Physical & Occupational Therapy in Pediatrics最新文献

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.

Aims: To use a case series to define readiness criteria and outline a collaborative process for application of ischial weight bearing knee ankle foot orthoses (IWB-KAFOs) for individuals with spinal muscular atrophy (SMA).

Methods: Five individuals with SMA receiving disease modifying therapy (DMT) were included in this retrospective case series. All were able to sit hands-free but unable to stand unsupported. Each individual received IWB-KAFOs for participation in dynamic standing and supported ambulation with an assistive device. On-going collaboration between providers for optimal fit, alignment and use were imperative for success. The 2-min walk test and 10-minute walk/run test were performed as functionally applicable. Additional outcomes for participation in typical environments were recorded based on parent and participant perception.

Results: All achieved hands-free standing at initial fitting of IWB-KAFOs and progressed to ambulation with an assistive device within four months. Individuals achieved varying distances and speed over time. Supervised ambulation provided an alternative strategy for exercise and increased functional participation across environments.

Conclusions: For individuals with SMA post DMT meeting the defined readiness criteria, use of IWB-KAFOs can be a successful adjunct to rehabilitation care to improve standing participation and engagement in the home and community settings.

Aims: This study describes the implementation and perspectives of a collaborative experiential learning experience (CELE) for understanding and examining infant development in Doctor of Physical Therapy (DPT) students.

Methods: The CELE blended an in-depth telehealth analysis with a broad in-person comparative analysis of infant development. Quantitative (questionnaire) and qualitative (semi-structured interview) methodologies examined the perspectives of students, clinical instructors (CIs), and parents.

Results: Over 80% of questionnaire respondents (44 students, 2 CIs, 7 parents) deemed the CELE valuable for learning and applying concepts in infant development. Similarly, over 80% of students and CIs felt the CELE promoted appreciation for natural environments and family-centered care. Thematic analyses of interviews (15 students, 4 CIs, 6 parents) highlighted the importance of the experiential and multimodal nature of the experience. Pedagogical components including structured expectations, non-intrusive and recorded feedback, peer collaboration, and reflection promoted learning. Specifically, enhanced understanding of infant development, clinical skills for pediatric and telehealth practice, appreciation for the cornerstones of pediatric rehabilitation, and the role of telehealth emerged.

Conclusions: This CELE is feasible within DPT curriculum to address the need for real-life pediatric experience and can provide future clinicians with unique opportunities for growth and learning in pediatric rehabilitation and telehealth.

Aim: This exploratory study investigated relationships between three proprioceptive modalities - joint movement sense (JMS), joint position sense (JPS), and dynamic position sense (DPS) - assessed with the sensor-based Proprioception Measurement Tool (ProMeTo) and motor outcomes in children with upper motor neuron (UMN) lesions.

Methods: In a cross-sectional study, 48 children with UMN lesions (mean age 11.0 ± 3.5; 27 girls) were recruited. Diagnoses included cerebral palsy, acquired brain injury, and other UMN-related conditions. Proprioception at the hip, knee, and ankle was assessed for JMS, JPS, and DPS. Motor outcomes included selective motor control, gait and balance, gross motor function, movement quality, and functional mobility. Statistical analyses comprised Mann-Whitney U-test, Wilcoxon's signed-rank, and Spearman's correlations (rho = ρ) tests.

Results: Children who correctly identified all JMS directions across joints showed significantly better motor outcomes. Negligible to moderate correlations (ρ = 0.01-0.55) emerged between proprioceptive modalities and motor outcomes, with the strongest relationships found between JPS at the hip (ρ = 0.431-0.46) and ankle (ρ = 0.36-0.55) and outcomes related to motor function, movement quality, and mobility.

Conclusion: Proprioceptive function, particularly JPS, shows moderate relationships with motor capacity and movement quality in children with UMN lesions. Further research is needed to confirm these associations and determine their clinical implications.

Aim: To explore how physical therapists, children with motor disabilities, caregivers, educational personnel, and physicians in Israel describe and characterize school-based physical therapy.

Method: We conducted a qualitative study including focus groups: four with children aged 4-21 with motor disabilities and four with caregivers of children in the same age-group. Participants (n = 38) were recruited from special education schools. Additionally, we conducted 25 interviews with physical therapists, educational personnel, pediatric orthopedists, and neurologists. The collected data were transcribed and reflexive-thematically analyzed. We ensured the study's trustworthiness using the constant comparison method, peer debriefing, reflexivity, and audits.

Results: Two themes were developed. The first, physical therapy in the lives of children with motor disabilities, refers to physical therapy in general. The second, something different refers to school-based physical therapy and includes sub-themes regarding physiotherapists' scope of practice, relationships, and sense of strangeness in school-based settings.

Conclusion: School-based physical therapy provides potential opportunities for close relationships and expanded practice in the child's environment. However, the estrangement and ambiguity of the physical therapists' role in a non-medical environment may push professionals to limit themselves to narrower, familiar practices. In such cases, the students do not benefit from what school-based physical therapy can offer.

Aim: Although the effectiveness of robot-assisted gait training (RAGT) in stroke has been reported, evidence in adolescents with childhood-onset stroke remains limited. This study reports the safety and clinical efficacy of RAGT using a robotized knee-ankle-foot orthosis in two adolescents with different gait patterns.

Methods: Case 1 (female, 15 years; Fugl-Meyer Assessment of Lower Extremity (FMA L/E) score 24) had moderate motor paralysis and walked with a short leg brace and cane, showing an extension-thrust pattern. Case 2 (male, 18 years; FMA L/E 26) used a short leg brace and demonstrated a stiff-knee gait. Both underwent 10 sessions of RAGT over 3 weeks. Comfortable and maximum gait speeds (10-m walking test), gait endurance (6-min walking test), gait symmetry (swing time ratio and normalized cross-correlation of knee joint angles), and safety were assessed pre- and post-intervention.

Results: Both participants completed RAGT safely. Comfortable gait speed improved from 0.78 to 0.99 m/s in case 1 and from 0.98 to 1.36 m/s in case 2. Improvements were observed in gait symmetry and kinematics, with partial correction of abnormal gait.

Conclusion: RAGT can be safely applied in adolescents with childhood-onset stroke and may contribute to improved gait performance and gait pattern.

Aim: This study aimed to 1) understand caregiver's perspectives on the facilitators and barriers of participating in a proposed pediatric therapy-based dance program, (2) explore caregivers' perspectives on a therapy-based dance program aimed at achieving individualized occupational therapy and physical therapy goals in a group setting, and (3) understand the impact of the COVID-19 pandemic on prioritization of participation in therapy services.

Methods: Eight caregivers to children with cognitive and/or physical disabilities participated in semi-structured virtual interviews consisting of open-ended questions. Interviews were audio recorded and transcribed verbatim and conventional content analysis was used to analyze the transcripts.

Results: Four categories were identified, mapping to the four layers of the Social Ecological Model of Health (Sallis & Fisher, 2008): 1) Child specific factors impact optimal participation in the program, 2) Family-related factors influence the feasibility of the child's participation, 3) Program specific factors should aim to meet each child's individual needs, and 4) Systemic healthcare factors influence the accessibility of services. Key recommendations for the program's re-design were identified from the data: 1) minimize costs and identify funding sources, 2) ensure small provider-to-participant ratios, 3) facilitate effective collaboration between the therapists and caregivers, 4) create a supportive environment of participants' needs. Conclusions: Factors related to the child, family, program and healthcare system offer guidance to the re-design of the proposed therapy-based dance program, and other pediatric therapy programs.

Aims: To explore trends in gross motor skill acquisition associated with a parent‑implemented Hip Helpers^® home program in two matched pairs of infants with Down syndrome (DS).

Methods: In this prospective exploratory matched‑pair case series, two 6-month-old (Child A1 and Child A2) and two 9-month-old (Child B1 and B2) children with Trisomy 21 DS participated in a Hip Helpers^® home program (two daily 30-minute sessions during active play). Pairs had similar motor abilities and continued usual therapies. Use of Hip Helpers^® for child A2 and B2 was discontinued when the children could pull themselves to a standing position. Testing using the Gross Motor Function Measure (GMFM-88) occurred monthly until each participant was able to take three independent steps.

Results: GMFM-88 change scores were variable across pairs, with the largest gains in Sitting (Dimension B). Crawling began later in garment users, suggesting a potential tradeoff. No adverse events were reported.

Conclusions: Neither child who participated in the Hip Helpers^® home program showed a faster acquisition of gross motor skills than is predicted for children with DS who do not use the garment. Feasibility was suggested; acceptability was not measured. Larger studies with objective adherence and standardized feasibility/acceptability tools are needed.