Physical & Occupational Therapy in Pediatrics最新文献

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.

Aims: Assessing reaching in children with unilateral cerebral palsy (uCP) is important, but no suitable quick and easy test exists for the clinic and home. This study aimed to evaluate the validity, discriminatory ability, and reliability of the Wall Arm Reaching Test (WART), a user-friendly reaching assessment.

Methods: 43 children with typical development (TD) and 28 children with uCP (10-18 years) participated. During the WART, they alternated rapidly between touching their hip and a wall-mounted target at their height for 30 s. For reliability, children completed the WART three times on-site (twice with the same examiner) and once at home, evaluated with intraclass correlation coefficients (ICC) and Bland-Altman plots. For validity, the uCP group performed a subset of the Melbourne assessment (MA2-reach).

Results: The WART demonstrated good validity, correlating with the MA2-reach (Spearman's r_s=0.66). It showed strong discriminatory ability, with significant higher scores for the unaffected versus affected arm (p < 0.001), and for the TD group compared to the uCP group (p < 0.001). Reliability ICCs ranged from 0.72-0.93 for uCP and 0.39-0.92 for TD.

Conclusions: The WART is a valid, reliable tool for assessing reaching in uCP in clinical and home environment, but poorly reliable at home in children with TD.

Aims: Assess the feasibility (adherence, fidelity, acceptance, implementation) and preliminary efficacy of Pedagogical Occupational Executive Training-Teacher (POET-T), a scalable, teacher-based adaptation of the validated parent-based POET intervention. POET-T is a consultation-based occupational therapy intervention to enhance children's executive control in educational settings.

Methods: Eleven early childhood teachers implemented the POET-T in mainstream classrooms over six weeks. Feasibility was assessed using teachers' questionnaires combining multiple-choice and open-ended questions and fidelity rating scales completed by consulting occupational therapists. The children's sample included 27 children identified with executive delays (aged 3.25-6.58 years, M = 4.47, SD = 0.95; 17 boys). Teachers completed the Executive Function & Occupational Routines - Early Childhood (EFORTS-EC) and the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P) questionnaires at three intervals: Pre-intervention, post-intervention, and follow-up (6-8 wk apart).

Results: Teachers' feasibility questionnaire showed consistent weekly use of the program's principles, with high acceptance, fidelity and implementation. Pre-to-post intervention comparison showed significant improvement in children's ability to manage their routines, but not in their general executive functions.

Conclusion: POET-T appears scalable and feasible in boosting children's executive control in daily routines that take place in the educational setting. Further research is needed to determine its effectiveness.

Aims: The purpose of this study was to gain a deeper understanding of family perceptions and ability to use education pertaining to home program recommendations for brachial plexus birth injury (BPBI).

Methods: A descriptive survey design was used to ask caregivers of infants with BPBI about their experiences and perceptions of the methods used to train them to perform passive range of motion (PROM), their preferred way to learn something new, their confidence after being trained, and factors affecting the frequency that they performed PROM in the first year of life.

Results: Twenty-nine caregivers of infants with BPBI ages two years or younger completed the anonymous survey. Respondents prefer a variety of methods to learn something new and most felt only somewhat confident or unconfident, and somewhat to very nervous to perform PROM after being trained, primarily due to fear about hurting their child. Time was the biggest factor affecting caregivers' ability to perform daily PROM, followed by lack of cooperation from their child.

Conclusions: The findings suggest that patient training and education needs to reflect core principles of occupational therapy by maximizing the fit between individual families and their contexts while using strategies to build caregiver capacity.

Aims: The aim of the present case series was to describe an instructional (attention) intervention for improving motor function in two children rehabilitating from Sydenam's chorea syndrome. Evidence suggests that paying attention to the body can be advantageous for afferent proprioceptive processing during motor skills wherein this information is relevant for successful task execution. This unique approach may also hold true for individuals with movement disorders, such as Sydenham chorea syndrome: a rare neurological condition that results in uncoordinated movements.

Methods: The present study provides a case study of two children unable to walk independently due to low postural stability. Both children completed "10-Meter Walk" and "Timed Up and Go" tests as a baseline, before undergoing three sessions per week of an intervention, for three months. Both children practiced walking and dynamic balance, with one child instructed to adopt an internal (bodily) focus and the other an external focus. A post-test experimental phase was then conducted to measure learning.

Results: Results revealed superior motor function when adopting a focus on body motion.

Conclusions: When movement disorders create ambiguity in motor efference, an internal focus on task-relevant proprioceptive information may facilitate more appropriate movement organization.

Purpose: Children with cerebral palsy (CP) experience higher rates of sleep disturbances. Power mobility may affect sleep health due to the cognitive activity associated with mobility. This study aims to establish proof-of-concept to examine the effect of a power mobility intervention on the sleep health of young children with CP.

Methods: Toddlers (12-36 months old) with CP completed a 12-week intervention and used the Explorer Mini. Caregivers reported the total number of days and the total duration in minutes of device use. Caregivers also evaluated changes in their child's sleep health.

Results: Spearman's correlations indicated moderate correlations between overall sleep score and Explorer Mini use. Mann-Whitney U tests indicated moderate effect sizes on Explorer Mini use between stable/worse sleep and better sleep groups.

Conclusion: Future work should expand upon this study and examine whether an association exists between power mobility use and sleep health using fully powered statistical analyses.

Aims: To investigate how effective is robot-assisted therapy vs. comparison intervention (no intervention, placebo or a conventional intervention) in improving affected upper limb outcomes (any related to the upper limb function, such as muscle strength, motor coordination, tones, reach, and grasp) in children with cerebral palsy (CP).

Methods: Searches of this systematic review with meta-analysis were conducted on Cochrane, LILACS, MEDLINE, PEDro, and Scielo databases. Studies with children with CP, which delivered robot-assisted therapy on upper limb were included.

Results: Four studies were included. The meta-analysis was performed for all Quality of Upper Extremities Skills Test subscales and muscle tone. Robot-assisted therapy, compared with conventional therapy, improved dissociated movements by 4,3 points (95%CI 0.9 to 7.6, I²=0%, p = 0.01), grasp by 5,7 points (95%CI 3.0 to 8.3, I²=0%, p < 0.001), and weight bearing by 8,7 points (95%CI 2.2 to 15.2, I²=0%, p = 0.008). The quality of evidence for all measures was rated as moderate.

Conclusion: Overall, robot-assisted therapy appears to be effective in improving dissociated movements, grasp, and weight-bearing, but not for muscle tone and protective extension in children with CP. However, these results need to be interpreted cautiously.

Aims: To assess test-retest reliability and concurrent validity of the 1-min sit-to-stand test (1-minSTST) in children and adolescents who are overweight or obese.

Methods: Thirty-nine overweight and obese children and adolescents were included. The 1-minSTST was administered twice with a one-hour break. Concurrent validity was evaluated by assessing correlations between 1-minSTST repetitions and six-minute walk test (6MWT) distances. The cardiorespiratory measures (blood pressure, heart rate, oxygen saturation, respiratory rate, dyspnea, and perceived fatigue) were recorded before and after each test.

Results: Test-retest reliability was excellent (ICC: 0.90, 95% confidence interval 0.90-0.97). There was no relationship between scores on the 1-minSTST and 6MWT (r = -0.06, p = 0.71). No statistically significant correlation was found between scores on each test and change in cardiorespiratory responses, except for respiratory rate (r = 0.43, p = 0.006). Change in cardiorespiratory responses was similar when performing each test (p > 0.05).

Conclusion: While the 1-minSTST seems promising, it is not significantly related to the 6MWT, indicating they may assess different dimensions of fitness in this population. Further investigations are needed to determine the clinical implications of 1-minSTST outcomes in pediatric population.