Pediatric rehabilitation最新文献

Background: Asymmetry in infancy is a diagnosis with a large spectrum of features, expressing an abnormal shape of parts of the body or unequal postures and movements, which might be structural and/or functional, with localized or generalized expression.

Purpose: The purpose of the present study is to highlight different therapeutic aspects of the most occurring asymmetries in infancy: congenital muscular torticollis, positional torticollis and plagiocephaly, based on best evidence in current literature.

Results: A flow chart is presented showing different pathways in therapeutic strategies, such as physical therapy, orthotic devices (helmet treatment and Dynamic Orthotic Cranioplasty) and surgery.

Conclusion: It is concluded that there are different views towards management on torticollis and plagiocephaly. A systematic therapeutic management to evaluate these asymmetries is indicated. The presented therapeutic flow chart might serve as a basis in order to achieve uniformity in therapeutic thinking and performance.

Background: Although many children with cerebral palsy (CP) develop secondary conditions requiring hospitalization, in-patient hospital utilization by this population has not been characterized.

Objective: To characterize hospitalizations in children with CP and to compare them with hospitalizations of those without CP using a large national data set.

Methods: Analysis of the Healthcare Utilization Project Kid Inpatient Database, a weighted survey of paediatric discharges from US hospitals in 1997.

Results: In 1997, 37,000 children with CP were hospitalized, generating charges approaching 600 million dollars. Children with CP demonstrated longer lengths of stay (6.3 vs 4.1 days, p < 0.001), higher total charges (16,024 vs 9952 dollars, p < 0.001), more diagnoses (5.6 vs 3.0, p < 0.001) and more procedures (1.7 vs 1.1, p < 0.001) per admission. Five major diagnostic categories accounted for 83.2% of the discharge diagnoses for children with CP (48.6% for those without CP, p < 0.001). Children with CP were more often transferred to other facilities (p < 0.001) or prescribed home health care (p < 0.001) upon discharge.

Conclusions: Hospitalization of children with CP represents a major expenditure for health care systems. Studies to improve the management of conditions associated with CP could result in better outcomes for children and families and potentially decrease costs associated with hospitalization.

This study assessed whether two children (11.9- and 9.7-years-old) with profound multiple disabilities and minimal motor behaviour could learn to control environmental stimulation using an eyelid response with a newly developed micro-switch. The response consisted of raising the eyelid markedly (i.e. by looking upward or opening the eyes widely). The micro-switch developed for this target response consisted of an electronically regulated optic sensor mounted on an eyeglasses' frame. Data showed that the children learned the target eyelid response to activate the micro-switch and to increase their level of environmental stimulation. Responding was largely maintained at a 2-month post-intervention check. These results indicate that continued work in this area has positive implications for the rehabilitation of children with most serious disabilities.

In Italy, paediatric rehabilitation is part of the activity of services for neurological and psychiatric diseases in childhood and adolescence. These services (UONPIA) have an integrated, multi-professional, child- and family-oriented approach to paediatric disabling conditions. At present, inadequate territorial distribution of services, shortage of resources and need of epidemiological monitoring and specific designs of bio-medical research are the main problems.

Objective: The facial anomalies and surgeries associated with Goldenhar Syndrome often lead to feeding problems. The purpose of this study was to demonstrate the outcome of Goldenhar Syndrome children admitted to the day patient paediatric feeding programme.

Subjects: Three children with Goldenhar Syndrome and feeding difficulties participated, mean age 3 years. Average length of stay was 8 weeks. Upon admission all were dependent on tube feedings.

Methods: The children received four therapeutic sessions daily. The sessions included oral motor interventions, behavioural techniques and a structured meal. Data regarding children's feeding were collected at admission and discharge.

Results: The patients had 52% acceptance of food/drink at admission and 88.7% at discharge. Expels were 30% at admission and 14% at discharge. Mouth clean was 9.3% at admission and 97% at discharge. Total inappropriate feeding behaviours averaged 83% at admission and 27.3% at discharge. Children averaged 3.4 g per meal at admission and 105.4 g at discharge. Two children were completely weaned from tube feedings by discharge.

Conclusions: Results support the hypothesis that combining oral motor and behavioural interventions offer effective treatment for children with Goldenhar Syndrome. Many children with Goldenhar Syndrome are reliant on tube feedings and this regimen allows them to eat orally, thereby improving their nutrition and quality of life.

Introduction: Severe burns result in skeletal muscle catabolism and weakness, which is worsened by prolonged physical inactivity. Exercise would be an ideal tool in the rehabilitation of burned children. However, it has been postulated that burned children may have an excessive rise in body temperature during exercise compared to non-burned children, partly due to the reduced area available for heat dissipation, thereby questioning the safety of exercise in burned children.

Methods: Children (n = 15) with >40% total body surface area (TBSA) burns and non-burned children (n = 13) successfully completed this study. All subjects completed 20 minutes of treadmill exercise at approximately 75% of their peak aerobic power. Tympanic temperature (Ttym), burned and unburned skin temperature were recorded pre-exercise, every 2 minutes during exercise and during recovery.

Results: Within burned children, significant differences between the temperature of unburned skin and burned skin, during later stages of sub-maximal exercise (minutes 12-20) were present. However, there were no significant differences between burned and non-burned children in Ttym or unburned skin temperature indicating that severely burned children do not demonstrate an impaired thermoregulatory response to 20 minutes of sub-maximal exercise at room temperatures.

Conclusion: It is concluded that exercise at moderate intensities conducted at room temperature is safe in burned children with <75% TBSA burns.

Despite increasing research into the severe effects of childhood memory disorders, there is currently a paucity of evidence available to inform the design of appropriate rehabilitation strategies. Indeed, within the paediatric literature there is no model that links specific memory disorders with hypotheses for appropriate rehabilitation strategies. This paper introduces a series of intervention hypotheses based on an examination of the strengths and weaknesses associated with each type of childhood memory disorder, including short-term phonological, visuo-spatial, central executive and long-term semantic and episodic memory. Guidance is provided for integrating the hypotheses within practical rehabilitation strategies and case studies are described to examine a number of the hypotheses.

Cognitive Behavioural therapy (CBT) has strong theoretical underpinnings that facilitate the systematic evaluation of outcomes and process of change adults. CBT has been extensively adapted for use with children and young people with session content and method of delivery modified to acknowledge developmental stage and ability. Current approaches emphasise the psychological management of the impact of symptoms of particular types of physical health difficulties and prevention of the development of psychological difficulties, as well as in the alleviation of procedurally related stress. The need for collaboration with families and other parts of a child's network is particularly relevant in the paediatric setting. This review describes what we have found helpful in our work and provides a road map of where to go to find out more about how to do more. General CBT approaches are described as well as examples of how CBT has been used specifically for procedural distress, diabetes, sickle cell disease, chronic pain and chronic fatigue.

Childhood memory disorders have received increasing empirical investigation over recent years and reviews of the dissociations within the developmental memory system are now available. However, there are few descriptions within the literature of children's consequent behavioural and learning difficulties within an educational context. This paper reviews the growing evidence that links specific memory disorders to academic skills and then provides clinical descriptions of the day-to-day behaviour and learning often observed following the identification of such children. It is anticipated that such descriptions will allow professionals to understand the range of consequences possible and alert health and educational staff to children at risk of suffering unidentified memory difficulties. A clinical description of the behavioural repertoire associated with different childhood memory disorders is also necessary to consider how professionals may design rehabilitative support.