Developmental Neurorehabilitation最新文献

Purpose: To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose.

Methods: An observational study of children receiving residential neurorehabilitation after severe ABI.

Results: Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists' expectations of recovery.

Conclusion: Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.

Background: Perinatal stroke causes hemiparetic cerebral palsy (HCP) and lifelong disability. Constraint-induced movement therapy (CIMT) and neurostimulation may enhance motor function, but the individual factors associated with responsiveness are undetermined.

Objective: We explored the clinical and neurophysiological factors associated with responsiveness to CIMT and/or brain stimulation within a clinical trial.

Methods: PLASTIC CHAMPS was a randomized, blinded, sham-controlled trial (n = 45) of CIMT and neurostimulation paired with intensive, goal-directed therapy. Primary outcome was the Assisting Hand Assessment (AHA). Classification trees created through recursive partitioning suggested clinical and neurophysiological profiles associated with improvement at 6-months.

Results: Both clinical (stroke side (left) and age >14 years) and neurophysiological (intracortical inhibition/facilitation and motor threshold) were associated with responsiveness across treatment groups with positive predictive values (PPV) approaching 80%.

Conclusion: This preliminary analysis suggested sets of variables that may be associated with response to intensive therapies in HCP. Further modeling in larger trials is required.

Purpose: To evaluate the processes and factors that influenced implementation and impact of a home-based bimanual training program in children with unilateral cerebral palsy aged 2 through 7 years.

Methods: The program encompassed bimanual task-specific training (3.5 hours/week for 12 weeks) adopting either implicit or explicit motor learning. A therapist and remedial educationalist coached parents. This mixed methods study included course attendance monitoring, questionnaires, registration form, video analysis, interviews, focus group discussion, and drop-out monitoring.

Results: Fourteen families participated. The program was not fully implemented as intended. Parents positively experienced the training and were well able to provide it. The program was demanding for the children and time-consuming for parents. Several components positively contributed to the program: task-analysis, instructional videos, and coaching by a therapist and remedial educationalist. Several modifications to the program were proposed.

Conclusion: Home-based bimanual training forms a demanding but promising therapeutic approach with potential for optimization.

Purpose: To compare the effects of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy.

Materials and methods: Twelve children with hemiplegic cerebral palsy and 12 typically developing children ages 5 to 12 years (GMFCS I-II) were evaluated with the Timed Up and Go (TUG) and Biodex Balance System during three upper extremity (UE) conditions: 1) Free UEs (no constraints), 2) Simple UE constraint (unaffected/dominant UE constrained with a sling), and 3) Difficult UE constraint (Simple constraint plus the other UE holding cup of water).

Results: The UE condition had significant effects on Overall Stability Index (OSI) (F_(2,44) = 24.899, p < .001), Medial-Lateral Stability Index (MLSI) (F_(2,44) = 4.380, p = .018), Anterior-Posterior Stability Index (F_(2,44) = 6.187, p = .004), and TUG scores (F_(2,44) = 113.372, p < .001). Group was significant for OSI (F_(1,22) = 7.906, p = .010), MLSI (F_(1,22) = 13.113, p = .002), and TUG (F_(1,22) = 36.282, p < .001).

Conclusions: The upper extremity appears to have a role in maintaining functional balance and postural stability in children with hemiplegic cerebral palsy and should be considered during intervention programs.

This study investigated the relationship between sleep, gastrointestinal symptoms, challenging behavior, adaptive behavior, and quality of life between children and adolescents with autism spectrum disorder (ASD), with and without attention-deficit/hyperactivity disorder (AD/HD) symptoms. Parents of 118 children and adolescents with ASD completed the Conners Early Childhood Rating Scale-Parent Short Form or the Conners 3-Parent Short Form, Children's Sleep Habits Questionnaire, Gastrointestinal Symptom Inventory, Behavior Problems Inventory-Short Form, Pediatric Quality of Life Inventory and the Vineland Adaptive Behavior Scales, Second Edition. The ASD group and the ASD with AD/HD groups differed significantly in sleep problems, gastrointestinal symptoms, and quality of life. Regressions indicated that AD/HD symptoms accounted for a small proportion of the variance for the differences in sleep problems and quality of life. AD/HD symptoms contribute to the complex needs of individuals with ASD. Research is necessary to investigate how these symptoms exacerbate comorbidities.

Nuhu and Rapp identified three profiles undergraduates displayed during social interactions. We evaluated the social validity of these three profiles in two studies. In Study 1 we presented video exemplars of speakers representing each profile to undergraduate participants and asked them to rate the speaker in respect to various statements. Results showed that one profile was rated significantly different than the other two profiles on all but one statement. In Study 2 we further evaluated the role of eye contact in the profile that participants rated differently in Study 1. Results from Study 2 showed that a speaker engaging in low eye contact was rated lower than a speaker engaging in either a validated or high level of eye contact. Likewise, participants with self-reported high social competency provided more negative ratings of a speaker who displayed low eye contact than participants with self-reported Moderate and Low social competency.

Purpose: Comparison of not only the upper and lower extremity but also trunk muscle masses measured by means of an ultrasound imaging device between children with Down syndrome (DS) and children with typical development (TD).

Methods: The study included 35 children with TD (TD group) and 26 children with DS (DS group). The upper and lower extremity and trunk muscle thicknesses were measured using an ultrasound imaging device.

Results: The thicknesses of the rectus abdominis, obliquus externus and internus abdominis, rectus femoris, and short head of the biceps femoris muscles were significantly lower in the DS group than in the TD group. The thicknesses of the other upper and lower extremity and trunk muscles did not differ significantly between the groups.

Conclusions: The results of this study demonstrated lower masses of trunk flexor and knee extensor and flexor muscles in children with DS compared to those in children with TD.

Objectives: To investigate the performance of the Physical Abilities and Mobility Scale (PAMS) in children receiving inpatient rehabilitation for paralysis related to spinal cord disease and injury (SCD/SCI).

Methods: Participants were 146 children with paralysis related to SCD/SCI, aged 2-21, admitted between January 2010 and 2017 for inpatient rehabilitation at a single free-standing academically affiliated pediatric rehabilitation hospital. Retrospective chart review was performed to obtain admission and discharge scores on the PAMS and the functional independence measure for children (WeeFIM®), collected as part of clinical care. Internal consistency was evaluated using Cronbach's alpha. Inter-rater reliability was evaluated through overall agreement, Pearson correlations, and intraclass correlations. Construct validity was examined through exploratory factor analysis. Criterion validity was explored through correlations of PAMS overall and item scores with WeeFIM® total and subscale scores. Sensitivity to change was tested using paired t-tests examining differences between admission and discharge scores for each item and for the total score on the PAMS.

Results: Internal consistency and inter-rater reliability were high (0.94 at admission and 0.95 at discharge). Total PAMS scores are highly correlated with total WeeFIM®, mobility, self-care, and cognitive subscores at admission and discharge. Correlations with the WeeFIM® ranged from low (cognitive) to strong (mobility). Total PAMS score and all individual items increased significantly between admission and discharge.

Conclusions: The PAMS is a useful measure capturing incremental and granular functional motor skills changes occurring during inpatient rehabilitation for children with spinal cord-related paralysis.