Physical & Occupational Therapy in Pediatrics最新文献

Aims: Identify occupational therapy service models in Chilean schools and explore the factors that influence these models, and how they align with inclusive practices.

Methods: This was a mixed-methods study that included a cross-sectional survey that obtained 241 valid responses from Chilean OTs working in schools, which were analyzed using descriptive statistics. Eighteen of these participants subsequently participated in four online focus groups, discussions that were analyzed using a thematic approach.

Results: Participants provided more frequent direct pull-out services (68.3%) with weekly 45 min sessions, conducted mainly in an OT room or mainstream classroom. Five factors were perceived to influence services: institutional constraints, the educational community's perspectives on OTs, characteristics of students, a persistent structural demand for a deficit-based approach, and the impact of the COVID-19 pandemic.

Conclusions: The service model of OTs in Chilean schools was characterized by difficulty aligning with inclusive practices. This reveals a praxis with a markedly medical focus, making it difficult to distinguish it from clinical practice, an essential aspect for the development of OT services in schools.

Aims: To develop and validate the Iranian ICF-CS for 6-12-year-old children with CP from the perspective of Iranian Occupational Therapists (OTs).

Method: In the first phase, using the Delphi technique, a three-round electronic-mail-survey was conducted from January to May 2022 among 22 experienced Iranian OTs working with children with CP. The experts were asked to identify and reach consensus on the most relevant ICF categories concerning the patients' problems, resources, and environmental aspects in children with CP. In the second phase, a new sample of 12 Iranian OTs rated the essentiality and relevancy of categories identified in the Delphi phase, with Content Validity Ratio (CVR), Item-Content Validity Index (I-CVI), Modified Kappa, and Scale-Content Validity Index/Average (S-CVI/Ave) calculated to ensure robust validation.

Results: Among 154 proposed categories of the Delphi process, 119 categories were confirmed in the validation phase including 6 Body-structures, 37 Body-functions, 52 Activity-and-participation, and 24 Environmental-factors with the CVR and I-CVI ranges of 0.67- 1.00 and 0.83-1.00 respectively. The S-CVI/Ave of 0.93 was obtained as the scale-level CVI.

Conclusion: The Iranian ICF-CS for 6-12-year-old children with CP, consisting of 119 categories, demonstrated strong content validity from the perspective of Iranian OTs.

Purpose: To explore the concurrent validity and responsiveness of the Wheelchair Skills Test-Questionnaire (WST-Q) caregiver proxy, and the inter- and intra-rater reliability of the Wheelchair Skills Test (WST) in children and young adults with cerebral palsy (CP).

Methods: Concurrent validity and responsiveness of the WST-Q caregiver proxy were assessed in 12 participants with CP (mean age 15 years; SD: 3 years 6 months); power wheelchair users. Concurrent validity of the WST-Q was determined using Pearson's correlation coefficients, and responsiveness with linear regression. Inter- and intra-rater reliability of the WST were assessed with intraclass correlation coefficients (ICC) (n = 4).

Results: The WST-Q caregiver proxy showed good concurrent validity with WST total scores (r = 0.623, p < 0.001). No acceptable responsiveness was found for the WST-Q caregiver proxy (R² = 0.317, p = 0.071). Inter-rater reliability for the WST total scores was good (ICC = 0.864, p < 0.001); and intra-rater reliability ranged from good to excellent (Rater 1 ICC = 0.857; Rater 2 ICC = 0.904; Rater 3 ICC = 0.923, all p < 0.001).

Conclusions: The WST-Q caregiver proxy appears to be valid for assessing levels of wheelchair skills in children and young adults with CP, however, it lacks suitability to measure intervention effects due to its poor responsiveness. The WST appears reliable for measuring wheelchair skills in young adults with CP.

Aim: To explore oral feeding management practices, specifically initiation and advancement of oral feeds, across level II and III neonatal intensive care units (NICUs) in Canada.

Methods: A national online survey was conducted across 65 NICUs (34 level II, 31 level III), which included questions on hospital demographics and clinical approaches for initiating, advancing, and managing oral feeds. A descriptive analysis was performed on the responses.

Results: Of the 65 NICUs surveyed, 74% (n = 48) completed the survey. Many reported using custom-developed NICU guidelines for initiating and advancing oral feeds (n = 22, 46%), while few used evidence-based protocols (n = 16, 33%) or standardized assessments (n = 1, 2%). The most common clinical factors considered for initiating and advancing oral feeds include, behavioral cues (n = 47, 98%), stable vital signs (n = 47, 98%), gestational age (n = 43, 90%), and suck-swallow-breathe coordination (n = 26, 54%). Most units utilized a multidisciplinary approach (n = 38, 79%) with family involvement (n = 38, 79%). Feeding issues were typically addressed only during hospitalization, with no post-discharge follow-up (n = 31, 65%).

Conclusion: This study revealed significant variation in oral feeding management practices across Canadian level II and III NICUs and highlights a shift toward evidence-based clinical factors for oral feeding initiation and advancement. These findings highlight the need for standardized, evidence-based guidelines to ensure consistent and optimal care in NICUs.

Aim: Disorders of visual efficiency present with symptoms that can impact a young person's occupational engagement. Often these disorders result from concussion, but may also present idiopathically. Literature is available on the ocular implications of concussion and the symptoms of visual efficiency disorders, regardless of cause. Lacking is an understanding of the lived experience of diagnosed youth. Patient-reported experiences on life with disorders of visual efficiency can inform client-centered evaluation and treatment. The aim of this study was to describe the lived experience of youth with visual efficiency disorders resulting from concussion or unknown etiology.

Methodology: Retrospective descriptive qualitative study of anonymized verbatim transcripts from semi-structured individual interviews (n = 4) and coed focus groups (n = 20).

Results: Disorders of visual efficiency influence participation across occupational domains, affect social-emotional well-being, and are often managed through environmental and activity adaptations. Participants described experiences of occupational alienation, family and peer challenges, and variability in supports at school.

Conclusions: Similarities exist in occupational, social-emotional and adaptive needs of youth with disorders of visual efficiency resulting from either concussion or unknown etiology. These self-described experiences can assist caregivers, educators, and therapists in evaluation, intervention, and implementation of supports to improve engagement in valuable life roles.

Aims: Handwriting is crucial for academic success, influenced by sensorimotor and socioeconomic factors. Therapists, in collaboration with educators, play a key role in its support. The first objective is to investigate the association between SES and handwriting skills and to identify related factors associated with SES. The second objective is to investigate the direct and mediating roles of sensory-motor parameters in handwriting skills.

Methods: Sixty-three children were divided into High-SES and Low-SES groups based on family income and parental education level. Handwriting skill was evaluated based on legibility and speed. Proprioception, grip strength, lateral pinch strength, and tip pinch strength were assessed.

Results: The High-SES group demonstrated significantly faster handwriting speed and better proprioception, while motor parameters showed no significant differences between groups. Proprioception was found to mediate 15% of the association between SES and handwriting speed. Proprioception and lateral grip strength predicted faster handwriting speed, while grip strength predicted slower handwriting across participants.

Conclusion: Study results indicate that improving proprioception is one of the key factors in supporting handwriting performance in students with low SES. Activities aimed at enhancing proprioception and lateral grip strength can be used to improve handwriting in all children, regardless of SES differences.

Aims: This study aimed to estimate the extent to which dual-task-based balance exercise vs. single-task-based balance exercise (I) vs. no training (C) affects single-limb static and dynamic balance performance (O) in children with a history of ankle sprain (P). This study aimed to assess the impact of dual-task-based balance exercises on enhancing single-limb static and dynamic balance performance in children with a previous ankle sprain history.

Methods: In this quasi-experimental study, 66 male children (mean age = 9.34 ± 0.88 years) with a history of ankle sprains were recruited from sports clubs and assigned to one of three groups: (1) balance training with a dual task (22 participants; 12 sessions); (2) balance training with a single task (22 participants; 12 sessions); or (3) a control group (no training; 22 participants). Static balance (Stork test) and dynamic balance (Y balance test) were assessed before and after the intervention.

Results: Results indicated that static balance in male children during dual-task training outperformed single-task training and the control group (p < .05). Single-task training also surpassed the control group (p < .05). In dynamic balance, both dual-task and single-task balance training groups performed better than the control group (p < .05), with no significant difference between the two training methods (p > .05).

Conclusion: These findings suggest that balance exercises, particularly those incorporating cognitive dual tasks, can enhance the balance performance of male children with a previous ankle sprain history. Coaches and physiotherapists working with such male children are encouraged to incorporate the dual-task model into their training regimens.

Aims: Children with life-limiting illnesses face physical, cognitive, and emotional challenges that restrict their activities of daily living. Although these needs require a holistic approach, rehabilitation services, particularly occupational therapy, are often limited in pediatric palliative care. This study aimed to evaluate the unmet rehabilitation needs of children receiving pediatric palliative care in Turkey based on the Person-Environment-Occupation model.

Methods: A sequential explanatory mixed-methods design was used. Quantitative data on self-care, mobility, and caregiver burden were collected through standardized assessments. Qualitative data were gathered from semi-structured interviews with parents and analyzed using Directed Content Analysis.

Results: Quantitative findings revealed considerable impairments in mobility, self-care, and cognition, resulting in high caregiver burden. Qualitative findings contextualized these limitations, revealing themes of loss of independence, emotional distress, environmental barriers, and lack of professional and social support. Limited access to occupational therapy may impact quality of life.

Conclusion: The findings suggest that occupational therapy may support children's participation in activities of daily living and ease caregiver burden in pediatric palliative care. Interventions focusing on physical, cognitive, and emotional challenges, as well as environmental adaptation, appear promising. Further research is needed to examine the long-term effects of occupational therapy in different care settings.

Aim: To examine the relationship between feeding therapy and the timing of independent oral feeding (IOF) in preterm infants in the neonatal intensive care unit (NICU).

Study design: A retrospective analysis of 536 preterm infants (<37 wk gestation) admitted to a level IV NICU between January 2017 and December 2019 was conducted. Clinical and therapy data were extracted from the electronic health record to examine associations between feeding therapy utilization and feeding outcomes.

Results: Medically complex infants were more likely to receive a feeding therapy referral (p = .001), and infants who received feeding therapy achieved IOF an average of 1.5 wk later than those who did not (p < .001). Among infants receiving therapy, earlier initiation was beneficial as each additional week of delay in therapy initiation corresponded to a 0.02-week delay in achieving IOF after adjusting for medical factors (p = .023). No association was found between feeding therapy frequency and postmenstrual age at IOF.

Conclusion: Early initiation of feeding therapy may help expedite IOF. Timely referrals can support oral motor development and improve feeding outcomes in preterm infants. The lack of association with frequency may reflect staffing limitations that impacted consistent therapy delivery rather than a true absence of benefit.

Aims: Examine adherence, facilitators and barriers, satisfaction and trends in effectiveness of a telerehabilitation home exercise program (TRHExP) with remote coaching for adults with cerebral palsy (CP).

Methods: Six ambulatory adults with CP (range: 21-38 years, mean: 27, SD: 6.9; 4 females), participated in an 8-week TRHExP designed to increase physical activity (PA) to 150 min per week (min/wk). Pre, post, and process measures included functional mobility tests, patient reported measures, semi-structured interviews, and exercise observation. Individualized programs were based on clinical guidelines and personal goals. Weekly coaching sessions reviewed adherence, performance, and progression.

Results: Four of six participants completed the 8-week program; two dropped out midway through due to life circumstances. PA frequency was a median of 4 ×/wk and a median of 150 min/wk. TRHExP was the primary contributor to PA. Participant time and energy were barriers. Completing activity logs and perceived improvement were facilitators. Personal goal performance increased to 75% and satisfaction to 100%. Changes to self-report measures and functional tests were equivocal.

Conclusion: Ambulatory adults with CP may benefit from individualized TRHExP with weekly remote coaching to increase PA. Tailored telerehabilitation PA programs with remote coaches may foster health promotion for adults with CP.