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: 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.

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.

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.