Physical & Occupational Therapy in Pediatrics最新文献

Aims: The aim of this study was to identify and describe methods that physiotherapists use to evaluate the immediate effects of their interventions for infants in hospital with acute respiratory tract infections.

Methods: We constructed an anonymous digital survey to physiotherapists working with infants aged 0-24 months in Sweden. The survey was distributed by e-mail and posted on web pages for seven weeks, which included a reminder.

Results: Replies were obtained from 88 respondents, and 52 completed surveys remained to be analyzed. All 21 counties in Sweden were represented. The most prevalent answer options were as follows: more productive/increased or decreased cough (73%), increased oxygen saturation (35%), changed secretion sounds (33%), reduced work of breathing (20%), and parental report (16%).

Conclusions: The physiotherapists reported to use diverse methods for evaluation of their interventions. However, to a large degree they used subjective measures, which depend on the individual clinician's assessment and interpretation. The evaluation methods vary in psychometric properties and robustness. This study identifies the need for consensus about valid, reliable, and clinically relevant evaluation methods for this patient group.

Aims: To examine the responsiveness of the Seated Postural & Reaching Control (SP&R-co) test in children with cerebral palsy (CP) classified at levels III to V on the Gross Motor Function Classification System (GMFCS).

Methods: Eleven children received a motor learning-based intervention. Expert and blinded raters scored pre- and post-intervention SP&R-co test videos. Responsiveness was measured with paired t-tests, and effect sizes with Cohen's d. Minimum Clinically Important Differences (MCIDs) were estimated for SP&R-co overall and dimension scores.

Results: The SP&R-co test was responsive to group improvement in sitting-related postural and reaching control (SP&R-co overall = 48.9 points, p < 0.001). It captured increases in the active (change = 2.4 points, p = 0.040), proactive: bimanual (change = 10.5 points, p = 0.001), proactive: unimanual (change = 19.8 points, p < 0.001), and reactive (change = 15.3 points, p = 0.016) dimensions. Most children showed overall score improvements exceeding the MCID value, whereas clinical improvements in dimension scores varied across children with different GMFCS levels.

Conclusions: This preliminary study shows that the SP&R-co test is responsive to clinical changes in postural and reaching control strategies in children with CP who can follow test directions and are classified as GMFCS levels III-V.

Aims: Children with cerebral palsy (CP) have low physical activity (PA) and high sedentary behavior. The aim was to trial a participation-focused behavior-change intervention to increase PA and decrease sedentary behavior.

Methods: Twelve children with CP were recruited (mean age 5 years 6 months ± 1 year 2 months, Gross Motor Function Classification System [GMFCS] levels I = 1, II = 1, III = 1, IV = 4, V = 5); eight with complete post-intervention data (mean 5 years 10 months ± 1 year 4 months, GMFCS I = 1, III = 1, IV = 4, V = 2). Children received 8 weekly sessions targeting individualized PA participation goals in a pre-post feasibility trial. Outcomes included: implementation, effectiveness (Canadian Occupational Performance Measure [COPM]), device-measured PA, goal confidence, quality of life, and barriers to PA participation. Semi-structured interviews explored acceptability and were analyzed thematically.

Results: Implementation was feasible with ≥90% sessions attended and high enjoyment (89.5%). After 8 wk, COPM goal performance (mean difference [MD] = 2.9, 95% CI 0.7, 5.0; p = 0.02), satisfaction with performance (MD = 3.0, 95% CI 1.6, 4.4; p = 0.002), and confidence (MD = 1.4, 95% CI 0.4, 2.5; p = 0.02) significantly increased with no change in other outcomes. All six caregivers interviewed reported the intervention to be acceptable.

Conclusions: Active Start Active Future was feasible to conduct, acceptable and showed preliminary evidence to improve PA in young children with CP.

Aims: To determine inter-rater and test-retest reliability of a video analysis tool (VAT-AAT) for evaluating changes in frequency and duration of verbal social behaviors, non-verbal social behaviors, play behaviors, and negative behaviors of children and young people aged 3-25 years with autism during animal-assisted therapy (AAT).

Methods: Following recruitment and training, 23 occupational therapy students from an Australian metropolitan university rated a simple or complex video-recorded AAT session on two occasions. Expert raters determined acceptable score ranges which were compared with collected data from the raters to determine intraclass correlation coefficients (ICC).

Results: ICCs were 0.84 (simple session) and 0.89 (complex session) for inter-rater reliability and 0.84 (simple session) and 0.89 (complex session) for test-retest reliability. The percentage agreement was similar across level of session complexity and rater experience with children and autism but was lower for participants with less experience with animals (<10% difference in percentage agreement).

Conclusions: The VAT-AAT has good inter-rater and test-retest reliability when used in AAT with children and young people with autism. Session complexity or rater experience with children or autism did not impact on the level of agreement with expert raters. Validity of the tool now needs to be established.

Aim: To investigate the affordances available to children, 6-9 years-old, with autism spectrum disorder (ASD) in southern Brazil. The initial assumption of this study was that children with ASD would present low opportunities for motor stimulation as observed in children with typical development, and that richer motor affordance contexts (higher movement opportunities) would be associated with higher socioeconomic status and parents' education.

Methods: 52 guardians of children of both sexes diagnosed with ASD participated in the investigation. The Childhood Autism Assessment Scale was used to classify the level of ASD, and the Affordances for Motor Behavior of Schoolchildren (AMBS) to analyze affordances in children's main environments. The statistical analysis was performed using univariate and multivariate analysis and a logistic regression model.

Results: The findings indicate that children with ASD have low opportunities for motor stimulation. Multivariate analysis showed this is particularly noticeable in families with lower income levels. Also, materials made available for children with ASD usually do not encourage gross motor skills, which does not help to prevent their sedentary lifestyle.

Conclusion: Better knowledge about the opportunities for motor stimulation of children with ASD can help to create individualized strategies that support their caregivers and improve children's developmental outcomes.

Aims: To investigate the effects of a specific balance training (BT) on lower extremity functions during and after pediatric oncological therapy.

Methods: During a 6-week intervention (DRKS00031418), children with cancer during (IG1) and after (IG2) acute oncological treatment participated in a child-friendly BT up to 6×/week. Training sessions were conducted supervised or self-administered. Parameters of feasibility were evaluated and effects on physical abilities were assessed through functional tests.

Results: 20 children (IG1 n = 10, IG2 n = 10) with different oncological diagnoses between 5 and 21 years participated. Of 36 training sessions offered, 22.8 ± 9.1 sessions took place (participation rate: 63.2 ± 25.3%), without occurrence of adverse events/severe side effects deteriorating health status or leading to study drop out. Functional tests revealed improvements in symptoms of chemotherapy-induced peripheral neuropathy in lower extremities in the total group (IG1 + IG2) (n = 18, T1: 8.6 ± 4.4, T2: 6.2 ± 5.8, p < 0.05, Wilcoxon test) and in active ankle dorsiflexion range of motion (extended legs) in IG1 (n = 9, T1: 2.2 ± 9.7, T2: 8.1 ± 11.5, p < 0.05, Wilcoxon test).

Conclusions: The study's findings underline the feasibility of BT during and after pediatric-oncological therapy. Furthermore, the study revealed first improvements on single physical parameters.

Aim: This scoping review synthesizes literature about occupational therapy parent-mediated interventions (PMIs) that target occupation-based outcomes for children with developmental disabilities (DD).

Methods: A search of PubMed, Web of Science, and CINAHL from 2010 through 2023 was performed resulting in 471 publications. Studies were included if they involved PMIs for participants with DD aged 3-12 years and were published in English. Studies were excluded if the outcomes were not occupation-based. A thematic analysis was conducted following an iterative review of charted data.

Results: Twelve studies met the inclusion criteria reflecting four themes across occupational therapy PMIs, including variation in terminologies, types of PMIs, key components of PMIs, and the overall impact. While the effects of PMIs are difficult to define due to the variability in the samples, interventions, and outcomes, this review suggests general positive impacts of PMIs.

Conclusion: The emerging body of evidence supporting PMIs within the field of occupational therapy suggests they are feasible and have the potential to improve child and parent outcomes when delivered to children with DD. Further research is needed to clarify PMIs' components, unify the identification terminology, and test the efficacy of different types of PMIs for specific populations.

Aim: We aimed to describe telehealth used to detect infants at risk of neurodevelopmental delay and assess the assessors' and caregivers' perceptions and costs.

Methods: This was an observational study in which five physical therapists applied the General Movement Assessment, the neurological exam based on the Hammersmith Infant Neurological Examination, and the Alberta Infant Motor Scale via telehealth in 65 infants at risk of neurologic delay during the COVID-19 pandemic. The perceptions of assessors and caregivers were assessed using a questionnaire. We tabulated the family's costs (internet access) and the therapist's expenses (internet access and professional fees).

Results: In general, assessors felt comfortable and reported good quality of teleassessment. They highlighted the significant effort they and caregivers required for synchronous methods, challenges in clearly guiding caregivers on infant positioning, difficulties in adjusting the camera's position, and unstable internet connections. Most assessors expressed a willingness to continue using telehealth. Caregivers displayed high satisfaction, and the costs were minimal.

Conclusion: Teleassessment during the COVID-19 pandemic was feasible, although implementing this method of health service in general clinical practice still requires further scrutiny.

Aims: To determine the potential of low-end high-intensity home-based hand-arm bimanual intensive therapy (H-HABIT) in mitigating post-modified constraint-induced movement therapy (mCIMT) regression in children with unilateral cerebral palsy (UCP).

Methods: Twenty-two children (aged 4-12 years) with UCP were assigned to either the experimental (n = 12) or control group (n = 10). Both groups completed 30 h of mCIMT for three weeks, followed by 30 h of H-HABIT for five weeks in the experimental group and none in the control group. Assessments, including the assisting hand assessment (AHA) and other standardized measures, were performed at baseline, post-mCIMT, and post-H-HABIT. Triaxial accelerometers were worn on both wrists during each phase to monitor the activity.

Results: The experimental group showed AHA scores from baseline to post-H-HABIT, with a significant time × group interaction (p = 0.001, ƞ² = 0.29) indicating distinct trajectories from the control. In contrast, actigraphy-based measures of the upper limb remained stable over time. Caregiver feedback for H-HABIT showed that 83.33% found the guidelines easy to follow, and 91.67% rated therapist interactions as helpful.

Conclusions: H-HABIT may help prevent post-mCIMT regression. Further research should refine task selection and explore advanced assessment methods to better capture real-world function.