnostic odysseys for children and their families, this study illustrates the importance of expanding the focus of these studies to include therapeutic odysseys. Because therapeutic odysseys continue regardless of whether diagnoses are made, future research should investigate how to support caregivers through children's therapies within and outside of the COVID-19 context.

Aims: The Little Developmental Coordination Disorder Questionnaire (LDCDQ) is a parental questionnaire designed to identify preschool children at risk of Developmental Coordination Disorder (DCD). This study aimed to translate and cross-culturally adapt the LDCDQ for French European informants (Little Developmental Coordination Disorder Questionnaire-French European [LDCDQ-FE]) and to undertake a pilot examination of its psychometric properties on a French sample.

Methods: A thorough process of cultural adaptation was completed. The psychometric properties were examined with a sample of 154 French children aged to 5y11m (control = 121; clinically referred = 33). A sub-group of 34 children was assessed using the MABC-2 to measure convergent validity.

Results: Principal component analysis demonstrated a four-component structure, accounting for 67.5% of the variance. Internal consistency was acceptable to good (α = 0.74-0.89). Significant correlation between the LDCDQ-FE and the MABC-2 total scores showed convergent validity. Discriminant validity was supported by significant score differences between the clinically referred and a matched control sub-group. Using ROC curves, a cutoff of 67 was proposed for a sensitivity of 81.3% and a specificity of 77.8%.

Conclusions: Results show initial evidence of the psychometric properties of the LDCDQ-FE and are encouraging of its use to identify young preschoolers at risk for DCD. In future studies, the test-retest reliability should be investigated, and study sample sizes expanded.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neuro-developmental health condition in children and adolescents. Parenting a child with ADHD can profoundly affect mothers' health. Research is limited regarding occupational experiences and their impact on health among mothers of children with ADHD (MoCwADHD). Ultra-orthodox MoCwADHD may have unique cultural circumstances that have not been studied.

Aims: To broaden understanding of parental stress, psychological health, and quality of life (QoL) of ultra-orthodox MoCwADHD and explore a possible role of occupational experiences on these outcomes.

Methods: Ultra-orthodox MoCwADHD (N = 114) completed a sociodemographic questionnaire and measurements to assess child ADHD symptomatology, mother's ADHD, parental stress, psychological health, QoL, and occupational experiences.

Results: Participants displayed moderate parental stress, and 54.9 percent also showed psychological distress symptoms, similar to the literature on MoCwADHD in the general population. Frequency of engagement in health promoting occupations reflected patterns in line with cultural beliefs. Structure Equation Modeling showed that child ADHD negatively affected mothers' stress, psychological health and QoL. Importantly, occupational experiences directly and indirectly, via parental stress, impacted psychological health and QoL.

Conclusions: MoCwADHD impacts maternal health in the ultra-orthodox population and occupational experiences may be a modifiable target for promoting their health.

Aims: To understand the experiences of young people returning to physical leisure activities following a severe acquired brain injury (ABI).

Methods: Seven young people (5 male; 14-19 years) participated. Semi-structured interviews were conducted with young people who sustained a severe ABI 1-3 years prior to the study. Data thematically analyzed using Braun and Clarke's six-phase approach.

Results: Three main themes were created: My changing sense of identity around physical activity after my brain injury (how important physical activity was to them, how participation changed following their ABI); Why I take part in physical leisure activities (fun, friendships, help with recovery and physical and emotional health); and I can't do it alone (need for trusted adults to practically and emotionally support them to try and activities and continue to participate).

Discussion: Returning to physical leisure activities after ABI was important to young people, especially if they were active prior to their injury. However, participating with changed abilities was practically and emotionally challenging. Services need a multidisciplinary approach to ensure young people are supported with psychological processes of loss, adjustment, identity and resilience in addition to the practical help necessary to enable meaningful participation in activities they consider fun.

The aim of this perspective is to describe the theory and practical steps of using principles of social network analysis to help measure the social inclusion of individuals with intellectual and developmental disabilities (IDD). Social inclusion for those with disabilities has become an important area of focus of rehabilitative professionals in the past decade. Social inclusion is comprised of the domains participation and social interaction. Decreased social inclusion can negatively impact quality of life and health. Individuals with IDD continue to experience barriers to social inclusion such as limited opportunities to socialize and participate in community groups, physical barriers, and the lack of available valued social roles. There are limited methods for measuring social inclusion for individuals with IDD. Social network analysis is one way to analyze and understand social relationships to better understand the social inclusion of individuals with IDD. Providing a way to measure social inclusion may help answer questions about the effectiveness of interventions, ultimately leading to increased social inclusion for individuals with IDD.