Journal of Pediatric Rehabilitation Medicine - Volume 5, issue 2
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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: Objective: The aim of this study was to elucidate the feasibility, efficacy, and sustainability of a home-based, two-week, forced-use therapy (FUT) program for children with hemiplegic cerebral palsy (CP). Methods: A single-blinded, randomized controlled design was chosen. The Melbourne Assessment of Unilateral Upper Limb Function (MA) was carried out at baseline, pretest, post-test, and follow-up at two weeks, three months, and 12 months. Additionally, a questionnaire was used to evaluate the clinical relevance and…integration of FUT in the home setting. 23 children, ages six to 16 years, took part in the study and were randomized into either an intervention group (n=12, mean age 9.8 ± 3.5 years) or a control group ($n=$ 11, mean age 11.7 ± 3.7 years). The intervention consisted of constraint of the unaffected hand for six hours per day and promotion of different activities of daily living according to an age-related manual for the use of the non-constraint hand. Results: Unpaired t-tests for the change in MA scores relative to the pre-test values showed no difference between the groups at any time point: post-test (p=0.304), two weeks (p=0.193), or three months (p=0.957). Improvements in Activities of Daily Living (ADLs) assessed by questionnaires were observed by 64% of parents of the intervention group. Fifty-five percent of parents stated that the FUT program was exhausting and only 45% indicated that they achieved constraint for 6 hours per day. Conclusion: Our results evaluating a home-based FUT program of 14 days show no statistically significant improvement of upper extremity function in children with CP. The lack of compliance and absence of structured exercises proved to be considerable pitfalls of the home-based FUT program. Therefore, future home based FUT concepts should put special emphasis on the close monitoring and support of children and their families, as well as the integration of structured exercise sessions.
Abstract: Objective: A multi-site Randomized-Controlled Trial compared a home-based Supported Speed Treadmill Training Exercise Program (SSTTEP) with a strengthening exercise program in children with cerebral palsy (CP) on the following categories; Participation, quality of life (QOL), self-concept, goal attainment, and satisfaction. Design: Twenty-six children with spastic cerebral palsy were assigned by site-based block randomization to the SSTTEP (n=14) or strengthening exercise (n=12) group. Both groups participated in a two week clinic-based…induction period and continued the intervention at home for ten weeks. Data were collected at baseline, post-intervention (12 weeks), and follow-up (16 weeks). Assessments included the Canadian Occupational Performance Measure, Children's Assessment of Participation and Enjoyment Scale, Pediatric Quality of Life Cerebral Palsy Module, and Piers-Harris Children's Self-Concept Scale. Evaluators were blinded to group assignment at two sites. Results: Satisfaction and performance on individual goals, participation, and parent-reported QOL improved in both groups with improvement maintained for four weeks post intervention. Conclusion: The hypothesis that the SSTTEP group would have better outcomes than the exercise group was not supported. However, both groups showed that children with CP can make gains in participation, individual goals, and satisfaction following a 12-week intensive exercise intervention, and these findings persisted for four weeks post intervention.
Keywords: Partial body-weight supported treadmill-training (PBWSTT), spastic cerebral palsy, Canadian Occupational Performance Measure, Children's Assessment of Participation and Enjoyment Scale, Pediatric Quality of Life assessment, and Piers-Harris Children's Self-Concept Scale
Abstract: Objective: The purpose of this study was to review the feasibility and usefulness of instituting a clinical protocol of scheduled assessments for children after a moderate or severe traumatic brain injury (TBI) sustained before the age of 2 years and showing no immediate deficits at hospital discharge, as well as to explore the early developmental trajectories of these children. Design: Exploratory analytical cohort study. Setting: Pediatric Trauma Center Out-patient services. Participants: 31 children…were followed within the clinical protocol of scheduled assessments. Outcome measures: The protocol included an immediate post-injury clinical assessment of infants who sustained a TBI and follow-up assessments at the ages of 9 months, 18 months (if injured prior to that age), 30 months, and 42 months. Domains assessed at each scheduled visit included hearing, speech and language, motor performance, personal social abilities, and adaptive behaviors. Results: Clinicians reported few difficulties with scheduling or administering the assessments, maintaining a 67% participation rate at the end of the follow-up period, thus demonstrating the feasibility of the protocol in this population. Scores on the majority of formal tests showed high variability and 15–20% of children presented with clinically significant motor and/or language delays. By 42 months of age, difficulties with adaptive behavior and personal social abilities were identified in our sample of children when compared to published norms. Qualitative clinical findings from professionals identified between 25–50% of children with potential attentional difficulties throughout the follow-up period. Conclusion: Findings from this study demonstrate the feasibility of implementing a clinical protocol of assessment for infants and toddlers who sustain a TBI before the age of 2 years and present with no impairments at the time of discharge from hospital. Developmental problems in this population appear to be easier to identify later in the toddler years as opposed to immediately following the TBI, emphasizing the importance of providing screening for developmental issues in this population prior to school entry.
Keywords: Traumatic brain injury, children, language development, motor development
Abstract: Muscle weakness may contribute to crouch gait in individuals with cerebral palsy, and some individuals participate in strength training programs to improve crouch gait. Unfortunately, improvements in muscle strength and gait are inconsistent after completing strength training programs. The purpose of this study was to examine changes in knee extensor strength and knee extension angle during walking after strength training in individuals with cerebral palsy who walk in crouch gait and to determine subject characteristics associated…with these changes. A literature review was performed of studies published since January 2000 that included strength training, three-dimensional motion analysis, and knee extensor strength measurements for individuals with cerebral palsy. Three studies met these criteria and individual subject data was obtained from the authors for thirty crouch gait subjects. Univariate regression analyses were performed to determine which of ten physical examination and motor performance variables were associated with changes in strength and knee extension during gait. Change in knee extensor strength ranged from a 25% decrease to a 215% increase, and change in minimum knee flexion angle during gait ranged from an improvement of 9° more knee extension to 15° more knee flexion. Individuals without hamstring spasticity had greater improvement in knee extension after strength training. Hamstring spasticity was associated with an undesired increase in knee flexion during walking. Subject-specific factors such as hamstring spasticity may be useful for predicting which subjects will benefit from strength training to improve crouch gait.
Abstract: Aim: To evaluate the reliability and validity of the PEDI in Hebrew (PEDI-H) in children with cerebral palsy (CP) using health care professionals' (HCP) and mothers' evaluations. Methods: The sample comprised 73 participants (40 males, 33 females) with CP. Two modes of PEDI-H administration were used: interview of the mothers by a social worker and HCP evaluation. PEDI-H reliability was examined by two modes: 1) internal consistency via Cronbach's alpha and 2) overall absolute…agreement within subject reliability via intraclass correlation coefficient (ICC). Discriminative validity using collapsed strata of the Gross Motor Functional Classification System (GMFCS) (area under the curve=AUC) were examined for each of the PEDI-H sub-domains. Results: Participants' mean age was 8 years 8 months (standard deviation (SD) 2 years 10 months). The reliability of mothers' PEDI-H was good-to-excellent (Cronbach's alpha=0.889–0.964, ICC=0.845–0.938). The HCPs' reliability was excellent (Cronbach's alpha and ICCs > 0.90). The PEDI-H was also reliable in children with mild, moderate, and severe CP (GMFCS=I+II, III and IV+V, respectively), in younger (6–7 years) and older children (8–12 years), and in children with various CP distribution. Mothers and HCPs had low accuracy in Social-Function domains (AUC=0.538–0.686) and moderate-to-high accuracy in Mobility and Self-Care domains (AUC=0.887–0.967). PEDI-H was able to distinguish between children with various CP severities. Conclusion: The PEDI-H has good psychometric properties when administered by mothers and HCPs and can be used in older children with CP.
Keywords: CP, PEDI, rehabilitation, psychometrics, function
Abstract: Modified Constraint Induced Movement Therapy (CIMT) and Neuro-Developmental Treatment (NDT) are both intervention strategies that focus on active practice to optimize function. CIMT involves constraint of the less involved upper extremity during function and NDT includes facilitation of optimal postural control and symmetry to enhance the ability to complete a given motor function. The purpose of this article is to describe an intervention protocol for children with hemiplegia that integrates key NDT and…CIMT principles. Two children participated in a modified CIMT (mCIMT)/NDT program 2 hours a day for two months. The children wore a constraint on the less involved arm and participated in guided play with early intervention members and parents. Play was individualized to developmental level and incorporated principles of NDT. Function was measured pre- and post-intervention using the PDMS-2, QUEST, ACQUIRE Therapy Motor Patterns, and ACQUIRE Functional Activities. Both children demonstrated motor skill acquisition, improved quality of functional use, and increased frequency of bilateral hand use. Parents found the protocol challenging but manageable in their daily routines. The inclusion of NDT principles within a mCIMT protocol may be an effective intervention to maximize functional motor skill acquisition in children with hemiplegia. Additional research is warranted to support this intervention.
Keywords: Cerebral palsy, hemiplegia, Constraint Induced Movement Therapy, Modified Constraint Induced Movement Therapy, Neuro-Developmental Treatment, infant toddler program, early intervention services
Abstract: The use of Interactive Computer Play (ICP) in rehabilitation is developing rapidly and is especially promising in interdisciplinary pediatric rehabilitation. This case report examines how the Nintendo Wii® can be used in the rehabilitation of an adolescent with Acquired Brain Injury (ABI). In particular it describes the use of the Nintendo Wii in a structured group therapy called the GameLaB.
Abstract: Objective: To compare effects of 2 dosage levels of constraint-induced movement therapy (CIMT) for children with hemiplegic cerebral palsy (CP). We hypothesized that high-dosage CIMT would produce larger benefits than moderate-dosage. Methods: Three sites enrolled a total of 18 children (6 children per site from 3–6 years) with unilateral CP. Children were randomly assigned to CIMT for 21 days for either 6 hours/day (high-dosage=126 hours) or 3 hours/day (moderate-dosage=63 hours); both groups wore a…long-arm cast. Evaluators (blind to dosage) assessed children 1-week prior, then 1-week and 1-month after treatment with the Assisting Hand Assessment (AHA), The Quality of Upper Extremity Skills Test (QUEST) Dissociated Movement and Grasp sections, the Shriners Hospital Upper Extremity Evaluation (SHUEE), and the Pediatric Motor Activity Log (PMAL). Results: All children responded well to casting and received the full intended dosage. Both groups showed statistically significant gains on the AHA, QUEST, SHUEE, and PMAL. Effect sizes ranged from 0.36–0.79. Overall, both groups showed comparable improvements at 1-week and 1-month post-treatment. Conclusions: Pediatric CIMT at both moderate and high dosages produced positive effects across multiple reliable, valid outcome measures. The findings refuted the hypothesis of differential dosage benefits. Future research should address long-term effects, enroll larger and more diverse samples, and assess lower dosages to ascertain a minimal-efficacy threshold.