Pediatric rehabilitation最新文献

Background: The purpose of this study was to explore the differences in and potential uses of information derived from developmental vs. functional assessment during the acute rehabilitation of very young children with acquired brain injury. Both methods of assessment are typically used during hospitalization in order to assist in developing individualized goals and outcome measures. With the trend of shortened hospital stays, effective assessment for determining optimal treatment goals and outcomes becomes increasingly important. The results from a developmental and a functional assessment obtained on 23 inpatient children below 6 years of age who had experienced either an acquired brain injury or encephalitis were compared. The data was collected through a retrospective chart review spanning 4 years.

Methods and outcome measures: Each child received a cognitive and a language test using either the Early Learning Accomplishment Profile (E-LAP) or the Learning Accomplishment Profile Diagnostic (LAP-D) for the developmental assessment measure. The Functional Independence Measure for Children (WeeFIM) was used as a functional assessment. Summary statistics and frequencies were calculated for variables including age and diagnosis. Partial Pearson correlations and 95% confidence intervals were calculated between the functional and developmental assessments, adjusting for the amount of time between administrations of the two exams. Pearson correlations were computed between length of hospital stay and performance on the developmental and functional quotients.

Results: Moderate, statistically significant Pearson partial correlations were found between the E-LAP/LAP-D cognitive quotient and the WeeFIM cognitive quotient (r = 0.42, 95% CI (0, 0.72)), the E-LAP/LAP-D language quotient and the WeeFIM cognitive quotient (r = 0.55, 95% CI (0.17, 0.79)) and the E-LAP/LAP-D cognitive quotient and the WeeFIM total quotient (r = 0.50, 95% CI (0.10, 0.76)). An inverse correlation was found between the length of stay and the E-LAP/ LAP-D cognitive quotient (r = -0.68, 95% CI (-0.86, -0.34)) as well as the E-LAP/LAP-D language quotient (r = -0.61, 95% CI (-0.83, -0.23)).

Conclusions: The moderate but limited correlations between developmental and functional assessments may be attributed to differences in the two forms of assessment including the test items, their administration and scoring. While both forms of assessment were thought to be useful for developing individualized treatment goals and measuring outcomes, there were advantages and disadvantages to each.

A 4-year longitudinal intervention was conducted with 10 young severely dysarthric children with cerebral palsy. Two procedures were implemented, each one for a period of 2 years. The first procedure centred on training the oral praxies, whereas the second one favoured a more functional approach based on voice and prosody training as well as parents' and school teachers' involvement. Bobath neurodevelopmental treatment was given throughout the 4-year period. Results clearly favour the second type of procedure which in interaction with Bobath's technique proved able to bring the children from unintelligible to an acceptable level of functional speech.

Purpose: To examine influences on classroom performance and behaviour following traumatic brain injury (TBI).

Methods: A case-study of one child who suffered a moderate TBI, with frontal brain damage, aged 8, followed up at ages 12 and 13 years. Parents and child were interviewed to establish pre- and post-injury behaviour and functioning. All 19 teachers who taught the child reported on classroom performance, behaviour and educational achievement in each of their subjects. The child completed a comprehensive neuropsychological assessment battery including the Weschler Intelligence Scale for Children (WISC-III(UK)), Children's Memory Scale (CMS) and Vineland Adaptive Behaviour Scales (VABS).

Results: This child demonstrated above-average intelligence and good attention/concentration on the CMS. However, he was unable to focus or maintain attention in most classroom situations. His behaviour was erratic and disruptive in class and at home. At 5-year follow-up, his behaviour had deteriorated in both home and school situations, particularly in less structured environments.

Conclusions: Teachers of more structured subjects (maths and science) perceived the child as excitable but performing at average or above-average levels, whereas teachers of less structured subjects (art, drama, music) perceived him to be 'attention-seeking' and very disruptive in class. The influences of environmental factors are discussed.

In response to increasing demand for more accountability and improved outcomes in the provision of behavioural services, Specialist Education Services (SES) in New Zealand employed the trainer of trainers programme developed by the Institute for Applied Behaviour Analysis (IABA). The goal was to develop a national training team capable of training SES staff to carry out assessments and develop support plans that could meet defined standards. The purpose of this study was to evaluate the outcomes of this trainer of trainers project. The primary methods of evaluation included the pre-post training comparisons of trainees' functional assessments and positive behaviour support plans, against 140 defined criteria. The results of this project indicated that the SES national training team was able to train SES staff to meet the same standards of service delivery as the external IABA trainers. Further, a Periodic Service Review (PSR) system was implemented to insure that service standards could be maintained at a high level. A major conclusion reached in this study was that a trainer of trainer approach appears to be effective in preparing large numbers of educational personnel to meet the increasing demands by schools for professionals to meet a high standard of service delivery.

In the countries of the western world, the institutional option for confining and endeavouring to 'correct' traits and attributes of people who did not conform to a rising consciousness of 'normalcy' developed rapidly during the 19th century. Scotland, a small, but rapidly urbanizing and industrializing country on the edge of Europe, was not an exception, but in its adoption of the institutional option for children with disabilities, its responses and objectives to different forms of impairment followed an uneven path. This article considers the reason for this erratic response, and the varied objectives of those responses, in the context of different forms of impairment and the differing interests of those with a professional or philanthropic involvement. The responses of some of the children directly affected are also considered.

Objectives: (1) To determine the feasibility of qualitative sensory testing in the lower extremities (LE) of children with cerebral palsy (CP), especially spastic diplegia. (2) To determine if there is a detectable difference in qualitative LE sensory function in children with CP compared to typical children. (3) To determine if dorsal rhizotomy results in detectable changes in LE sensory function in children with spastic diplegia.

Design: Objectives 1 and 2: Prospective observational cohort study. Objective 3: Add-on to prospective interventional studies.

Setting: Regional tertiary children's hospital.

Participants: Objectives 1 and 2: 62 children with CP and 65 typical children between 3-18 years of age. Objective 3: 34 children with spastic diplegia.

Interventions: Objectives 1 and 2: None. Objective 3: Dorsal rhizotomy.

Main outcome measures: Pain, light touch, direction of scratch, vibration, toe position and knee position using standard qualitative techniques.

Results: Objective 1: 32 (52%) children with CP and 55 (85%) typical children completed all items (p = 0.09). Objective 2: Summary scores for separate LE sensory modalities were lower in children with CP for direction of scratch (p < 0.001), toe position (p = 0.01) and vibration sense (p = 0.01). Objective 3: No changes of LE sensory function.

Conclusions: LE sensory testing in young children with CP is feasible. There is a qualitative sensory deficit in this sample of children with CP and specifically in children with spastic diplegia that is traditionally associated with dorsal column sensory modalities. A conservative dorsal rhizotomy does not produce a measurable change in LE sensory function in this sample of children with spastic diplegia.

Acute lymphoblastic leukaemia (ALL) is the most common form of paediatric leukaemia. The survival rate in children with ALL has improved significantly over the past several years, which makes quality of life an important focus for researchers. Some of the side effects of treatment (i.e. osteoporosis and obesity) are not realized until years after conclusion of therapy. Few studies have addressed the impact of physical activity (PA) on the side effects that occur during treatment of children with ALL. This paper discusses the increased risk for both osteoporosis and obesity due to treatment for ALL and suggests ways that PA may attenuate bone loss and risk of obesity by discussing what is known about effects of PA in healthy children and children with other chronic diseases. Recommendations will be made for PA interventions and future research in children with ALL.

The knowledge of adult life with Duchenne muscular dystrophy (DMD) is sparse. The purpose of this study was to review existing information and describe body functional, social participatory and quality of life profiles of the ordinary adult Danish DMD patient. Sixty-five study subjects aged 18-42 years were included in a cross-sectional survey based on data from a semi-structured questionnaire comprising 197 items. The ordinary adult DMD patient states his quality of life as excellent; he is worried neither about his disease nor about the future. His assessment of income, hours of personal assistance, housing, years spent in school and ability to participate in desired activities are positive. Despite heavy immobilization, he is still capable of functioning in a variety of activities that are associated with normal life. He lacks qualifying education and he is in painful need of a love life. The frequency of pains is surprisingly high; nearly 40% has pains daily. The nature, magnitude, consequence and possible cure of these reported pains must be scrutinized. Parents and professionals, paediatricians not the least, must anticipate in all measures taken that the DMD boy grows up to manhood and will need competences for adult social life in all respects.

This study evaluated the use of micro-switch clusters to improve response activity and posture with two children with multiple disabilities. The children were first taught a hand response and then required to combine this response with appropriate head position. The micro-switch clusters adopted for this purpose consisted of a pressure or mercury micro-switch for the hand response combined with a mercury micro-switch for the head position. Both children had an increase in the frequency of the hand response and in the percentage of times this occurred in combination with appropriate head position. These changes were maintained at a 2-month post-intervention check.