Journal of Pediatric Rehabilitation Medicine - Volume 13, issue 3

Authors: McLaughlin, Matthew

Article Type: Editorial

Abstract: The role of pediatric rehabilitation providers during the Coronavirus Disease 2019 (COVID) pandemic of 2020 highlighted the need for improved knowledge about medications utilized in pediatric patients. Pediatric patients with cerebral palsy who were previously receiving botulinum toxin injections on a regular basis went prolonged periods of time between injections, and patients who have intrathecal baclofen pumps were called in to get refills with different intervals. The medically complex patients treated by rehabilitation providers were limited in the type and scope of care they received, and some may have developed adverse outcomes related to this delay in care. As a …Pediatric Physiatrist who has advanced training and significant research experience within the realm of Clinical Pharmacology, I have seen this pandemic demonstrate the Sisyphean challenge of continuing appropriate tone management in patients with cerebral palsy while ensuring those patients with neuromuscular conditions maintain their highest level of function. Both of these clinical problems received significant attention within this issue, which I hope allows providers taking care of these populations a reference point to take to the bedside. Show more

Keywords: Pediatrics, rehabilitation, COVID-19

DOI: 10.3233/PRM-200026

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 221-223, 2020

Authors: Pico, Elaine L.

Article Type: Editorial

DOI: 10.3233/PRM-200027

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 225-227, 2020

Authors: Vercler, Christian

Article Type: Editorial

Keywords: Ethics, COVID-19, vaccine, coronavirus

DOI: 10.3233/PRM-200025

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 229-231, 2020

Authors: Habib-Hasan, Zehra | Sheikh, Memoona Salman | Hoodbhoy, Zahra | Azam, Iqbal | O’Neil, Margaret

Article Type: Research Article

Abstract: PURPOSE: The aim of this study was to evaluate the feasibility and effectiveness of the Parent Empowerment Program (PEP) to help caretakers deliver a home program to promote developmental activities and gross motor function in their children with Down syndrome. METHODS: Parents attended a 14-month program with training sessions 1–4 times a month. Outcomes were measured using a change in the Gross Motor Function Measure (GMFM-88) at baseline and assessment one. RESULTS: Forty-eight families participated in the PEP. Children’s mean age was 16.2 ± 10.8 months. There were significant changes …in GMFM-88 scores between baseline and assessment one; t (30) = - 9.158, p < 0.001; 95% CI - 14.6 – - 22.9. Previous hospitalization significantly affected GMFM scores. CONCLUSION: This study describes a clinically applied research that focuses on program design, development and evaluation. Findings indicate that the PEP is effective in improving gross motor function in children with Down’s syndrome in Pakistan. Parents were satisfied with the program outcomes and were able to cope with the requirements at home. The PEP had favorable outcomes and may be an effective method to support PT services in resource poor countries. Show more

Keywords: Down syndrome, Pakistan, parent education

DOI: 10.3233/PRM-190605

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 233-240, 2020

Authors: Badger, Sarah | Waugh, Mary-Clare | Hancock, Jan | Marks, Susan | Oakley, Karen

Article Type: Research Article

Abstract: PURPOSE: Abusive head trauma (AHT) can have debilitating sequelae for children who survive. A retrospective medical record review was used to describe short-term developmental outcomes of children with AHT and identify predictors of poorer outcomes. METHOD: Children with AHT who received follow up by the hospital’s rehabilitation department for 12 to 24 months post-injury were included in this review. Data for 85 children were collected on hearing, vision, gross motor, fine motor, speech and language, cognition, play, adaptive functioning, behaviour and personal-social skills. RESULTS: Global assessment found 42% of children had a good …recovery, 34% had a moderate disability and 24% had a severe disability. For whom there was data, more than half had abnormal cognition, behaviour and personal-social skills, whilst more than a third had abnormal speech and language, neurological signs on last assessment, vision, play skills, and gross and fine motor skills. Factors that predicted poorer prognosis across all developmental domains included paediatric intensive care unit admission, longer length of hospital stay, breathing difficulty and lower Glasgow Coma Scale on presentation. CONCLUSION: This study highlights the substantial number of children who have abnormal development in the short-term post-AHT and assists in identifying those who require extensive long-term follow up. Show more

Keywords: Abusive head trauma, developmental outcomes, paediatric rehabilitation, paediatric brain injury, shaken baby syndrome

DOI: 10.3233/PRM-190624

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 241-253, 2020

Authors: Gilardone, Giulia | Fumagalli, Francesca Maria | Monti, Alessia | Pintavalle, Giuseppe | Troletti, Isabella Derada | Gilardone, Marco | Corbo, Massimo

Article Type: Case Report

Abstract: PURPOSE: There is a general lack of evidence on the efficacy of rehabilitation training methods after childhood stroke. The aim of the current paper is to provide an example of a multidisciplinary assessment and intensive patient-centered rehabilitation program that was devised following the Clinical Guidelines for Childhood Stroke Diagnosis, Management and Rehabilitation, based on the International Classification of Functioning, Disability and Health. METHOD: The case of a 13-year-old teenager with physical, linguistic, cognitive and emotional impairments after acute ischemic stroke (AIS) in left middle cerebral artery territories is presented and his neurorehabilitation program is described. …RESULTS: After an intensive and comprehensive rehabilitation period, the patient showed significant improvement involving language abilities, cognitive flexibility, logical reasoning and motor independence. A 6-month post-stroke follow-up evaluation showed further gains in spontaneous language, improved motivation and collaboration, reduction of impulsiveness and better general motor stability. CONCLUSION: This case highlights how an intensive, patient-centered, interdisciplinary rehabilitation approach can lead to good improvement across different domains, maximizing the spontaneous recovery in children and adolescents after AIS. Show more

Keywords: Pediatric stroke, multidisciplinary rehabilitation, intensive treatment, ICF

DOI: 10.3233/PRM-190636

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 255-262, 2020

Authors: Hansen-Jaumard, Delphine | Elfassy, Caroline | Montpetit, Kathleen | Ghalimah, Bayan | Hamdy, Reggie | Dahan-Oliel, Noemi

Article Type: Research Article

Abstract: PURPOSE: Arthrogryposis multiplex congenita (AMC) refers to a large heterogeneous group of conditions involving joint contractures in two or more different areas of the body. Contractures can lead to decreased range of motion and strength, and affect ambulation and autonomy. The aim of this study was to describe the orthopedic interventions and functional outcomes of a large cohort of children with AMC followed in a pediatric orthopedic center. METHODS: A retrospective chart review of all children diagnosed with AMC followed at Shriners Hospital for Children – Canada (SHC) between January 1979 and July 2016 was conducted. …One hundred twenty patients were identified, of whom six were excluded due to misdiagnosis or insufficient chart information. One hundred fourteen were retained. Patient demographics, AMC classification, comorbidities, operative and non-operative treatments received as well as community ambulation status, level of autonomy in self-care and transfers at latest follow-up were recorded. RESULTS: There were 54 males and 60 females with a mean age at last clinic visit of 10 years 3 months. Amyoplasia and distal arthrogryposis (DA) were equally represented in our sample, 47 (41.2%) and 49 (43.0%) participants respectively, with the category Other comprising the remaining 18 (15.8%) participants. Children with DA had less involvement of the proximal joints than those in the two other groups. Contractures and deformities of the foot and ankle were the most prevalent, affecting 91.5% with Amyoplasia, 85.7% with DA and 83.3% in the Other category. Contractures of the shoulder and elbow were more common among individuals with Amyoplasia and those categorized Other than those with DA. In terms of walking ability, 98% of participants with DA were independent ambulators. Walking ability varied among the Other participants. Similarly, most children with DA were independent in self-care and transfers at the most recent follow-up. CONCLUSION: The relatively large sample size of this study allowed for a better insight into the challenges associated with AMC management. These findings demonstrated the need for genetic testing to provide accurate diagnosis and classification, along with the use of standardized outcome tools to measure effectiveness of interventions. As AMC is rare, multi-site prospective studies are needed to improve research opportunities, develop functional measures specific to AMC and disseminate findings on a wider scale. Show more

Keywords: Arthrogryposis multiplex congenita, surgical management, rehabilitation, functional outcome, ambulation, self-care

DOI: 10.3233/PRM-190657

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 263-271, 2020

Authors: McLaughlin, Matthew J. | Fisher, Mark T. | Vadivelu, Sathya | Ramsey, Justin | Ratnasingam, Denesh | McGhee, Emily | Hartman, Kim

Article Type: Research Article

Abstract: PURPOSE: After the onset of the Coronavirus pandemic of 2019–2020 (COVID-19), physicians who inject OnabotulinumtoxinA (BoNT-A) were left with determining risks and benefits in pediatric patients with cerebral palsy. Many of these patients have pre-existing conditions that make them more prone to COVID-19 symptoms, and this susceptibility potentially increases after BoNT-A injections. METHODS: A retrospective chart review of 500 patients identified 256 pediatric patients with cerebral palsy who received an intramuscular BoNT-A injection to determine relative doses used for each Gross Motor Functional Classification Score (GMFCS). Data regarding age, weight, GMFCS, BoNT-A total body dosage, and …inpatient hospitalizations for 6 months post-injection were collected. Differences between GMFCS levels were analyzed using one-way analysis of variance testing. Inpatient hospitalizations were recorded and assessed using relative risk to determine the population risk of hospitalization in the setting of initiating injections during the COVID-19 pandemic. RESULTS: Based on GMFCS level, patients who were GMFCS I or II received fewer units of BoNT-A medication per kilogram of body weight compared to GMFCS III–V (p < 0.0005, F = 25.38). There was no statistically significant difference in frequency or time to hospitalization when comparing patients receiving BoNT-A compared to a control group. CONCLUSIONS: Resumption of BoNT-A injections during the time of COVID-19 requires a systematic approach based on risks and potential benefits. Data from this analysis does not show increased risk for patients who received injections historically; however, recommendations for resumption of injections has not previously been proposed in the setting of a pandemic. In this manuscript, a tiered approach to considerations for injections was proposed. Botulinum toxin type A injections have a history of improving spasticity in the pediatric patient with cerebral palsy. Ensuring appropriate selection of patients for injection with BoNT-A during this pandemic is increasingly important. Show more

Keywords: Cerebral palsy, botulinum toxins, drug-related side effects and adverse reactions, adverse events, COVID-19

DOI: 10.3233/PRM-200756

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 273-279, 2020

Authors: Dietzen, Anton | Ide, William | Pavone, Larissa

Article Type: Research Article

Abstract: PURPOSE: Telehealth services have been touted to improve access to specialty pediatric care. COVID-19 accelerated the adoption of telehealth across many medical specialties. The purpose of this study was to examine telehealth utilization and satisfaction among pediatric physiatrists. METHODS: Using Google Forms, a voluntary survey was created and administered to pediatric physiatrists. The survey collected information on practice setting, telehealth utilization, provider satisfaction, perceived satisfaction of patients and families, and the anticipated role of telehealth in pediatric rehabilitation going forward. RESULTS: Seventy-eight respondents completed the survey. There was a significant reported increase in …telehealth utilization since COVID-19 from 14.5% to 97.4%. Eighty-two percent of participants reported feeling comfortable utilizing telehealth, 77% felt confident in the quality of the care provided, and 91% believed patients were satisfied with telehealth visits. Responses indicate that telehealth is expected to play a role in future pediatric physiatry and interest in telehealth continuing medical education is prevalent. Most pediatric physiatrists plan to continue or expand telehealth offerings after COVID-19. CONCLUSION: Telehealth adoption has been expedited by COVID-19. Physician interest in and satisfaction with telehealth is high. Patient and family perceptions, outcomes of care, and barriers to implementation limiting program expansion deserve further study. Show more

Keywords: Telehealth, telemedicine, pediatric rehabilitation, COVID-19, PRM, pediatric physiatry

DOI: 10.3233/PRM-200762

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 281-288, 2020

Authors: Kivlehan, Emily | Chaviano, Kelli | Fetsko, Lauren | Javaid, Simra | Chandan, Priya | Rojas, Ana-Marie | Dubon, Mary E.

Article Type: Research Article

Abstract: PURPOSE: The COVID-19 pandemic hastened the need for graduate medical education (GME) innovation, resulting in the creation of multiple pediatric rehabilitation medicine (PRM) e-learning initiatives. There has been a paucity of data regarding trainee perceptions regarding quickly developed new methods of learning during the pandemic. This study explored PRM trainee perceptions of e-learning and effects of the pandemic on education. METHODS: Questionnaire study with data collected via REDCap. RESULTS: Greater than half of PRM trainees (56.6%, 30/53) responded. Most respondents reported that the virtual lectures series (79.3%), journal club (78.9%), and virtual arts …initiatives (75.0%) were valuable to their education. Common benefits noted included access to subject experts, networking, lecture recording, and location flexibility. Common concerns included lack of protected time, virtual platform fatigue, and decreased engagement. Most respondents were not redeployed. Relative to before the pandemic, less satisfaction with clinical education (70.0%) and greater satisfaction with non-clinical education (60.0%) was reported. The majority of graduating trainees felt positively (83.3%) and 16.7% were neutral regarding confidence to graduate. CONCLUSION: Trainees perceived national e-learning as valuable to their education, especially due to the access to expert leaders around the nation. Future work should explore ways to overcome barriers and optimize benefits of GME and PRM e-learning. Show more

Keywords: Pediatric Rehabilitation Medicine, e-learning, graduate medical education, COVID-19, asynchronous learning, online learning, virtual learning

DOI: 10.3233/PRM-200765

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 3, pp. 289-299, 2020