Pediatric rehabilitation最新文献

Background: Physicians often account for delays in detection and intervention for infant hearing loss for reasons that are rarely investigated, especially in developing countries. This study, therefore, explores current physician knowledge, attitude and training towards infant hearing loss in Nigeria.

Methods: Knowledge of documented risk factors, intervention options and attitude towards timely intervention for infant hearing loss was investigated through a questionnaire survey among 246 final year medical students and 161 physicians drawn from tertiary hospitals in Lagos.

Results: Medical students were significantly less knowledgeable than practising physicians about most risk factors for hearing loss except for craniofacial anomalies, intra-uterine infections and low birthweight. Few respondents (11.4-42.9%) were knowledgeable about the risk of low birthweight and maternal exposure to noise in pregnancy for infant hearing loss. Medical students were significantly more aware of early detection possibility (67.8% vs 38.9 %, p=0.000) and more knowledgeable about the use of hearing aids for babies (57.3% vs 50.3%). Most respondents had a fairly positive attitude towards parental concern and early detection while medical students were significantly more positive in their attitude towards infant hearing screening (86.6% vs 74.5%, p=0.002).

Conclusions: Medical students demonstrated greater awareness of early detection possibilities for infant hearing loss than physicians, although they had limited knowledge of some important risk factors. Continuing physician education reflecting evidence-based trends in child healthcare is necessary, while medical education also needs to be updated periodically.

The objective of this study was to examine occupational therapists' (OT) and physiotherapists' (PT) perceptions regarding waiting time and the quality and quantity of the services they provide for children with disabilities. A survey was sent by post to all paediatric OTs and PTs in Quebec, Canada. A Service Delivery Questionnaire included questions regarding therapist/client characteristics, waiting times and quality and quantity of services provided. The Measure of Processes of Care for Service Providers (MPOC-SP) rated use of family-centred care by responding clinicians. Waiting times were longest for OT services (p<0.0001), speech/language interventions (p<0.0001) and services in rehabilitation and community health centres (p<0.0001). Quality of services was rated higher by PTs, experienced therapists and those using more methods of keeping up-to-date. The frequency and duration of services varied according to profession, type of clientele and setting. According to clinicians directly involved in the provision of rehabilitation services, long delays exist for children waiting for rehabilitation services, and perceived quality of services differs according to specific therapist and client characteristics. These findings will assist those involved in planning the distribution of co-ordinated rehabilitation services for children.

As medical and technological advances have made it possible to prolong the life of children with chronic respiratory failure, children are being referred to post-acute inpatient rehabilitation programmes. In these settings, children can be weaned from their ventilators and receive medical and rehabilitative care in a developmentally supportive environment at a lower financial cost than in an intensive care unit. There is strong evidence that weaning children from mechanical ventilation has beneficial effects on their functionality, ease of care and quality of life. There is, however, little scientific evidence describing how often successful weaning is achieved or the most effective methods. The purpose of this article is to present a consensus report detailing a structured approach to weaning children from mechanical ventilation in a post-acute care setting. This study proposes a Weaning Severity Index and a Weaning Algorithm for use in the assessment and implementation of the weaning process in post-acute rehabilitation. Future clinical studies are needed to validate the suggested approach to ventilator weaning and to determine whether or not the weaning algorithm results in beneficial patient outcomes.

This article reviews the educational facilities available in the last decades of the 20th century for blind and partially sighted children and young people in Romania and the UK. A turning point in England and Wales came with the Education (Special Educational Needs) Act 1981. For Romania, the turning point came in 1990 with the overthrow of the Ceaucescu regime in late 1989. Romania is seeking entry to the European Union in 2007. This has provided an incentive to bring special educational philosophy and facilities quickly into line with other countries in the European Union. Similar problems regarding inclusion are encountered in both countries. Differentiating features are their different demographic characteristics and the educational resources and assets available at the time of the major changes. Finally, there is a brief review of the number of people with sight loss in paid employment as the next logical focal point for a national inclusion strategy. The UK has been able to develop and advance further than Romania in this sphere, but the legal framework is in place in Romania. The generic terms visually impaired (VI) and sight loss are both used throughout when referring to blind and partially sighted people.

Introduction: Disturbances in handwriting legibility and speed are found among elementary school-aged children. The aim of this paper is to present a set of sophisticated analytical tools suitable for visualization and evaluation of handwriting disturbances.

Methods: Handwriting samples from 30 children, 15 proficient and 15 non-proficient handwriters, aged 8-9 years were collected with the aid of a digitizing tablet. Temporal and spatial measures of the handwriting process dynamics based on signal processing methods were developed and visually presented.

Results: Significant differences between proficient and non-proficient handwriters were found in handwriting characteristics such as the standard deviations of letter width (t=2.96, p=0.008), letter height (t=3.24, p=0.005) and pen elevation (t=2.91, p=0.008). Significant differences were also found for the number of pen lifts (t=2.27, p=0.03), for the value of the correlation coefficients between letter length and time (t= -6.62, p=0.000) and between the actual and computed number of words (t=2.79, p=0.01).

Conclusions: The techniques described in this paper provide objective measures for handwriting performance presented in a way designed to help clinicians and educators visualize handwriting difficulties during clinical evaluation and intervention. Data visualization and analysis appear to enhance information concerning the spatial and temporal dynamics of handwriting.

Paediatric scoliosis is associated with signs and symptoms including reduced pulmonary function, increased pain and impaired quality of life, all of which worsen during adulthood, even when the curvature remains stable. Spinal fusion has been used as a treatment for nearly 100 years. In 1941, the American Orthopedic Association reported that for 70% of patients treated surgically, outcome was fair or poor: an average 65% curvature correction was reduced to 27% at >2 year follow-up and the torso deformity was unchanged or worse. Outcome was worse in children treated surgically before age 10, despite earlier intervention. Today, a reduced magnitude of curvature obtained by spinal fusion in adolescence can be maintained for decades. However, successful surgery still does not eliminate spinal curvature and it introduces irreversible complications whose long-term impact is poorly understood. For most patients there is little or no improvement in pulmonary function. Some report improved pain after surgery, some report no improvement and some report increased pain. The rib deformity is eliminated only by rib resection which can dramatically reduce respiratory function even in healthy adolescents. Outcome for pulmonary function and deformity is worse in patients treated surgically before the age of 10 years, despite earlier intervention. Research to develop effective non-surgical methods to prevent progression of mild, reversible spinal curvatures into complex, irreversible structural deformities, is long overdue.

Previous studies have shown that long-term non-invasive ventilation (NIV) is not always routinely offered by all physicians in Duchenne Muscular Dystrophy (DMD), despite evidence that this treatment improves quality of life and survival. This study examined UK physicians' practices related to respiratory follow-up and DMD ventilation. A mailed questionnaire was used. Thirty-eight of the 59 (64%) UK physicians identified via the Muscular Dystrophy Campaign (MDC) responded. Eighty-one per cent of respondents felt ethically obliged to discuss NIV with families while 13% believed that NIV results in poor quality of life. Forty-seven per cent of physicians discuss in-depth the use of NIV when the patient is in respiratory failure. Eighty-four ventilated DMD patients in the respondents' practice use NIV (via Bi-Pap Nasal mask). Nearly 66% of physicians do not consider the public cost to be an impediment to offering NIV, despite significant problems with resources' allocation in their area. While the majority of UK physicians have comparable attitudes and practices regarding NIV, the questionnaire highlighted that not all specialists were aware of the existence of consensus guidelines regarding respiratory monitoring. In addition, different practices of disclosure of life-prolonging ventilation options were used by different physicians. Seventy-one per cent of physicians wished for national consensus guidelines for different DMD age groups.

Objectives: To determine the prevalence of previous fracture, the rate of fracture over time and associated risk factors for fracture in children with moderate or severe cerebral palsy (CP).

Study design: Three hundred and sixty-four children with moderate-to-severe motor impairment (Gross Motor Function Classification System III, IV and V) enrolled in a multi-centre, region-based longitudinal study of growth, nutrition and health. Of these, 297 had baseline fracture information and 261 children had at least one follow-up assessment. Median duration of follow-up was 1.6 years, for over 600 person-years of follow-up.

Results: Forty-six (15.5%) children reported 62 previous fractures at baseline assessment. Children with a history of fractures at baseline were older (mean age 11.9 vs. 8.9 years, p<0.0001) and had greater body fat (triceps z-score -0.01 vs. -0.68, p=0.0003) than children with no previous fracture. Twenty children (6.7%) reported 24 fractures during the follow-up period. Factors associated with risk of fracture during the follow-up period were higher body fat (p=0.03), gastrostomy use (p=0.05) and previous fracture (p=0.10). Based on 24 fractures in 604.5 person-years of follow-up, the rate of fracture was 4.0 per hundred children (4.0%) per year. For children with a history of fracture at baseline, the fracture rate was 7.0% per year; for children with gastrostomy, 6.8% per year; and for children with high triceps skinfold, 9.7% per year.

Conclusions: Children with moderate or severe CP are at high risk for fracture. Children with greater body fat, feeding gastrostomy and prior history of fracture are at highest risk and may benefit most from intervention. Further longitudinal study and clinical trials in children with CP are needed to better understand the factors contributing to fracture risk in this population and the best methods of prevention and treatment.