Physical & Occupational Therapy in Pediatrics最新文献

Aims: To investigate the feasibility and preliminary effects of a modified sports intervention (Sports Stars) combined with a contextual-focused approach (Pathways and Resources for Engagement in Participation- PREP).

Methods: This is a feasibility randomized clinical trial (RCT), registered under RBR-4m3b4b6 and U1111-1256-4998. Eighteen children with cerebral palsy (CP) were allocated to either the Sports Stars Brazil + PREP group (n = 9) or the Sports Stars Brazil group (n = 9). Feasibility outcomes included willingness to participate; acceptability of random allocation and screening; evaluator blinding feasibility; group contamination; treatment adherence and satisfaction; therapist communication; adverse events, and implementation resources. Effectiveness outcomes included performance and satisfaction with participation goals, participation pattern, physical literacy, family empowerment, and physical activity level. Descriptive statistics and tests were applied.

Results: Feasibility analysis showed a high completion rate and adequate satisfaction, credibility, and acceptability in both groups. Significant differences were found favoring the Sports Stars Brazil + PREP group in performance (p = 0.02) and satisfaction (p = 0.04); family empowerment at post-intervention (p = 0.005); and involvement in school (p = 0.04) at follow-up. No significant differences were found for other outcomes.

Conclusions: A future robust clinical trial appears feasible with adjustments. Combining a context-focused intervention with a modified sports approach shows potential to improve participation outcomes.

Aim: The Test of Gross Motor Development Third Edition (TGMD-3) is used to assess the development of fundamental movement skills in children from 3 to 10 years old. This study aimed to evaluate the intra-rater, inter-rater, and test-retest reliability and to determine the minimal detectable change (MDC) value of the TGMD-3 in children with developmental coordination disorder (DCD).

Methods: The TGMD-3 was administered to 20 children with DCD. The child's fundamental movement skills were recorded using a digital video camera. Reliability was assessed at two occasions by three raters using the generalizability theory.

Results: The TGMD-3 demonstrates good inter-rater reliability for the locomotor skills subscale, the ball skills subscale, and the total score (φ = 0.77 - 0.91), while the intra-rater reliability was even higher (φ = 0.94 - 0.97). Test-retest reliability was also shown to be good (φ = 0.79-0.93). The MDC₉₅ was determined to be 10 points.

Conclusion: This study provides evidence that the TGMD-3 is a reliable test when used to evaluate fundamental movement skills in children with DCD and suggests that an increase of 10 points represents a significant change in the motor function of a child with DCD.

Introduction: Sickle cell disease (SCD) affects 1 in every 350 newborns in the United States. Children with SCD are at risk for impaired postural control. The purpose of this study was to explore if children with SCD have impaired postural control as compared to age- and sex-matched controls.

Methods: Twenty-eight children between the ages of 6 and 17 years were recruited for the study including children with SCD and age- and sex-matched controls. Posturography measures included Limits of Stability (LOS) and Modified Clinical Test of Sensory Interaction in Balance (mCTSIB) testing and balance was measured using the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition (BOT-2).

Results: There were no between-group differences in posturography measures. Children with SCD had significantly poorer BOT-2 balance performance as compared to age- and sex-matched controls (p < 0.001).

Conclusion: This sample of children with SCD does not demonstrate impairments in posturography as measured by limits of stability and sensory integration despite having significantly impaired balance compared to peers. Additional research is necessary to determine why children with SCD demonstrate gross balance impairments without concurrent impairments in postural control.

Aim: To understand caregivers' experiences of implementing sleep systems for children with complex neurodisability. This knowledge would help develop and refine the evidence base to inform clinical practice to improve care and support increased engagement and adherence to this approach.

Methods: Semi-structured interviews were conducted with nine caregivers (7 mothers, 2 fathers) of eight children aged 4-17 years (mean age 7.7 years) with complex neurodisability. Interviews were audio-recorded and transcribed. Interpretive Description methodology and inductive analysis based on Morse's four-step framework were employed to analyze the data.

Results: Three themes were developed: (1) It's a complex night; (2) This is what I know, incorporating subthemes "What I know about my child" and "What I know about sleep systems"; and (3) Support me to support my child. Sleep system interventions that account for nighttime health complexity and address caregivers' priorities of sleep and comfort for their child were perceived as more sustainable and successful by caregivers.

Conclusion: Embedding principles of family-centered care in sleep system assessment, prioritizing caregivers' goals of sleep and comfort, and fostering hope and trust through the co-production of postural care solutions are critical components of care. A shift in focus from "future prevention" of deformity to "protection and comfort" may advance the quality of care and uptake of sleep systems.

Aims: To describe the content of commercial pediatric neurological physical therapy posts on Instagram and report the main interventions and products featured.

Methods: A cross-sectional study was conducted using five pediatric neurological physical therapy hashtags on Brazilian commercial Instagram profiles, on three different days. The initial 50 posts for each hashtag were extracted by two independent reviewers. Data included the source of the posts, content characteristics, target populations, interventions featured in the posts and on the Instagram profiles, as well as the products promoted in the posts.

Results: A total of 449 Instagram posts from 190 profiles were analyzed. Most posts were in video format (n = 278; 61.9%), categorized as service reports (n = 203; 45.2%), and posted by autonomous physical therapists (n = 195; 43.4%). The most frequent interventions were Suit therapy (n = 60; 15.9%) and mobility training (n = 59; 15.6%). Cerebral palsy (n = 90; 20%) and Down syndrome (n = 35; 7.7%) were the most frequently represented health conditions.

Conclusions: Instagram offers various interventions and products for pediatric neurological rehabilitation. Excess information may cause indecision and adherence to ineffective treatments by families. Future research should assess the evidence behind services on social media and their impact on parents' decision-making.

Aim: This study aimed to establish normative values for the Functional Reach Test (FRT) in Japanese children aged 3-6 years and examines age-related differences in FRT scores. Additionally, we evaluated the relationship between FRT scores and several factors and a predictive equation was developed to improve the clinical application of FRT.

Methods: A cross-sectional study was conducted with 163 developing Japanese children. Participants completed two trials, with the average serving as the FRT score. Normative values were established for each age group. One-way analysis of variance and multiple regression analysis were used to assess age-related differences and factors influencing FRT performance, respectively.

Results: FRT values significantly increased with age: 9.4 cm (3 years), 10.8 cm (4 years), 11.3 cm (5 years), and 15.7 cm (6 years). Six-year-olds exhibited significantly higher scores than all younger age groups (p < .001). Multiple regression analysis identified age and height as significant predictors, and a predictive equation incorporating these variables was developed.

Conclusion: This study provides normative FRT data for Japanese children aged 3-6 years, emphasizing the role of age and height. The predictive equation enhances the clinical application of FRT as a balance screening tool for children.

Aims: To summarize evidence on effective knowledge translation (KT) interventions to increase evidence-based practice among pediatric rehabilitation professionals.

Methods: The PRISMA 2020 Checklist was used for search, selection, and data extraction. The Mixed Methods Appraisal Tool assessed quality, while the Cochrane Effective Practice and Organization of Care described KT interventions.

Results: Our search yielded 7233 records; 29 met the inclusion criteria. Two studies used educational materials alone. The remaining 27 studies used multifaceted KT interventions, combining education with local opinion leaders or knowledge brokers (n = 12), continuous quality improvement (n = 11), reminders (n = 6), communities of practice (n = 6), provider performance monitoring (n = 5), audit and feedback (n = 2), information and communication technology (n = 2), clinical practice guideline (n = 1), or routine patient-reported outcome measures (n = 1). Significant improvements in knowledge (n = 10), skills (n = 6), adherence and use (n = 4), perceptions (n = 3), intentions of use (n = 2), confidence level (n = 1), beliefs and attitudes (n = 3), and professional behavior change (n = 2) were reported. Included studies had a moderate to high-risk bias.

Conclusion: Educational and local opinion leaders were common in multifaceted KT interventions, the majority resulting in improved professional knowledge, skills, attitudes and beliefs, and behaviors. Rigorous study designs are needed to confirm these findings.

Aims: To describe the teaching strategies that physiotherapists currently employ in individual therapy sessions for children with DCD using the OPTIMAL theory for motor learning as a framework, focused on (1) autonomy (supporting autonomy vs. therapist-controlled), (2) expectancies (enhancing vs. lowering expectancies), and (3) attention (promoting an internal vs. an external focus of attention).

Methods: Eighteen physiotherapy sessions were videotaped and analyzed with Noldus The Observer XT using the OPTIMAL Strategies Observational Tool (OSOT). Relative duration (% of session time) and frequency were extracted for teaching strategies related to autonomy, expectancies, and attention.

Results: Physiotherapists mostly applied strategies to support autonomy and enhance expectancies in contrast to therapist-controlled strategies, and lowering expectancies. Strategies to promote either an internal or an external focus of attention were used to a similar extent. Furthermore, strategies were frequently combined; physiotherapists often employed more than one teaching strategy at a time.

Conclusions: The insight into current physiotherapy teaching practice that this study provides can help inform research and application regarding effective motor teaching for children with DCD. Follow up studies are needed to further investigate how child and task characteristics influence teaching strategy employment and to examine physiotherapists' reasoning behind their choice of strategies.

Aims: To evaluate the effects of telerehabilitation (TG) compared with an unsupervised home exercise training program (HG) on muscle function, physical activity (PA), and sleep in children with cystic fibrosis (CF).

Methods: Thirty children with CF (mean age = 10.2 ± 1.9 years) were randomly allocated to TG or HG. The exercise protocol was applied thrice a week for six weeks in the TG via Skype. The same exercises were sent in an exercise booklet to the HG, and phone contact was made once a week. Muscle function (one-minute sit-to-stand (1-min STS), sit-up, pushup, squat, and plank tests)), PA (Physical Activity Questionnaire for Older Children), and sleep (Epworth Sleepiness Scale (ESS) and Pediatric Sleep Questionnaire (PSQ)) were assessed before and after the 6-week study period.

Results: The 1-min STS significantly improved in the TG compared with the HG (p ≤ .001, η_p² = 0.474). The sit-up (p = .005, η_p² = 0.247), pushup (p = .002, η_p² = 0.180), squat (p = .002, η_p² = 0.284), and plank (p < .001, η_p² = 0.360) test scores were significantly improved in the TG compared to the HG. No significant changes between groups were seen for PA (p = .261, η_p² = 0.045), ESS (p = .160, η_p² = 0.069), or PSQ (p = .763, η_p² = 0.003).

Conclusion: Children who received TG improved muscle function more than children who received an HG. The effectiveness of longer term TG programs should be investigated in children with CF.