Journal of Pediatric Rehabilitation Medicine - Volume 14, issue 3

Authors: Pico, Elaine L.

Article Type: Editorial

DOI: 10.3233/PRM-219012

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 331-332, 2021

Authors: Vova, Joshua A.

Article Type: Research Article

Abstract: Anti-N-Methyl-D-Aspartate Receptor Encephalitis (ANMDARE) is one of the most common autoimmune encephalitis in the pediatric population. Patients with ANMDARE initially present with a prodrome of neuropsychiatric symptoms followed by progressively worsening seizures, agitation, and movement disorders. Complications can include problems such as aggression, insomnia, catatonia, and autonomic instability. Due to the complexity of this disease process, symptom management can be complex and may lead to significant polypharmacy. The goal of this review is to educate clinicians about the challenges of managing this disorder and providing guidance in symptom management.

Keywords: Anti-NMDA receptor encephalitis, ANMDARE, pharmacology, treatment, behavior

DOI: 10.3233/PRM-200677

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 333-343, 2021

Authors: Hart, Emerson | Grattan, Emily | Woodbury, Michelle | Herbert, Teri Lynn | Coker-Bolt, Patty | Bonilha, Heather

Article Type: Research Article

Abstract: PURPOSE: Unilateral spatial neglect (USN), an inability to attend to one side of space or one’s body, is commonly reported in adult stroke survivors and is associated with poor outcomes. USN has been reported in pediatric survivors of stroke, but its impact is unclear. The purpose of this systematic review was to summarize and evaluate the literature regarding USN in pediatric stroke survivors. METHODS: PRISMA guidelines, Scopus, CINAHL, PubMed, and other relevant databases were searched with terms including “children”, “stroke”, and “unilateral neglect”, with the ages of participants limited from to birth to 18 years. Data were extracted …from studies on the clinical presentation of pediatric USN, the assessment of this condition, treatment options, or USN recovery. RESULTS: A total of 18 articles met inclusion criteria. There were no current prevalence data available. USN presents similarly in children compared to adults. Several different USN assessments were used, however, there were little data regarding treatment options. Furthermore, the data suggest that not all children fully recover. CONCLUSION: This systematic review reveals a lack of quality research to inform the assessment and treatment of children with USN. Although the literature spans decades, there remain no guidelines for standardized assessment or treatment. Similar to adults, paper-and-pencil testing may be less able to identify USN than functional assessments. It is likely that there are children who struggle with undetected USN-related deficits years after their injuries. With a rise of pediatric stroke survivors, there is a pressing need for clinicians to be educated about USN in children, clinical presentations, assessments, and treatments. Show more

Keywords: Stroke (MeSH), neglect, pediatrics (MeSH), perceptual disorders (MeSH)

DOI: 10.3233/PRM-200779

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 345-359, 2021

Authors: De Tienda, Marine | Bouthors, Charlie | Pejin, Zagorha | Glorion, Christophe | Wicart, Philippe

Article Type: Research Article

Abstract: PURPOSE: Multiple synostoses syndrome (MSS) is a rare genetic condition. Classical features consist of joint fusions which notably start at the distal phalanx of the hands and feet with symphalangism progressing proximally to carpal, tarsal, radio-ulnar, and radio-humeral joints, as well as the spine. Usually, genetic testing reveals a mutation of the NOG gene with variable expressivity. The goal was to present the anatomical, functional, and radiological presentations of MSS in a series of patients followed since childhood. METHODS: Patients with more than 3 synostoses affecting at least one hand joint were included. When possible, genetic screening was …offered. RESULTS: A retrospective study was performed from 1972 to 2017 and included 14 patients with a mean follow-up of 18.6 years. Mutation of the NOG protein coding gene was seen in 3 patients. All presented with tarsal synostoses including 9 carpal, 7 elbow, and 2 vertebral fusions. Facial dysmorphia was seen in 6 patients and 3 were hearing-impaired. Surgical treatment of tarsal synostosis was performed in 4 patients. Progressing joint fusions were invariably seen on x-rays amongst adults. CONCLUSION: Long radiological follow-up allowed the assessment of MSS progression. Feet deformities resulted in a severe impact on quality of life, and neurological complications secondary to spine fusions warranted performing at least one imaging study in childhood. As there is no treatment of ankylosis, physiotherapy is not recommended. However, surgical arthrodesis for the treatment of pain may have reasonable outcomes. Show more

Keywords: Multiple synostosis, carpal tarsal coalition, symphalangism

DOI: 10.3233/PRM-200702

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 361-369, 2021

Authors: Fukatsu, Hikari | Nohara, Kanji | Tanaka, Nobukazu | Fujii, Nami | Sakai, Takayoshi

Article Type: Research Article

Abstract: PURPOSE: This study examined whether certain medical complications influence the feasibility of tube removal. METHODS: 42 subjects with dysphagia who were under the age of 2.5 years were nourished entirely through feeding tubes. Additionally, they were judged to have no aspiration. The following data about the infants were collected through a retroactive survey: age at which oral feeding training commenced, gender, and whether certain medical complications (cardiovascular, respiratory, digestive, neurological, or oral) had been present at birth. The data were analyzed to determine which type of medical complication affected the likelihood of removing the feeding tube from the …infant at 3 years of age. RESULTS: Of the five medical complications examined, cardiovascular complications significantly affected the feasibility of tube removal (p  = 0.049). CONCLUSION: Pediatric dysphagia patients with cardiac complications, compared to those with other complications, may take longer to transition off tube feeding. Show more

Keywords: Feeding tube, medical complications, cardiovascular complications, dysphagia

DOI: 10.3233/PRM-200786

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 371-377, 2021

Authors: Alidad, Alireza | Tarameshlu, Maryam | Ghelichi, Leila | Haghani, Hamid

Article Type: Research Article

Abstract: PURPOSE: Feeding problems are common in premature infants (PIs) and may lead to negative consequences such as malnutrition, dehydration, excessive weight loss, as well as developmental and psychological deficits. Moreover, they are associated with increased length of hospital stay/cost. There is not enough evidence on how feeding problems should be treated in PIs. The goal of this study was to investigate the effects of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in PIs. METHODS: A single-blind randomized clinical trial was performed on 44 PIs with feeding problems. Patients were randomly categorized into …two groups: (1) combined intervention (CI) and (2) non-nutritive sucking (NNS). The CI group received NNS, oral motor stimulation and oral support simultaneously. Infants in both groups received 14 treatment sessions for 14 consecutive days. The Preterm Oral Feeding Readiness Assessment Scale (POFRAS) was used as the primary outcome measure. Weight, volume of milk intake, time to achieve full oral feeding, and length of hospital stay were secondary outcome measures. All measures were assessed before treatment, after the 7th session, after the 14th session, and after 7 days after the end of treatment. RESULTS: Both groups improved in all outcome measures across time (P  < 0.001). The improvements in the POFRAS, volume of milk intake, and time to achieve full oral feeding were significantly greater in the CI group than the NNS group (P  < 0.001). The improvements attained in weight and length of hospital stay were not significantly different between the CI and NNS groups (P  > 0.05). Large effect sizes were found for POFRAS score in both CI (d  = 3.98) and NNS (d  = 2.19) groups. CONCLUSION: The current study showed that the combined intervention including NNS, oral motor stimulation, and oral support significantly improved the feeding performance in PIs. Show more

Keywords: Oral motor stimulation, non-nutritive sucking, oral support, premature infants

DOI: 10.3233/PRM-190651

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 379-387, 2021

Authors: Cermak, Carly A. | Scratch, Shannon E. | Reed, Nick P. | Beal, Deryk S.

Article Type: Research Article

Abstract: PURPOSE: To examine language outcomes in the short-term stage (i.e., within three months) of early childhood traumatic brain injury (TBI). METHODS: A retrospective chart review over a 10-year period (January 1, 2007 to December 31, 2016) was completed at a single-site inpatient rehabilitation hospital. Inclusion criteria were children aged 15 months to five years 11 months with a diagnosis of closed TBI. RESULTS: Twenty-four charts were included in the descriptive analysis of language; there were fewer children with expressive language scores (n  = 18) than receptive language scores (n  = 24), likely due to word retrieval difficulties as …per clinical documentation. Effects of TBI on language performance were more pronounced in receptive than expressive language. For children with scores in both receptive and expressive language areas (n  = 18), five children had below average scores. These children were described as having language delays pre-injury (n  = 2), lower exposure to English (n  = 1), information processing difficulties (n  = 1), and difficulties with formulation and organization of language (n  = 1). CONCLUSION: This study represents an initial step in understanding expressive and receptive language performance shortly after early childhood TBI. Challenges with assessment as well as directions for future research are discussed. Show more

Keywords: Acquired brain injury, early childhood, language, rehabilitation, traumatic brain injury

DOI: 10.3233/PRM-200795

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 389-399, 2021

Authors: Phelan, Ivan | Furness, Penny J. | Dunn, Heather D. | Carrion-Plaza, Alicia | Matsangidou, Maria | Dimitri, Paul | Lindley, Shirley

Article Type: Research Article

Abstract: PURPOSE: Children who sustain Upper Limb Injuries (ULIs), including fractures and burns, may undergo intensive rehabilitation. The discomfort of therapy can reduce their compliance, limit their range of motion (ROM) and lead to chronic pain. Virtual Reality (VR) interventions have been found to reduce anticipated and procedural pain. This feasibility study aimed to explore perceptions and impacts of a custom-made, fully immersive Head-Mounted Display VR (HMD-VR) experience within a United Kingdom (UK) National Health Service (NHS) outpatient rehabilitation service for children with ULIs. METHODS: Ten children aged 9–16 in one UK Children’s hospital trialled HMD-VR during one rehabilitation …session. They, their parents (n  = 10), and hospital physiotherapy staff (n  = 2) were interviewed about their perceptions of pain, difficulty, enjoyability, therapeutic impacts, benefits, and limitations. Children rated the sessions on enjoyability, difficulty, and pain compared to usual rehabilitation exercises. Physiotherapists were asked to provide range of motion readings. RESULTS: Inductive thematic analysis of interview data generated three themes, ‘Escape through Engagement’; ‘Enhanced Movement’; and ‘Adaptability and Practicality’. Children rated the session as more enjoyable, less difficult and painful than their usual rehabilitation exercises. Findings suggested that HMD-VR was an engaging, enjoyable experience that distracted children from the pain and boredom of therapy. Also, it seemed to enhance the movement they achieved. Participants perceived it was useful for rehabilitation and adaptable to individual needs and other patient groups. Suggestions were made to increase adaptability and build in practical safeguards. CONCLUSION: Findings from this small-scale feasibility study suggested HMD-VR was perceived as usable, acceptable, and effective with potential for further development. Future work could include larger scale trials. Show more

Keywords: Virtual reality, upper limb injury, children’s rehabilitation, physiotherapy, burns, fractures

DOI: 10.3233/PRM-190635

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 401-414, 2021

Authors: Marchese, Victoria | Rock, Kelly | York, Teresa | Creath, Robert | Gray, Vicki

Article Type: Research Article

Abstract: PURPOSE: This study explored neuromuscular mechanisms and clinical measures that contribute to countermovement jump performance in survivors of childhood acute lymphoblastic leukemia (ALL CCS) compared to age- and sex-matched peers. METHODS: This exploratory cross-sectional observational study examined 12 participants, six ALL CCS and six age- and sex-matched peers (7–16 years). During a countermovement jump, rates of muscle activation of lower leg muscles were measured with electromyography, and joint torques and peak jump height with force plates and a motion capture system. Clinical measures included muscle extensibility, balance, and mobility measured by active ankle dorsiflexion, Bruininks-Oseretsky Motor Proficiency (BOT-2), …and Timed Up and Go (TUG) tests. RESULTS: Compared to peers, ALL CCS demonstrated reduced gastrocnemius muscle extensibility and tibialis anterior rate of muscle activation, decreased jump height, and poorer performance on the BOT-2 and TUG. Jump height was significantly correlated with clinical measures of the BOT-2 and TUG. CONCLUSION: These ALL CCS demonstrated neuromuscular impairments that may impact jump performance, an essential childhood physical activity. Further research is needed to explore intervention strategies to improve the neuromuscular mechanisms that contribute to high-level gross motor skills in ALL CCS. Show more

Keywords: Cancer, motor skills, biomechanics, jumping

DOI: 10.3233/PRM-200784

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 415-423, 2021

Authors: Khallaf, Mohamed E. | Fayed, Eman | Sweif, Radwa E. | Alsalem, Abdulkarem

Article Type: Research Article

Abstract: PURPOSE: Down Syndrome (DS) is characterized by intellectual disability, hypotonia, and joint laxity. Physical disability can be an additional problem and manifests as reduced lower limb muscle strength and impaired balance. The objectives of this study were to characterize DS dynamic foot-ground contact area and to study its relationship with balance impairment among adolescents with DS. METHODS: Twenty-eight children and adolescents with DS and 28 non-DS adolescents/children were matched for age and sex. The Oxford Ankle Foot Questionnaire (parents’ version) was used to measure disability related to ankle/foot problems in all subjects. A pressure-sensitive mat was used to …assess the contact area and arch index. Also, a Biodex balance system was used for measuring postural stability. RESULTS: There were significant differences between both groups in all domains of the Oxford Ankle Foot Questionnaire, overall contact area, and arch index (p  < 0.05). Overall postural stability index was significantly decreased in subjects with DS (p  < 0.05). There was a nonsignificant correlation between contact area and postural stability (p  > 0.05). CONCLUSION: Adolescents with DS exhibited larger mid-foot and forefoot contact areas with respect to non-DS matched children. Impairment of balance in adolescents with DS is a multifactorial problem not related to changes in the foot contact area. Show more

Keywords: Ankle, balance, adolescents, down syndrome, foot

DOI: 10.3233/PRM-200764

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 3, pp. 425-432, 2021