Journal of Pediatric Rehabilitation Medicine - Volume 11, issue 3
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Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach is an international journal designed to parallel the multi-disciplinary team approach of caring for a child with an acute or chronic disease. The issues will primarily be themed and broad in scope including, but not be limited to cerebral palsy, traumatic brain injury, spinal cord injury, spina-bifida, amputation, muscular dystrophies of all types, stroke, cancer, mental retardation, developmental delays, and others.
The aim is to include a wide range of experts who care for children with the above diagnosis. Authorship by two different disciplines is requested though not required to encourage an interdisciplinary and collaborative approach. The goal is for the reader to obtain not just the medical perspective, but also nursing, occupational, physical and speech therapy, psychology, home care, etc., in providing the most comprehensive care for children. Manuscripts will be blinded and peer reviewed with appropriate feedback. Statistical analysis will be reviewed by the biostatistician. Readers are encouraged to submit and or suggest case reviews, commentaries, editorials, original research, conference schedules, or reviews.
Abstract: Non-nutritive sucking is often used with premature infants by either using a pacifier or an expressed breast nipple to support the introduction and development of early oral feeding. The pattern of non-nutritive sucking is distinct in that it involves two sucks per second in contrast to nutritive sucking which is one suck per second. Although some literature has identified that non-nutritive sucking has some benefit for the premature infant’s feeding development, it is not entirely clear why such an approach is helpful as neurologically, activation of non-nutritive and nutritive skills are different. A summary is presented of the main approaches…that use non-nutritive sucking with reference to the literature. This paper also considers other factors and beneficial approaches to managing the introduction of infant feeding. These are: the infant’s toleration of enteral feeds pre oral trials, overall development and gestational age when introducing oral experiences, developing swallowing skills before sucking, physiological stability, health status, as well as the development and interpretation of infant oral readiness signs and early communication.
Keywords: Infant, premature, non-nutritive sucking, feeding, nutrition, communication
Abstract: BACKGROUND: There are several gaps in the literature related to the prognosis and care of children who have experienced a brain injury then develop paroxysmal sympathetic hyperactivity (PSH). OBJECTIVE : The objective of the present study was to explore the characteristics and prognosis of children who have experienced severe brain injury and developed PSH. METHODOLOGY: A secondary analysis was conducted using an established clinical dataset of children who had experienced severe brain injury and were admitted to an academic children’s rehabilitation center (n = 83). RESULTS:…Those children with PSH had a significantly longer acute care length of stay (p = 0.024) and total length of stay (p = 0.034) compared with those without PSH. There was no significant difference in cognitive and motor function or transition to rehabilitation between those with and those without PSH after controlling for age and etiology of injury. IMPLICATIONS: The findings from the present study reveal factors regarding the elusive phenomenon of PSH among children.
Abstract: PURPOSE: The purpose of this study was to examine the effects of biofeedback therapy as a non-invasive intervention to treat Bladder Bowel Dysfunction in pediatrics. METHODS: Six databases were searched between February 2016 and September 2016. Biofeedback studies for children aged 4–16 with idiopathic urinary or fecal incontinence were included. Articles were excluded on subjects’ medical histories, study design, timeline of study, and lacking expert review. Quality was determined using Sackett’s Levels of Evidence and the PEDro scale. RESULTS: Twelve articles were included in the review. Quality of evidence was moderate, as the average PEDro score…of the selected articles was 5.3. The participants’ ages ranged from 4–16 years old. Studies demonstrated that a multifactorial approach consisting of biofeedback therapy and behavioral modification can be successful in resolving Bladder Bowel Dysfunction. CONCLUSION: Biofeedback is a beneficial treatment for children with dysfunctional voiding and functional fecal incontinence. More conclusive research needs to be completed to explore the effects of biofeedback therapy treatment to make more concrete conclusions. Healthcare professionals should consider biofeedback as an alternative approach in conjunction with traditional treatments. A multidisciplinary approach is best when treating dysfunctional voiding and functional fecal incontinence in the pediatric population.
Abstract: PURPOSE: Development of an easy to use tool for the assessment of Developmental Coordination Disorder that is applicable to Indian children. METHODS: The steps for instrument development were followed stringently. In order to ensure the robustness of the tool, psychometric properties were determined with 127 children attending various schools. The Winsteps program was used to analyze data for a Rasch model analysis. RESULTS: The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) analysis showed an acceptable limit. The real item separation reliability of 4.84 demonstrates that the items of this tool create a well-defined variable.…CONCLUSION: This study met the objectives that it attempted to. The final tool consists of two versions- the Assessment Battery for Children with coordination Disorder-Short Version (ABCD-SV) consisting of 12 items, and the ABCD-FV consisting of 20 items. ABCD fulfills criterion A and B of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria for Developmental Coordination Disorder (DCD).
Keywords: Developmental Coordination Disorder, motor dysfunction, clumsiness, spatial awareness, object manipulation, movement control
Abstract: PURPOSE: To modify the Performance-Oriented Mobility Assessment-Gait (POMA-G) subtest and validate this modified POMA-G (mPOMA-G) in children with hypophosphatasia (HPP), a rare metabolic disorder that can manifest with musculoskeletal symptoms that impair mobility and ambulation. METHODS: Based on feedback from an expert panel, the POMA-G was modified by removing gait initiation/path assessments and expanding the rating scale for step length/continuity to capture aspects of observational gait analysis relevant to children with HPP. Three trained physical therapists used the mPOMA-G for video-based assessments of gait in 14 children with childhood HPP who participated in a clinical study…of asfotase alfa or in a natural history study. Intraclass correlation coefficients (ICCs) were calculated to determine interrater and intrarater agreement. Concurrent validity was evaluated by correlations with other validated assessment tools. RESULTS: Across 192 observations from available videos, interrater and intrarater agreement of mPOMA-G scores was significant (ICCs: 0.76 for both; P < 0.001). mPOMA-G scores had strong concurrent validity with the Childhood Health Assessment Questionnaire, Pediatric Outcomes Data Collection Instrument Transfer and Mobility Scale, Sports and Physical Function subscale, and 6-Minute Walk Test (all P ⩽ 0.0002). CONCLUSION: The mPOMA-G is a reliable and valid measure for detecting clinically significant impairments in children with HPP.
Abstract: PURPOSE: To evaluate variables that modulate pain during intramuscular botulinum toxin A injections in children. METHODS: As part of a Quality Improvement project, this retrospective analysis compared reported pain during and five minutes post injections with patient and procedural variables using subgroup and regression analyses (N = 593 procedures with 249 unique patients). RESULTS: Mean procedural pain for all procedures (n = 563) was 3.8 ± 3.0. Most children reported no pain (83.8%) or mild pain…(12.1%) five minutes after the procedure. Provider, previous patient experience, and dose did not significantly impact pain. Linear regression analysis (R= 2 0.64) demonstrated that younger age (p < 0.05), use of vapo-coolant spray or topical anesthetic (p < 0.01), and body region injected (p < 0.01) were significantly associated with increased procedural pain. Logistic regression (R= 2 0.14) demonstrated that pain during the procedure (p < 0.001) and older age (p < 0.01) increased the likelihood of pain post-procedure. Utilization of personnel for distraction did not significantly predict pain ratings at either time point. CONCLUSION: Age, topical anesthesia, and injected region impact procedural pain and in nearly 96% of cases, patients report mild or no pain within five minutes. Additional research into these predictors is necessary, but short-lived procedural pain may suggest that frequent use of sedation/anesthesia is unnecessary.
Abstract: PURPOSE: Recurrent botulinum toxin (BoNT) injections are used in the pediatric population for management of spasticity, but the procedure is often associated with significant pain and anxiety for patients. Non-pharmacologic treatment alternatives for procedural discomfort are limited. Immersive virtual reality (VR) has shown efficacy in treatment of procedural discomfort in pediatric patients. A retrospective chart review was performed to assess feasibility and use of treating BoNT procedure-related discomfort in pediatric patients with VR. METHODS: Fourteen patients undergoing elective BoNT injections viewed VR videos using a mobile VR headset during the procedure. Face, Legs, Activity, Cry, Consolability…scale (FLACC) scores were obtained and feedback was elicited following injections. RESULTS: The VR intervention was well tolerated, and patients’ guardians requested that it be used again in 9/14 cases. The remainder either had high FLACC scores despite VR and neutral or negative guardian impressions of intervention, or were unable to utilize the device. CONCLUSION: VR was helpful in reducing BoNT procedure-related discomfort in a majority of patients. Challenges with VR setup, patient tolerance, and selecting viewing experiences were identified to guide further research and use of VR in a clinical environment.