Journal of Pediatric Rehabilitation Medicine - Volume 14, issue 2

Authors: Gaebler-Spira, Deborah | Green, Michael

Article Type: Editorial

DOI: 10.3233/PRM-219006

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 151-152, 2021

Authors: Flanagan, Deirdre | Gaebler, Deborah | Bart-Plange, Emma-Lorraine B. | Msall, Michael E.

Article Type: Editorial

Abstract: PURPOSE: Recognizing health disparities among children with cerebral palsy (CP) is necessary for understanding potential risk factors for CP and for implementing early and effective preventative and intervention treatments. However, there is currently little and conflicting evidence regarding the direct impact of contextual factors such as socioeconomic status (SES) for children with CP in the United States. These contextual factors include the complex social determinants of health on prematurity, comprehensive informed obstetric management for minority and vulnerable populations, and cumulative adversity disproportionately experienced by children, by gender, minority status, immigration, poverty, and structural racism. METHODS: This …study presents results from a review of health disparities among children with CP, using registry and population surveillance data from Australia, Canada, Scandinavia, the United Kingdom, Ireland, Turkey, and the United States. RESULTS: The review confirmed that there are significant health disparities among children with CP, both in terms of prevalence and severity, based on factors such as SES, neighborhood disadvantage, maternal education, gender, and minority status. CONCLUSION: Strategies need to be implemented in the United States to promote enablement and functioning among children with CP who face additional health disparities. This requires a greater understanding of population groups at increased risk, comprehensive assessment and care for young children with motor delays, and systematic population counts of children and adults with CP using registries and systems of neurodevelopmental surveillance across health, education, and community rehabilitation. These efforts also require sensitivity to structural and persistent racism, stigma, trauma-informed care, and culturally sensitive community engagement. Additional efforts are also required to improve outcomes over the life course for individuals living a life with CP from a framework of enablement, self-direction, equity and social justice. Show more

Keywords: Cerebral palsy, early detection, enablement, registries, functioning, health disparities

DOI: 10.3233/PRM-210015

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 153-159, 2021

Authors: Bailes, Amy F. | Kean, Jacob | Gross, Paul H. | Narayanan, Unni | Noritz, Garey | Hurvitz, Ed | Leonard, Jeffrey | Shusterman, Michele | Gannotti, Mary

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to measure the growth of the Cerebral Palsy (CP) Research Network towards becoming a Learning Health Network in order to guide future development. METHODS: Thirteen CP Research Network leaders completed the Network Maturity Grid (NMG) which consists of six domains with eight to 10 components each. The six domains are Systems of Leadership, Governance and Management, Quality Improvement, Engagement and Community, Data and Analytics, and Research. Radar mapping was utilized to display mean scores on a 5-point ordinal scale (1 = not started to 5 = …idealized state) across domains and for individual components within domains. Consensus was reached for top priorities for the next 3–5 years. RESULTS: Domain scores ranged from 2.4 in Quality Improvement to 3.2 in System of Leadership. The lowest scoring component was clinician clinical decision support and the highest was common purpose. The following priority areas of focus were agreed upon moving forward: development of leaders, financial sustainability, quality improvement education and training, patient reported data, data quality and validation, and primary data collection. CONCLUSION: Results from this project will be utilized for strategic planning to improve the network. Conducting regular self-assessments of the network with the NMG will be useful in achieving the network’s ultimate goal to improve care and outcomes for individuals with CP. Show more

Keywords: Cerebral palsy, learning health network, quality improvement

DOI: 10.3233/PRM-210011

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 161-171, 2021

Authors: Chan, Elizabeth | Frisina, Cynthia | Gaebler-Spira, Deborah

Article Type: Editorial

Abstract: BACKGROUND: Shared decision-making is a newer model of patient-centered healthcare; it is particularly important for people with chronic conditions including cerebral palsy. Health literacy is the ability of an individual to obtain, communicate, process, and understand health information and is a crucial component to shared decision-making. With the abundance of information that can be found on the internet, it can be difficult to navigate and determine which websites contain reliable information. OBJECTIVE: Provide a commentary article aimed to provide healthcare professionals a current, annotated list of reliable online resources in regards to cerebral palsy throughout the …lifespan with the goal of supporting health literacy and therefore improving shared decision-making and reducing disparity. CONCLUSION: Access to accurate and reliable information is an important aspect of health literacy, which in turn will optimize outcomes and build the foundation for shared decision-making between the provider and the patient. Educational materials should be easy to navigate and utilize. This article serves as a guide for reliable CP resources. Show more

Keywords: Shared decision making, health literacy, cerebral palsy, resources

DOI: 10.3233/PRM-210026

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 173-182, 2021

Authors: Heinen, Florian | Kanovský, Petr | Schroeder, A. Sebastian | Chambers, Henry G. | Dabrowski, Edward | Geister, Thorin L. | Hanschmann, Angelika | Martinez-Torres, Francisco J. | Pulte, Irena | Banach, Marta | Gaebler-Spira, Deborah

Article Type: Research Article

Abstract: PURPOSE: Investigate the efficacy and safety of multipattern incobotulinumtoxinA injections in children/adolescents with lower-limb cerebral palsy (CP)-related spasticity. METHODS: Phase 3 double-blind study in children/adolescents (Gross Motor Function Classification System – Expanded and Revised I–V) with unilateral or bilateral spastic CP and Ashworth Scale (AS) plantar flexor (PF) scores ? 2 randomized (1:1:2) to incobotulinumtoxinA (4, 12, 16 U/kg, maximum 100, 300, 400 U, respectively) for two 12- to 36-week injection cycles. Two clinical patterns were treated. Pes equinus (bilateral or unilateral) was mandatory; if unilateral, treatment included flexed knee or adducted thigh. Endpoints: Primary: …AS-PF change from baseline to 4 weeks; Coprimary: investigator-rated Global Impression of Change Scale (GICS)-PF at 4 weeks; Secondary: investigator’s, patient’s, and parent’s/caregiver’s GICS, Gross Motor Function Measure-66 (GMFM-66). RESULTS: Among 311 patients, AS-PF and AS scores in all treated clinical patterns improved from baseline to 4-weeks post-injection and cumulatively across injection cycles. GICS-PF and GICS scores confirmed global spasticity improvements. GMFM-66 scores indicated better motor function. No significant differences between doses were evident. Treatment was well-tolerated, with no unexpected treatment-related adverse events or neutralising antibody development. CONCLUSION: Children/adolescents with lower-limb spasticity experienced multipattern benefits from incobotulinumtoxinA, which was safe and well-tolerated in doses up to 16 U/kg, maximum 400 U. Show more

Keywords: Botulinum toxin, spasticity, cerebral palsy, all movement disorders, all paediatric, incobotulinum

DOI: 10.3233/PRM-210040

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 183-197, 2021

Authors: Wright, Edward | Fetsko, Lauren

Article Type: Review Article

Abstract: Serious adverse events (serious AEs) following the therapeutic use of Botulinum Toxin Type A (BoNT-A) are infrequent. Children with pediatric spasticity often have comorbidities that can cloud causation around an adverse event (AE). If a serious AE occurs, clear documentation of information sharing and informed consent as well as the provider-patient relationship are critical to minimizing litigation risks. Reviewing the litigation that has occurred following BoNT-A for pediatric spasticity can offer insight into how providers’ perspectives regarding this intervention may differ from those of the public who might serve as jurists. This article offers suggestions for content sharing during the …consent process to optimize patient understanding about potential adverse events. Show more

Keywords: FDA label, indication, off label drug use, serious adverse events, idiosyncratic reactions, Black Box Warning, consent, information sharing, causation, Botulinum Toxin Type A, pediatric spasticity, Cerebral Palsy, medication guide

DOI: 10.3233/PRM-210031

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 199-211, 2021

Authors: Mian, Mariam N. | Alwasiah, Nadia | Savitz, Ariel

Article Type: Research Article

Abstract: PURPOSE: Pediatric outpatient procedures can be traumatic experiences for patients. This retrospective study, evaluates intramuscular midazolam as a safe option for anxiolysis during spasticity management injections. METHODS: We performed a retrospective chart review of 72 patients from a Tertiary Pediatric Hospital Outpatient Clinic. One hundred and twenty injections were administered over two years by a single practitioner. Comorbidities included asthma, sleep apnea, chronic obstructive disease, and epilepsy. Duration of sedation, safety of midazolam as determined through the use of the REACT (Respiration, Energy, Alertness, Circulation, Temperature) score, and frequency of side effects (prolonged sedation, breakthrough crying, …medication reversal, and emergent evaluation) were recorded. A student’s t test evaluated the relationship between the above comorbidities and duration of sedation. RESULTS: The average duration of sedation was 29 minutes (95% CI 26.51–31.35) with an average dose of midazolam of 0.20 mg/kg (95% CI 0.9–0.21). None of the subjects required medication reversal or emergent evaluation. 39% of the patients had prolonged sedation (> 30 minutes after medication administration), 22% had breakthrough crying, and 0% had respiratory events requiring oxygen, intubation or an emergency evaluation. No statistical significance found between the comorbidities and duration of sedation. CONCLUSION: Intramuscular midazolam is a possible effective anxiolytic medication strategy for outpatient pediatric injections. Additional studies are needed to ensure its safety and efficacy. Show more

Keywords: Pediatric anxiolysis, intramuscular midazolam, in-office botulinum toxin, midazolam safety, pediatric sedation

DOI: 10.3233/PRM-190629

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 213-218, 2021

Authors: Marsico, Petra | Frontzek-Weps, Victoria | van Hedel, Hubertus J.A.

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to create a clear, standardized test description to rate spasticity severity into four categories according to the definition given by Lance [1], referred to as the Velocity Dependent Measure of Spasticity (VDMS). METHOD: Muscle groups of the upper and lower limbs of children with neuromotor disorders were evaluated on their response to passive movement in a fast-versus slow-velocity test condition. The interrater and test-retest reliability were assessed using Gwet’s alpha one (95%-CI) and the percentage agreement. RESULTS: Two physiotherapists independently assessed 45 children and youths (age …4–19 years). The interrater reliability of the VDMS was substantial to almost perfect (Gwet’s alpha one: 0.66–0.99, n = 45) while the test-retest reliability was almost perfect as well (Gwet’s alpha one: 0.83–1.00, n = 42). CONCLUSION: The VDMS can be recommended as a reliable assessment with a standardized procedure to assess spasticity of the extremities in children with neuromotor disorders. Show more

Keywords: Cerebral palsy, muscle hypertonia, muscle spasticity, outcome assessment, reliability

DOI: 10.3233/PRM-200704

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 219-226, 2021

Authors: O’Sullivan, Rory | French, Helen P. | Van Rossom, Sam | Jonkers, Ilse | Horgan, Frances

Article Type: Research Article

Abstract: PURPOSE: The aim of this study was to examine the relationship between gait analysis measures associated with crouch gait, functional health status and daily activity in ambulant cerebral palsy (CP). METHODS: Three-dimensional gait analysis was carried out on 35 ambulant participants with bilateral CP crouch gait (knee flexion at mid-stance (KFMS) ⩾ 19 0 ). KFMS, knee-flexion at initial contact, gait speed and step-lengths were extracted for analysis. Steps/day and sedentary time/day were assessed using an ActivPAL accelerometer. Functional health status was assessed using the five relevant domains of the …Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Associations between variables were assessed with correlation coefficients and multivariable linear regression. RESULTS: There were no significant correlations between KFMS and PODCI domains (ρ = - 0.008–0.110) or daily activity (ρ = - 0.297–0.237) variables. In contrast, multivariable analysis found that step-length was independently associated with the Sports and Physical Function (p = 0.030), Transfers and Basic Mobility (p = 0.041) and Global Function (< 0.001) domains of the PODCI assessment. Gait speed was independently associated with mean steps/day (p < 0.001). CONCLUSIONS: Step length and gait speed are more strongly associated with functional health status and daily activity than knee flexion during stance in children and adolescents with CP crouch gait. Show more

Keywords: Cerebral palsy, functional health status, gait/balance, activities of daily living

DOI: 10.3233/PRM-200676

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 227-235, 2021

Authors: Kachmar, Oleh | Kushnir, Anna | Fedchyshyn, Bohdana | Cristiano, Julián | O’Flaherty, John | Helland, Kjetil | Johnson, Gordon | Puig, Domenec

Article Type: Research Article

Abstract: PURPOSE: To assess the changes in balance function in children with cerebral palsy (CP) after two weeks of daily training with personalized balance games. METHODS: Twenty-five children with CP, aged 5 to 18 years were randomly selected for experimental or control groups. Over a period of two weeks, all participants received 8–9 game sessions for 15–20 minutes, totaling 150–160 minutes. The experimental group used personalized balance games available from the GAmification for Better LifE (GABLE) online serious gaming platform. Children from the control group played Nintendo Wii games using a handheld Wii Remote. Both groups received …the same background treatment. Recorded outcome measures were from a Trunk Control Measurement Scale (TCMS), Timed Up & Go Test (TUG), Center of Pressure Path Length (COP-PL), and Dynamic Balance Test (DBT). RESULTS: After two weeks of training in the experimental group TCMS scores increased by 4.5 points (SD = 3.5, p < 0.05) and DBT results increased by 0.88 points (IQR = 1.03, p < 0.05) while these scores did not change significantly in the control group. Overall, TUG and COP-PL scores were not affected in either group. CONCLUSION: This study demonstrates improvement of balancing function in children with CP after a two-week course of training with personalized rehabilitation computer games. Show more

Keywords: Game therapy, serious games, physical therapy, rehabilitation, neurological disorders

DOI: 10.3233/PRM-190666

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 237-245, 2021

Authors: Zarkou, Anastasia | Lee, Samuel C.K. | Prosser, Laura | Hwang, Sungjae | Franklin, Corinna | Jeka, John

Article Type: Research Article

Abstract: PURPOSE: To investigate foot and ankle somatosensory function in children with cerebral palsy (CP). METHODS: Ten children with spastic diplegia (age 15 ± 5 y; GMFCS I–III) and 11 typically developing (TD) peers (age 15 ± 10 y) participated in the study. Light touch pressure and two-point discrimination were assessed on the plantar side of the foot by using a monofilament kit and an aesthesiometer, respectively. The duration of vibration sensation at the first metatarsal head and medial malleolus was tested by a 128 Hz tuning fork. Joint position sense …and kinesthesia in the ankle joint were also assessed. RESULTS: Children with CP demonstrated significantly higher light touch pressure and two-point discrimination thresholds compared to their TD peers. Individuals with CP perceived the vibration stimulus for a longer period compared to the TD participants. Finally, the CP group demonstrated significant impairments in joint position sense but not in kinesthesia of the ankle joints. CONCLUSIONS: These findings suggest that children with CP have foot and ankle tactile and proprioceptive deficits. Assessment of lower extremity somatosensory function should be included in clinical practice as it can guide clinicians in designing more effective treatment protocols to improve functional performance in CP. Show more

Keywords: Cerebral palsy, sensory processing, sensation, proprioception, somatosensory function, sensory thresholds

DOI: 10.3233/PRM-190643

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 247-255, 2021

Authors: Siemens, Marshall | Wunder, Shane | Kraushaar, Jacqueline | Mortimer, J. Alexandra | Siddiqui, Muhammed | Kane, Kyra

Article Type: Research Article

Abstract: PURPOSE: Hip displacement impacts quality of life for many children with cerebral palsy (CP). While early detection can help avoid dislocation and late-stage surgery, formalized surveillance programs are not ubiquitous. This study aimed to examine: 1) surgical practices around pediatric hip displacement for children with CP in a region without formalized hip surveillance; and 2) utility of MP compared to traditional radiology reporting for quantifying displacement. METHODS: A retrospective chart review examined hip displacement surgeries performed on children with CP between 2007–2016. Surgeries were classified as preventative, reconstructive, or salvage. Pre- and post-operative migration percentage (MP) …was calculated for available radiographs using a mobile application and compared using Wilcoxon Signed Ranks test. MPs were also compared with descriptions in the corresponding radiology reports using directed and conventional content analyses. RESULTS: Data from 67 children (115 surgical hips) were included. Primary surgery types included preventative (63.5% hips), reconstructive (36.5%), or salvage (0%). For the 92 hips with both radiology reports and radiographs available, reports contained a range of descriptors that inconsistently reflected the retrospectively-calculated MPs. CONCLUSION: Current radiology reporting practices do not appear to effectively describe hip displacement for children with CP. Therefore, standardized reporting of MP is recommended. Show more

Keywords: Cerebral palsy, hip subluxation, hip dislocation, hip surgery, surveillance program, migration percentage, radiology reporting

DOI: 10.3233/PRM-201506

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 257-263, 2021

Authors: Umar, Abdullahi B. | Yakasai, Abdulsalam M. | Danazumi, Musa S. | Shehu, Usman T. | Badaru, Umaru M. | Kaka, Bashir

Article Type: Research Article

Abstract: PURPOSE: This study aimed to identify the needs and priorities of parents of children with cerebral palsy (CP) in order to improve care by increasing family participation in rehabilitation programmes. METHODS: This cross-sectional questionnaire-based study was conducted between January to March 2019. Convenience sampling was used to recruit 43 family members (18 years and above) of children with CP who came to the physiotherapy departments for rehabilitation services for their children. Fisher’s exact test was used to analyse the association between socio-demographic characteristics and each of the need items. RESULTS: Five different items …were identified to be the family needs that were most frequently met: a) ‘need for active involvement in the child’s treatment and therapies’ (n = 40; 93.0%), b) ‘need for the provision of standard medical care (n = 39; 90.7%), c) ‘need for questions to be answered honestly’ (n = 38; 88.4%), d) ‘need for healthcare professionals to respect the child’s wishes’ (n = 36; 83.7%), e) ‘need for mothers to discuss their feelings (depression, stress etc.) with someone who has similar experience’ (n = 36; 83.7%). Conversely, three items were the most unmet family needs: a) ‘need to have professionals to consult whenever the child needs help’ (n = 39; 90.7%), b) ‘need to be informed about the child’s prognosis’ (n = 41; 95.3%), and c) ‘need to have financial support to provide the child with adequate care’ (n = 43; 100%). CONCLUSION: All participants overwhelmingly reported that their financial needs were their highest priority. The multiple needs of families of children with disabilities must be assessed and considered in rehabilitation services when treating children with CP. Show more

Keywords: Cerebral palsy, disability, family needs, family participation, rehabilitation services, Nigeria

DOI: 10.3233/PRM-200696

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 265-274, 2021

Authors: Dawson, Shay | McCormick, Bryan | Piatt, Jennifer | Knapp, Doug | Dickinson, Stephanie

Article Type: Research Article

Abstract: PURPOSE: Youth with physical disabilities are at an elevated risk for poor psychosocial health. Pediatric medical camps are one common intervention utilized to provide short-term psychosocial support. However, there is a growing criticism that the effects of such programs diminish as participants return to home and school settings post residential camp experience. A post camp support intervention, the first known in the literature, was tested for perceptions of mattering and self-esteem. Specifically, this study examined the psychosocial effect of a year-round mentoring and online support program as an adjunct to residential camp (intervention) as compared to peers that attended …only the summer residential experience (comparison group). METHODS: A quasi-experimental design using an intervention and comparison group was implemented. Data were analyzed using a repeated measures analysis of variance to test for within group and between group effect. RESULTS: A small effect (partial η 2 = 0.096) between groups (p < 0.17) and a moderate effect (partial η 2 = 0.133) within groups (p < 0.10) was detected for the mattering construct. A positive effect for self-esteem was not detected between or within groups. CONCLUSIONS: The online and mentoring support program appeared to improve perceptions of mattering three months into implementation. Future implications center on the refinement of the support program and suggestions for further longitudinal research. Show more

Keywords: Adolescent, camping, community integration, social distance, self-concept

DOI: 10.3233/PRM-190673

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 275-284, 2021

Authors: Gray, Susan Hayden | Byrne, Rachel | Christensen, Sinead | Williams, David | Wylie, Molly | Fowler, Eileen | Gaebler-Spira, Deborah | Marciniak, Christina | Glader, Laurie

Article Type: Research Article

Abstract: PURPOSE: To explore the recalled experiences of women with CP regarding sexual health education and services they received. METHODS: Semi-structured interviews and focus groups were conducted at four academic tertiary hospitals with 33 adult women with CP. Templates were used to ask about four key content domains: appointment planning (including planning for a gynecologic exam), accessibility of services, experiences with providers, and recommendations for improvement. Sessions were transcribed verbatim and analyzed to generate a coding dictionary. Blinded coding was carried out for each transcript, with duplicate coding used to confirm identified themes. Iterative analysis was used …to identify and consolidate coding and key themes. RESULTS: Similar barriers were discussed at the four sites, including lack of accessible exam tables, hospital staff unfamiliar with physical disabilities, and assumptions that women with CP are not sexually active. Many described the sexual education they received as brief, omitted, or mistimed. Self-advocacy was crucial, and recommended strategies ranged from pre-gynecologic exam medication to visit checklists. CONCLUSION: Reproductive health education for young women with CP is frequently inadequate. Medical professionals lack relevant knowledge and awareness; medical facilities lack necessary infrastructure. Recommendations for improvements are made. Show more

Keywords: Health education, sexual education, reproductive health, cerebral palsy

DOI: 10.3233/PRM-210020

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 285-293, 2021

Authors: Kim, Do Hyun

Article Type: Research Article

Abstract: PURPOSE: We explored the test-retest reliability of pelvic rotation measured using a smartphone and established criterion-related validity by analyzing simple linear regression between pelvic rotation data obtained using the smartphone and those measured by a palpation meter. METHODS: We recruited 12 children with cerebral palsy (CP) (7 boys and 5 girls) and measured pelvic rotation using a smartphone application and a palpation meter in the sitting, standing, and one-leg standing positions. Test-retest reliability was evaluated by calculating intraclass correlation coefficients (ICCs); simple linear regression was analyzed to explore the relationships between smartphone and palpation meter data. …RESULTS: In terms of the test-retest reliability of pelvic rotation measured by the smartphone, the ICCs ranged from 0.85 to 0.95. A positive linear correlation was found between smartphone and palpation meter data. CONCLUSIONS: We confirmed that measurement of pelvic rotation using a smartphone was reliable when children with CP were in the sitting, standing, and one-leg standing positions. In addition, pelvic rotation measured using the smartphone correlated significantly with that measured using a palpation meter. Show more

Keywords: Cerebral palsy, palpation meter, pelvic rotation

DOI: 10.3233/PRM-190621

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 295-299, 2021

Authors: Pierce, Wendy

Article Type: Book Review

Keywords: Quality of life, cerebral palsy, gait impairment, book review, gait disorders

DOI: 10.3233/PRM-210029

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 301-302, 2021

Authors: MacCarthy, Matthew

Article Type: Other

Keywords: Cerebral palsy, disability representation, adolescents

DOI: 10.3233/PRM-210008

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 303-305, 2021

Authors: McLaughlin, Matthew | Inanoglu, Didem

Article Type: Other

Keywords: Clinical response, pediatric patients, cerebral palsy

DOI: 10.3233/PRM-210028

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 307-314, 2021

Article Type: Other

DOI: 10.3233/PRM-219007

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 315-327, 2021

Article Type: Other

DOI: 10.3233/PRM-219008

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 2, pp. 329-330, 2021