Journal of Pediatric Rehabilitation Medicine - Volume 6, issue 1

Authors: Ottolini, Katherine | Harris, Amy B. | Amling, June K. | Kennelly, Ann M. | Phillips, Leslie A. | Tosi, Laura L.

Article Type: Research Article

Abstract: Skin breakdown is a frequent concern for individuals with spina bifida. We explored wound incidence in patients with spina bifida and how it varies across a person's life span and functional neurologic level. We examined the settings in which skin breakdown most commonly occurred, looking for evidence of chronic, non-healing wounds. We also sought to develop criteria to improve wound monitoring. We identified reported wound episodes in an open-cohort study over a 13-year period, examining the …hospital and outpatient clinical records of spina bifida patients at Children's National Medical Center (CNMC). Current age, age at wound presentation, sex, weight, functional neurologic level, wound location, setting in which the wound was acquired, the development of a chronic wound, and presence of a shunt were recorded. Of the 376 patients in our clinical population, 123 (average age: 18.8 years, range: infancy–56 years) developed a total of 375 wounds; the majority of patients who developed one wound went on to develop one or more additional wounds, and 20 patients developed chronic wounds. Our data suggest that age bracket (adolescents), wheelchair use, and bare feet, as well as possibly obesity and reduced executive functioning, are key risk factors for wound development. These findings have led to a focused effort to increase wound education and prevention. In addition we report on our early experience using a wound care specialist to champion this initiative. Show more

Keywords: Spina bifida, chronic wounds, skin breakdown, wound care, children

DOI: 10.3233/PRM-130231

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 1-10, 2013

Authors: Kim, Chong-Tae | Greenberg, Jared | Kim, Heakyung

Article Type: Research Article

Abstract: Length of stay (LOS) is one of the most important pieces of data used to measure clinical rehabilitation outcomes, but there is a paucity of LOS data regarding pediatric acute rehabilitation. The purpose of this study was to predict LOS based on admission diagnosis to an acute pediatric inpatient rehabilitation unit. The hypothesis was that LOS will vary according to admission diagnosis. One thousand one hundred forty-five patients were admitted to our acute inpatient …rehabilitation unit from January 1, 2000 to December 31, 2007. Common admission impairment groups were orthopedic conditions (29.3%), brain injury (17.9%), brain tumor (7.9%), pain syndrome (7.5%), complex medical conditions (7.4%), stroke (7.2%), meningoencephalitis (7.2%), and spinal cord injury (4.4%). The distribution of LOS data was significantly skewed to the right (for example, mean 40.6 days and median 26 days, respectively, in brain injury group). The median LOS of patients admitted with orthopedic conditions was the shortest (13 days), compared to patients admitted with spinal cord lesions, which was the longest (32 days). Logarithm-transformed mean LOS was different among the admission impairment groups (F=28.7, p < 0.01). However Tukey's Honestly Significance Difference test further showed that: 1) LOS data was not always statistically different across admission impairment groups, and 2) LOS of patients with orthopedic conditions and spinal cord lesions was the shortest and longest, respectively, compared to other admission impairment groups. No proportional decrease in median LOS was observed across the impairment groups from 2000 to 2007. LOS for pediatric acute inpatient rehabilitation varied according to admission diagnosis. When considering future comprehensive pediatric rehabilitation outcome studies, focusing on a uniform impairment group is suggested. In addition, attention to other factors such as functional status changes, severity of illness, payment types, and psychosocioeconomic status should be considered. Show more

Keywords: Length of stay, pediatric rehabilitation, admission impairment

DOI: 10.3233/PRM-130232

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 11-17, 2013

Authors: Sundaram, Balasubramanian | Shrivastava, Sonali | Pandian, Joseley Sunderraj | Singh, Vijay Pratap

Article Type: Research Article

Abstract: PURPOSE: To determine the effect of facilitated tucking (FT) on pain in preterm newborns during heel stick procedure done as a part of neonatal intensive care. METHODS: This randomized controlled cross-over pilot study included 20 preterm newborns of both sexes between gestational ages (GA) of 28 and 36 weeks based upon the eligibility criteria. Pain was measured using Premature Infant Pain Profile (PIPP) following both heel stick with FT and without FT. RESULTS: The newborns had a lower PIPP score …at 30 seconds (Mean, SD: 8.80, 3.82), 60 seconds (Mean, SD: 7.55, 3.28), 90 seconds (Mean, SD: 7.25, 3.06) and 120 seconds (Mean, SD: 6.65, 3.05) when heel stick was done with FT compared to the same procedure done without FT at 30 seconds (Mean, SD: 11.20, 3.44), 60 seconds (Mean, SD: 10.75, 3.24), 90 seconds (Mean, SD: 10.60, 3.22) and 120 seconds (Mean, SD: 10.50, 3.15). A (2 X 4) factorial ANOVA showed a statistically significant difference between these two procedures in all the time periods viz., 30 seconds (p=0.044), 60 seconds (p=0.004), 90 seconds (p=0.002) and 120 seconds (p< 0.0001) at 0.05 level in PIPP score and favoring FT. CONCLUSION: FT is an effective non-pharmacological pain management in preterm newborns during routine neonatal intensive care. Show more

Keywords: Cross-over trial, newborn care, non-pharmacological pain management

DOI: 10.3233/PRM-130233

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 19-27, 2013

Authors: O'Brien, Jane E. | Dumas, Helene M.

Article Type: Research Article

Abstract: OBJECTIVE: To describe hospital length of stay (LOS), discharge disposition, and reimbursement by clinical group for children admitted to pediatric post-acute rehabilitation. METHODS: Demographic and financial information for all admissions (n=382) for calendar years 2010 and 2011 were combined. Clinical groups (Active Rehabilitation, Medically Complex, Ventilator Dependent, Neonates) were delineated and compared by LOS, discharge disposition, and per diem and per admission reimbursement, as well as by age, gender, admission …number, and payer using descriptives, chi-square, or analysis of variance. LOS, discharge disposition, and reimbursement were also examined by payer and/or admission number. RESULTS: Clinical groups differed by LOS (p=0.008), discharge disposition (p < 0.001), age (p < 0.001), admission number (p < 0.001), and payer (p < 0.001). Although per diem reimbursement was not statistically significant between groups, total admission reimbursement was highest for the Ventilator group due to a significantly longer LOS (mean=57.78 days, SD=56.33, p=0.008). LOS nor discharge disposition was significantly different if the payer was public or private. Children were more likely discharged home from a first admission (r=0.321, p < 0.001) than a subsequent admission, and private payers had a significantly greater (p< 0.001) mean daily reimbursement rate. CONCLUSION: Hospital LOS, discharge disposition, and reimbursement vary by clinical group in pediatric post-acute rehabilitation. Show more

Keywords: Pediatric, reimbursement, hospital, discharge

DOI: 10.3233/PRM-130234

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 29-34, 2013

Authors: Johnston, Therese E. | McDonald, Craig M.

Article Type: Research Article

Abstract: Children with spinal cord injury (SCI) are at risk for the same health related complications experienced by adults with SCI; however, children are likely at increased risk due to the young age at which the injury was sustained. Common health related complications impact the cardiovascular, respiratory, and musculoskeletal systems, increasing the risk of cardiovascular disease, metabolic syndrome, and fractures, as well as impacting the ability to complete everyday tasks. The available literature shows that children and …adults with SCI have a high prevalence of metabolic syndrome and decreased muscle mass, resting energy expenditure, peak oxygen consumption, and bone mineral density. Exercise may have an impact on these complications, thus increasing overall health and fitness. Some literature is available on the effects of exercise for adults with SCI, but few studies have examined these effects for children. Pediatric and adult studies have shown some positive effects on muscle mass, resting energy expenditure, peak oxygen consumption, and bone mineral density. However, more research is needed to develop optimal exercise programs that adequately address long-term health in children who have a long lifetime ahead. Show more

Keywords: Spinal cord injury, pediatric, metabolic syndrome, fitness, exercise

DOI: 10.3233/PRM-130235

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 35-44, 2013

Authors: Zebracki, Kathy | Hwang, Miriam | Patt, Pamela L. | Vogel, Lawrence C.

Article Type: Research Article

Abstract: OBJECTIVE: The purpose of this manuscript is to present a general overview and preliminary results of pilot projects of two complications in pediatric spinal cord injury (SCI): autonomic cardiovascular dysfunction and vitamin D deficiency. METHODS: Retrospective cross-sectional investigations of blood pressures (BP), heart rates (HR), and vitamin D levels were performed. RESULTS: Among 279 children with SCI, it was observed that baseline BP increases and HR decreases with increasing age. Boys had …higher systolic BP and girls had higher HR, but a gender difference in diastolic BP did not emerge. There were no significant associations of baseline BP or HR as a function of injury level, severity, or duration. Among 82 youth with SCI, 79% had vitamin D deficiency or insufficiency. There were no differences in vitamin D status as a function of gender or level of injury. Adolescents, however, were more likely to exhibit deficiency compared to children. IMPLICATIONS: Because of the clinical significance of autonomic dysreflexia and orthostatic hypotension, baseline BP and HR need to be routinely assessed in youth with SCI. In view of the high prevalence of vitamin D insufficiency in youth with SCI and the risk of complications such as pathological fractures, serum 25-hydroxycholecalciferol levels should be routinely monitored. Show more

Keywords: Spinal cord injury, pediatrics, autonomic cardiovascular dysfunction, vitamin D

DOI: 10.3233/PRM-130236

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 45-52, 2013

Authors: van Alphen, N.A. | van Doorn-Loogman, M.H. | Maas, H. | van der Sluijs, J.A. | Ritt, M.J.P.F.

Article Type: Research Article

Abstract: Wrist extension is essential in the development of motor skills in young children. Adequate wrist extension is important for good grip function of the hand, as a slightly extended wrist results in a better and stronger grip. This retrospective study reviews the transfer of the flexor carpi ulnaris (FCU) or flexor carpi radialis (FCR) to the extensor carpi radialis brevis (ECRB) and/or longus (ERCL) to reconstruct wrist extension in 19 patients with obstetric brachial plexus palsy …(OBPP). The average age at surgery was 7.2 (range 4–18) years. The mean follow-up was 3 years. Preoperatively, none of the patients had active wrist extension, with an average wrist extension-lag of 37.4 (SD 15.1) degrees. Postoperatively, average active wrist extension was 9.2 (SD 25.5) degrees. Average gain in wrist extension was 46.6 (SD 28.2) degrees, however individual gain varied substantially, i.e. between 0 and 100 degrees. Two patients were unable to reach the neutral wrist position postoperatively and in two patients wrist extension did not increase. The results of the tendon transfer to provide improvement of wrist extension in OBPP were satisfactory in most patients. Show more

Keywords: Tendon transfer, flexor tendon, obstetric brachial plexus palsy, wrist extension

DOI: 10.3233/PRM-130237

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 53-57, 2013

Article Type: Other

DOI: 10.3233/PRM-130238

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 6, no. 1, pp. 59-60, 2013