Physical & Occupational Therapy in Pediatrics最新文献

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: 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.

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.

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: 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.

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: 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: 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.