Physical & Occupational Therapy in Pediatrics最新文献

Dynamic postural control provides functioning, independence, and quality of life.

Objective: to estimate the extent to which dynamic postural control (O) is affected in children with ASD (P/E) in comparison to their typically developing peers (C), summarizing the findings and answering the following research question: How is the postural control of children with ASD affected when facing dynamic tasks?

Methods: The search was conducted using the following databases: PubMed, Web of Science, SCOPUS, EMBASE. Studies addressing the postural control involving dynamic stability in children and adolescents with ASD and their typical peers were selected.

Results: Thirteen studies, published between 2005 and 2024, eight of which presented good methodological quality and five, fair ones, fulfilled the inclusion/exclusion criteria. We determined that dynamic postural control in ASD is affected by neuromotor deficits, such as reduced postural stability. Increased vulnerability to changes in body alignment and center of pressure results in compensatory movements to maintain posture.

Conclusion: Children with ASD present impaired dynamic postural control, reduced stability, greater vulnerability to changes in body alignment, and the use of specific compensatory mechanisms to keep posture and avoid falls. Further studies should address the impact of sensory information, age, cognition, and support level on dynamic postural control.

Aims: Postoperative mobilization in neonates is a critical component of the enhanced recovery pathway. We aimed to explore physical therapy (PT) and occupational therapy (OT) utilization in neonatal intensive care unit (NICU) patients and hypothesized that neonates with major abdominal surgery will experience increased barriers to receiving therapies compared to nonoperative neonates.

Methods: We retrospectively analyzed neonates admitted to our institution from January 2020 to December 2021. We compared therapy type/timing and clinical outcomes between operative and nonoperative neonates.

Results: We assessed 210 neonates (92 operative, 118 nonoperative). Operative neonates had lower median [Q1, Q3] gestational age (GA) at birth and birthweight. Operative neonates experienced significantly greater median [Q1, Q3] time from admission to first PT/OT session. Time from index operation to first therapy session was 25 days for PT and 22 days for OT. Number of active and missed PT/OT sessions were not significantly different between groups after accounting for length of stay (LOS). Operative neonates more frequently missed PT/OT sessions due to out-of-unit procedures or imaging.

Conclusion: Our data highlight a need for mitigation of barriers to mobilization among operative neonates, particularly in the first few weeks after surgery. Prospective studies are needed to explore the impact of earlier postoperative therapy among operative neonates.

Aim: To synthesize the existing literature on neonatal therapy interventions and evaluate their impact on oral feeding outcomes among preterm infants in the neonatal intensive care unit.

Methods: A systematic literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Physiotherapy Evidence Database (PEDro) databases for studies published from 2014 to 2023. Included studies were clinical trials evaluating neonatal therapy interventions delivered by neonatal therapists or caregivers trained by therapists, focusing on oral feeding outcomes for infants born at <37 week gestation. Primary outcomes were time to full oral feeding (FOF) and feeding quality. Secondary outcomes were weight gain and length of stay (LOS). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Results: Fourteen studies were included, identifying three categories of neonatal therapy interventions: oral motor stimulation, swallowing exercises, and sensory-based interventions. Most interventions began between 27 and 33 week postmenstrual age. Interventions generally resulted in improved oral feeding outcomes, notably faster achievement of FOF and improved feeding quality. Results for LOS and weight gain varied. Multidomain interventions demonstrated superior outcomes compared to single-domain approaches.

Conclusion: Neonatal therapy interventions can start early and improve oral feeding outcomes in preterm infants, particularly when using multi-domain approaches.

Aim: Children with spina bifida demonstrate impairments in walking; however, little is known about gross motor skill development and its association with lower limb muscle strength. This study aims to investigate the relationship between lower limb strength and gross motor skills in children with spina bifida.

Methods: Lower limb strength and level of lesion were determined by manual muscle test (MMT). Eighteen key gross motor skill items from the Gross Motor Function Measure (GMFM) were assessed, and level of ambulation classified according to a modified Hoffer's classification. Spearman's correlations were used to establish a relationship between muscle strength, level of lesion and gross motor skills.

Results: Participants included 42 children with spina bifida aged 4-16 years (median 8.1 years). Strong positive correlations were demonstrated between lower limb muscles and key gross motor items. While quadriceps strength demonstrates a relationship with supported weight bearing activities, hip extension, and abduction strength demonstrate strong relationships with independent standing, walking, and more complex gross motor skills.

Conclusion: Understanding the relationship between lower limb strength and motor skill attainment may assist in educating parents on functional potential and guiding goal setting for physiotherapy interventions.

Aims: This pilot study aimed to assess the dual-task performance and balance ability in children and adolescents with Juvenile Myoclonic Epilepsy (JME). Additionally, it sought to investigate the impact of dual-task conditions on functional performance and explore relationship between balance ability and dual-task performance.

Methods: Ten children and adolescents with JME (mean age 16.90 ± 1.20 years) were evaluated. Static and dynamic balance were assessed using the Balance Master System, with modified Clinical Test of Sensory Interaction on Balance (mCTSIB) and Limit of Stability tests measuring static and dynamic balance, respectively. The mCTSIB and TUG tests were performed under single- and dual-task (motor-motor, cognitive-motor) conditions.

Results: No significant differences were found in mCTSIB test between single-task and dual-task conditions (p > 0.05). However, TUG completion time increased under cognitive-motor dual-task conditions (p < 0.05). There was no significant correlation between balance and dual-task performance (p > 0.05).

Conclusions: This exploratory pilot study, conducted without a control group, suggests that children with JME may face difficulties with tasks requiring both cognitive and motor functions, as cognitive-motor dual tasks significantly increased task completion time. Lower scores in certain balance measures suggest a potential risk of balance impairment. These findings underscore the importance of integrating both cognitive-motor dual-task and balance assessments into rehabilitation programs for children with JME.

Aim: This study aimed to develop the Participation Questionnaire for Preschoolers (PQP) and validate its psychometric properties as a disability-specific tool designed to assess participation in preschool-aged children with autism spectrum disorder (ASD).

Methods: This cross-sectional study recruited caregivers of 412 children, including those diagnosed with ASD and those at risk for neurodevelopmental disorders. Participants were recruited from child development facilities, medical institutions, and developmental support websites across Japan. Data from 287 children diagnosed with ASD were analyzed for item reduction, followed by exploratory factor analysis and the calculation of Cronbach's alpha to evaluate internal consistency. Five hypotheses were tested to assess construct validity.

Results: Item reduction resulted in the removal of seven items and the identification of four factors: Friendship and Education, Family Satisfaction, Daily Living and Independence, and Leisure and Community Life. Cronbach's alpha values for these factors ranged from 0.74 to 0.88, indicating acceptable internal consistency. Three of the five hypotheses related to construct validity were supported, aligning with expectations.

Conclusion: The PQP exhibited structural validity, internal consistency, and construct validity. However, further longitudinal studies are needed to validate its measurement properties over time.

Aims: To evaluate attendance rates, daily therapy engagement, parents' perceptions regarding feasibility, acceptability, family-centeredness, and individualized outcomes of a collaborative telehealth-based physical therapy intervention for children with disabilities.

Method: Mixed-method design involving 15 families and 17 children with disabilities (range age 4-90 months). Parents recorded time spent on home activities. Family-centeredness was assessed using the Measure of Processes of Care-20-item (MPOC-20). The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to measure individualized outcomes. Interviews were conducted on families' perceptions of the telehealth service.

Results: Parents attended an average of 8.29 out of 9 scheduled telehealth sessions and spent an average of 1.32 (±0.58) hours per day on therapy activities. Parents rated the services as family-centered "to a fairly great extent" or "to a great extent". On average, children achieved individualized goals. Parents identified therapists' collaborative behaviors and information sharing as facilitators, beliefs about their abilities and technical issues as barriers, and empowerment and active engagement as benefits of the telehealth sessions.

Conclusion: The family-professional collaborative telehealth physical therapy was perceived by parents as acceptable and feasible to address their children needs. Children achieved individualized goals and participating families actively engaged in the intervention process.

Aims: The purpose of the study was to explore youth gymnastics coaches' perceptions on inclusive sports participation following an educational module. The study aims to explore implications for occupational therapy professionals' role in inclusive sports.

Methods: A qualitative descriptive approach was utilized with convenience sampling occurring through online platforms. Nine participants completed an educational module on autism spectrum disorder including strategies to promote inclusion in sports and address sensory and motor issues, prior to completing a semi-structured interview. Interviews were transcribed and coded prior to the determination of themes with triangulation and member checking employed.

Results: Thematic analysis resulted in the following themes: (1) occupational engagement in sports benefits both neurodiverse and neurotypical children; (2) sociocultural and physical environments create barriers to autistic youth's participation in sports; and (3) grace and knowledge enhance coaches' ability to promote inclusive occupational participation in sports for autistic youth. Themes were representative of the interconnected occupational components impacting inclusive sports of which occupational therapists are poised to address.

Conclusion: Lack of participation in sports for all children and children with disabilities is a complex system of physical, social, psychological, cultural, and environmental elements. Occupational therapists are equipped to educate youth sports providers and demonstrate leadership in advocating for inclusive sports programs to facilitate equitable sports participation, health, and wellness for children.

Aim: To assess the effectiveness of family-centered care (FCC) interventions on motor and neurobehavior development of very preterm infants.

Method: Randomized and quasi-randomized trials assessing the effect of FCC on motor and neurobehavioral outcomes in very preterm infants (28-32 wk gestation) were included. Five electronic databases and grey literature were searched from January 2010 to August 2022. Two reviewers independently screened the titles/abstracts and full texts, assessed the risk of bias, and extracted data. The Cochrane Risk of Bias 2.0 Tool and GRADE were used for risk and evidence certainty assessments. Meta-analysis or narrative synthesis was performed based on data availability and heterogeneity.

Results: Seventeen trials with 21 publications were included. GRADE showed low to moderate evidence. At 24 months, FCC interventions improved motor development (Mean Difference (MD):5.00, 95% CI: 2.58-7.42), cognitive development (MD: 3.64, 95% CI: 1.15-6.12), and behavior development (MD: -2.40, 95% CI: -4.32, -0.48) compared to control groups. Further, the FCC showed minimal or inconclusive effects on language, communication, and personal social development measured anytime between newborn and 24 months of age.

Conclusions: Early initiated FCC interventions can be a promising approach to improve motor, cognition, and behavioral development in very preterm infants.