Journal of Pediatric Rehabilitation Medicine - Volume Pre-press, issue Pre-press
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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: OBJECTIVES: To study the effect of induced fatigue of the unaffected limb on the sensory components of standing balance; proprioception and vestibular symptoms in children with hemiplegic cerebral palsy. METHODS: Setting: Outpatient Clinic of Faculty of Physical Therapy, Cairo University. Patients: Twenty-nine children with hemiplegic cerebral palsy [(ages 8.9 ± 2.3 years), motor ability I/II according to the GMFCS and spasticity of I/I+ according to the Modified Ashworth Scale]. Outcome Measures: Before and after the induced fatigue of the unaffected limb, the following measures were recorded: postural balance, using the…Biodex Balance System and the Timed Up and Go test; vestibular sense, using the Paediatric Vestibular Symptom Questionnaire; and proprioception measures of both knees, using the Biodex isokinetic dynamometer. RESULTS: There was a significant increase in the post-fatigue values for the overall stability index (p < 0.05), the Timed Up and Go test (p < 0.05), reposition errors of proprioception of the unaffected limb (p < 0.05) and the vestibular questionnaire (p < 0.05); there was a non-significant decrease in the post-fatigue values for reposition errors of proprioception of the affected limb (p = 0.859). CONCLUSION: Fatigue of the unaffected limb negatively affects postural balance and related sensory systems (proprioception of the fatigued limb and vestibular function) but does not have an impact on proprioception of the unfatigued limb.
Abstract: PURPOSE: Hepatoblastoma is the most common primary liver tumor in children and has a greater incidence in children with a history of prematurity and very low birth weight. To increase awareness of the association between prematurity and hepatoblastoma for health care providers who treat children with Cerebral Palsy (CP), we present two case reports. METHODS: Two case reports of premature, very low birth weight infants with hepatoblastoma are described and a literature review of hepatoblastoma in the setting of prematurity and cerebral palsy is performed. RESULTS: Each patient had a history of 26–28…week prematurity, very low birth weight, and CP. Both presented with worsening constipation and abdominal distension that did not respond to oral medications. Appropriate referrals to the ER were made which lead to a diagnosis of hepatoblastoma. Pediatric rehabilitation was a source of referral for diagnosis in one patient and aided in the rehabilitation course following treatment for both patients. CONCLUSIONS: Hepatoblastoma is the most common primary liver tumor in children and has an increased incidence in children with a history of prematurity and very low birth weight. Providers who frequently care for the very low birth weight and premature children with CP should be aware of this correlation and include hepatoblastoma in the differential when managing patients with suddenly worsening constipation or abdominal distension. Pediatric physiatrists and other providers for these patients could be a source of referrals and diagnosis leading to timely treatment.
Abstract: PURPOSE: To investigate the effects of robot-assisted gait training (RAGT) alongside conventional therapy on the standing and walking abilities of children with cerebral palsy (CP). METHODS: The study sample consisted of children (aged 4–18 years) with CP whose gross motor function classification system (GMFCS) was at levels I–V. In total, 75 children with CP were evaluated and 38 patients completed the study. Patients were divided into two groups as GMFCS levels I–III (Group 1) and levels IV–V (Group 2). RAGT (30 min/session) and conventional physiotherapy (30 min/session) were applied together in the treatment. The treatment duration…was 60 min per session, 3 or 4 sessions per week, for a total of 30 sessions over 8–10 weeks. 10-meter walk test (10MWT), 6-min walk test (6MinWT), gross motor functional measurement 66 (GMFM66) -D, and -E tests were performed. RESULTS: We showed that in both groups of CP patients (mild-moderate and severe), meaningful improvements were seen in the standing (D) and walking (E) sections of GMFM-66 after treatment. When we compared the post-treatment changes in 10-m walk test, 6-min walk test, GMFM66-D, and -E between Groups 1 and 2, we noted that the improvements were statistically significant in favor of Group 1 (p < 0.01). CONCLUSION: RAGT in combination with a conventional treatment program was significantly associated with improvements in the standing and walking abilities of children with mild to moderate CP (GMFCS levels I–III).
Keywords: Cerebral palsy, gait, rehabilitation, robot, training, therapyImplications for rehabilitation:•Robot-assisted gait training (RAGT) in addition to conventional treatment might contribute significantly to improvements in the standing and walking abilities of children with cerebral palsy (CP).•Children with mild to moderate CP had more significant improvements in standing and walking ability than did those who were severely affected after RAGT with conventional therapy.
Abstract: PURPOSE: To investigate the effectiveness of outpatient robot-assisted gait training (RAGT) in ambulatory children with spastic cerebral palsy. METHODS: Children were randomized to two different intervention sequences within a pragmatic crossover design. They performed five weeks of RAGT (3 sessions per week) and five weeks of usual care (UC). Dimension E of the Gross Motor Function Measure – 88 (GMFM E) was the primary outcome as well as Dimension D (GMFM D), and timed walking tests were assessed before and after each treatment sequence and after a 5 – week follow – up. RESULTS:…The trial was stopped early because of recruitment problems. We included 16 children with a mean age of 11.3 years (6.0–15.3 years). GMFM E median (IQR) change scores were – 0.7 (- 2.8 to 3.5) after RAGT and 0 (- 2.4 to 2.4) after UC. Neither GMFM E nor any secondary outcome measure changed significantly after RAGT or UC, nor were any period, follow – up, or carry – over effects observable. CONCLUSIONS: RAGT as a single intervention was not effective in improving walking abilities in the included children. It should be embedded in a holistic treatment approach, as it cannot cover all aspects relevant to gait. Furthermore, children’s personalized rehabilitation goals should be carefully monitored with individualized measurement instruments.
Abstract: PURPOSE: Youth with disabilities face challenges regarding achieving autonomy. The ‘Skills for Growing Up’ tool was adapted for use in Dutch pediatric rehabilitation (SGU-D) to support development of autonomy. This study presents the experiences with the SGU-D tool. METHODS: The SGU-D was implemented in 18 settings, of which 4 participated in the evaluation. Rehabilitation professionals were trained in the use of the SGU-D. In a qualitative study, participants were interviewed for their opinions regarding the tool. RESULTS: Experience with the SGU-D was evaluated in 11 youth with disabilities, 11 parents and 8 rehabilitation…professionals. They perceived the SGU-D as a helpful tool: i) to support development of autonomy, ii) to focus on future perspectives, and iii) to facilitate communication with family and rehabilitation professionals. Additional support from rehabilitation professionals on using the SGU-D was appreciated. CONCLUSION: Youth with disabilities, their parents and rehabilitation professionals value the SGU-D as a practical tool for working on autonomy, and to identify important areas of development.