Journal of Pediatric Rehabilitation Medicine - Volume Pre-press, issue Pre-press

Authors: Bourchtein, Elizaveta | McLaughlin, Alix | Walainis, Kimberly | Hughes, Amanda | Scott, Eric L. | Foxen-Craft, Emily

Article Type: Brief Report

Abstract: PURPOSE: The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP). METHODS: Participants (N  = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion. RESULTS: Pain intensity …was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, β = − .28, p  = .047, while pain catastrophizing was associated with baseline gross motor abilities, β = − .28, p  = .032. CONCLUSION: Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain. Show more

Keywords: Chronic pain, interdisciplinary collaboration

DOI: 10.3233/PRM-220132

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-8, 2024

Authors: El Sehmawy, Asmaa A. | Younes Abd Elaziz, Shaimaa | Abdelghany Elsheikh, Asmaa | Elsawy, Fatma A. | Abd Elsalam Amin, Amal | Mostafa Omran, Ahmed | Younan Abd El Malek, Amal

Article Type: Research Article

Abstract: PURPOSE: The current study aimed to determine the prevalence of specific psychiatric disorders, identify predictors associated with these disorders, and assess the quality of life (QoL) among children with congenital heart disease. METHODS: This comparative cross-sectional study was conducted in the National Heart Institute outpatient clinics. It included 204 children with structural congenital heart defects (CHD). In addition to assessing QoL with the Pediatric Quality of Life Inventory scale, the Mini-International Neuropsychiatric Interview for Children and Adolescents was utilized to identify psychiatric disorders in the children studied. RESULTS: Children with CHD were at …increased risk for mood and anxiety disorders. They were also more susceptible to obsessive-compulsive disorder than the comprative healthy group. In children with CHD, the cyanotic group demonstrated a greater decrease in QoL than the acyanotic group. CONCLUSION: Children with CHD have an increased risk of psychiatric disorders and a lower overall QoL score. Show more

Keywords: Children, depression, anxiety, quality of life

DOI: 10.3233/PRM-220109

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-10, 2024

Authors: Sikes, E. Morghen | Finlayson, Marcia | Banwell, Brenda | Marrie, Ruth Ann | Yeh, E. Ann | Motl, Rob

Article Type: Research Article

Abstract: PURPOSE: Pediatric-onset multiple sclerosis (MS) is associated with risk for functional limitations defined as the perceived reduction in capacity for undertaking activities of daily living. Moderate-to-vigorous physical activity (MVPA) has been associated with less frequent and less impactful functional limitations, but the symptoms of fatigue and depression have not been considered as potential confounding variables. This study examined whether fatigue and depression confound the association between MVPA and functional limitations among youth with pediatric MS. METHODS: Participant data were accumulated from three ongoing observational studies. The combined sample included 65 cases of pediatric-onset MS (24 male/41 female, 16±1.7 …years of age). Data on self-report MVPA, functional limitations, depression, and fatigue were analyzed. RESULTS: MVPA was significantly associated with functional limitations (r  = 0.45), fatigue (r  = –0.28), and depression (r  = –0.32). Functional limitations were associated with fatigue (r  = –0.45) and depressive symptoms (r  = –0.53). MVPA was significantly correlated with functional limitations (β= 0.27, p  = 0.04) even after accounting for general fatigue (β= 0.08, p  = 0.64) and depressive symptoms (β= –0.40, p  = 0.03) among those with pediatric MS. CONCLUSION: Self-reported MVPA was associated with perceived functional limitations among youth with pediatric MS independent of perceived fatigue and depressive symptoms. Show more

Keywords: Pediatric multiple sclerosis, physical activity, functional limitations, fatigue, depression.

DOI: 10.3233/PRM-220081

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-6, 2023

Authors: DeJong Lempke, Alexandra F. | Stracciolini, Andrea | Willwerth, Sarah B. | Ackerman, Kathryn E. | d’Hemecourt, Pierre A. | Meehan III, William P. | Whitney, Kristin E.

Article Type: Research Article

Abstract: PURPOSE: Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine. METHODS: This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame. RESULTS: Patients …most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2  = 69.7, p  = 0.002), treatments (X2 : 23.6–43.8, p : <  0.001–0.003), and referrals (X2  = 132, p  <  0.001) were for shin injuries. Larger proportions of nutrition assessments (X2  = 40.7, p  <  0.001), interventions (X2  = 26.8, p  = 0.003), and referrals (X2  = 27.5, p  = 0.002) were performed in or after the year 2015. CONCLUSION: Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations. Show more

Keywords: Relative Energy Deficiency in Sport (RED-S), rehabilitation, evidence-based practice, repetitive stress injury, tibial stress fracture

DOI: 10.3233/PRM-220082

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-13, 2023

Authors: Estes, Tyler | Gaul, Aaron | Thornton, Allison | Hobart-Porter, Laura

Article Type: Case Report

Abstract: CASE DESCRIPTION: A five-year-old male with spastic quadriplegia cerebral palsy and an expressive communication disorder presented because the family desired liberalization of diet. The diet consisted of pureed solids and no liquids due to deficits identified on bedside swallow evaluation; further dysphagia assessment had not been obtained due to significant procedural anxiety. Comprehensive approaches were taken involving premedication with buspirone, desensitization, distraction, and positive reinforcement. The fluoroscopic swallow study was successfully completed, and the patient’s diet was upgraded to include moderately thickened liquids. DISCUSSION: Procedural anxiety management in special populations is not well-researched. The lack of definitive recommendations …regarding these issues increases the difficulty of managing these patients. This case highlights one successful approach to addressing individual needs using widely-available pharmacologic and environmental techniques. Additionally, this case reinforces the need to identify underlying causes for procedural anxiety and involve an interdisciplinary team. CONCLUSIONS: Attempts should be made to identify factors driving procedural anxiety. After discussing with the patient and family, relevant information should be relayed to staff with an open-ended invitation to propose ideas. While not all hospitals have equivalent resources, concerns related to unfamiliarity, underlying anxiety, and locus of control can be addressed with limited resource utilization, as demonstrated in this case. Show more

Keywords: Cerebral palsy, dysphagia, procedural anxiety, systems of care, complex patient populations

DOI: 10.3233/PRM-230063

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-3, 2024

Authors: Lagarde, Marloes L.J. | van Hulst, Karen | Erasmus, Corrie E. | van den Engel-Hoek, Lenie | Geurts, Alexander C.H. | van Alfen, Nens

Article Type: Research Article

Abstract: PURPOSE: Quantitative muscle ultrasound (QMUS) is potentially valuable as a diagnostic tool in central neurological disorders, as it provides information about changes in muscle architecture. This study aimed to investigate whether ultrasound images of the submental and masticatory muscles in children with spastic cerebral palsy (CP) differ from those obtained in a reference group, and whether observed ultrasound abnormalities differ between subgroups of children with different Eating and Drinking Ability Classification System (EDACS) levels to support its construct validity. METHODS: A prospective cohort study was conducted in 25 children with spastic CP aged 3-18 years. QMUS of selected …muscles was performed. Muscle thickness and echogenicity in the CP group were compared to previously collected reference values, and between different EDACS levels within the CP group. RESULTS: Median echogenicity of all muscles was significantly higher in children with CP than in healthy controls. The temporalis muscle was significantly thinner in the CP group. There were no differences in muscle thickness or echogenicity between EDACS levels. CONCLUSION: QMUS is able to detect abnormal architecture of submental and masticatory muscles in children with spastic CP, but the interpretation of abnormalities in relation to the severity of mastication and swallowing problems needs further investigation. Show more

Keywords: Ultrasound, orofacial muscles, cerebral palsy, dysphagia

DOI: 10.3233/PRM-230029

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-10, 2024

Authors: Ziab, Hussein | Saleh, Soha | Talebian, Saeed | Olyaei, Golamreza | Mazbouh, Rami | Sarraj, Ahmad Rifai | Hadian, Mohamad Reza

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to compare the clinical efficacy of a virtual reality rehabilitation-based training (VRT) with balance-specific training (BST) and conventional training (CT) on the balance and gross motor functions (GMF) of children with cerebral palsy (CwCP). METHODS: This study was a double blinded, randomized controlled trial. Participants were recruited from different CP rehabilitation centers and clinics and were then randomly allocated using the block randomization method into three groups: (1) group 1 (VRT using a set of Xbox 360 games that triggered balance), (2) group 2 (BST applying a protocol of 13 exercises …to enhance balance in different conditions), and (3) control group 3 (CT using traditional physiotherapy techniques). All groups received 18 sessions over six weeks, three sessions per week, each lasting 60 minutes. Participants were assessed at three timepoints (baseline, post-treatment, and follow-up) using the Pediatric Balance Scale (PBS), the Gross Motor Function Measure (GMFM D & E), the Five Times Sit-To-Stand Test, and upper and lower segments’ center of mass (COM) displacement (UCOM and LCOM ). RESULTS: A total of 46 CwCP participated in this study. The repeated measures ANOVA revealed a statistically significant difference between groups in the dependent variables, except for the GMFM (D & E) and the PBS (p  < 0.05 and partial η 2  = 0.473). The post-hoc test showed a statistically significant difference in favor of the VRT group compared to other groups in terms of right UCOM (p  < 0.05) with a large effect size of the time* group interaction (partial η 2  = 0.87). Moreover, there was a statistically significant effect of time (i.e., baseline to post-treatment and baseline to follow-up) with F (18, 23) = 59.954, p  < 0.05, Wilks’ lambda = 0.021, partial η 2  = 0.979. CONCLUSION: The findings revealed that VRT was not superior to BST in the rehabilitation of balance and GMF in CwCP aged four to 12 years. However, when compared to CT, better results were reported. Furthermore, it appears that customized programs lead to greater improvements in balance than commercial programs. Future studies are needed to assess the physiological effects of the three types of rehabilitation interventions using more advanced measurement tools, such as functional magnetic resonance imaging, following VRT protocols. Show more

Keywords: Cerebral palsy, balance, task-specific training, conventional rehabilitation, virtual reality

DOI: 10.3233/PRM-220120

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-17, 2024

Authors: King, Christopher D. | Olbrecht, Vanessa A. | Crowley, Susan L. | Klages, Kimberly L. | Deet, Emily T. | Samuel, Nicole D. | Smith, Kelsey | Williams, Sara E. | Homan, Kendra J.

Article Type: Case Report

Abstract: Virtual reality (VR) is an innovative technology with the potential to enhance treatment for children with chronic pain and functional symptoms. Currently, little is known about patients’ experiences of VR in the setting of intensive interdisciplinary pain treatment (IIPT). This study aimed to better understand how patients engage with and benefit from VR. This case report focuses on a 12-year-old female with amplified musculoskeletal pain syndrome and comorbid functional neurological disorder receiving treatment in inpatient IIPT. VR was incorporated into physical/occupational and recreational therapy sessions. A semi-structured interview was completed one-month post-discharge. Qualitative analysis revealed three major themes: Process of …Change (VR was unique/immersive, reduced pain focus, challenged skepticism, and changed pain perception), Efficacy (VR increased movement, supported transitioning from a wheelchair to walking independently, and increased confidence, excitement, and surprise), and Engagement (VR aided in acknowledging progress, increased camaraderie, was fun, and challenged patient to extend treatment goals made in VR to real life). Therapist observations of the benefits and barriers to using VR in treatment are described. Overall, this report indicates that VR may be a helpful tool to use with existing IIPT interventions to enhance patient engagement in treatment and improve functionaloutcomes. Show more

Keywords: Virtual reality, children, chronic pain, functional neurological disorder, intensive interdisciplinary pain treatment

DOI: 10.3233/PRM-230059

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-9, 2024

Authors: Saviola, Donatella | de Gaetano, Katia | Bruni, Stefania | Chiari, Margherita | Moschini, Chiara | Battagliola, Erica | Colla, Daniela | Cantoni, Matteo | De Tanti, Antonio

Article Type: Case Report

Abstract: PURPOSE: A case report of a six-year and five-month-old female admitted with typical symptoms of Rubinstein-Taybi syndrome is presented. Clinical and rehabilitation settings where she acquired her reading, writing, and communication skills are described. METHODS: Because of her cognitive disabilities, a multidisciplinary and long-term intervention (2014–2020) was necessary. Treatment included orthoptic, psychomotor, logopedic, occupational, and neuropsychological care. Her family and school were involved. RESULTS: Increased attention led to decreased dysfunctional behaviors. Test results are still below average, but there has been significant improvement. Better communication skills resulted from increased phonetic range, improved articulation, lexical-semantic structure, comprehension, …and production of sentences. Digital technologies played a significant role in enhancing her communication skills, not just in social interactions but also in school activities. The patient is oriented in time and space with the help of agendas and calendars. She can express her needs and compose concise narratives. As a result of acquiring functional skills, she is better equipped to handle real-life situations, which has led to increased social and family activities. CONCLUSION: This case report highlights the importance of personalized rehabilitation programs. Obtaining an early genetic diagnosis is crucial for timely tailored rehabilitation, and any delays in this process can hinder progress. Show more

Keywords: Rubinstein-Taybi syndrome, rare genetic disease, language rehabilitation, cognitive rehabilitation, functional rehabilitation

DOI: 10.3233/PRM-230051

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-10, 2024

Authors: Srinivasan, Rajashree

Article Type: Book Review

Abstract: Appetite for Risk is an autobiographical memoir of the author’s life experiences. He vividly explains near-death experiences while maintaining humor, regaling about his escapades. It is thought-provoking to consider if human risky behavior is genetically predetermined.

Keywords: Appetite, risk, genetic, environmental, physician

DOI: 10.3233/PRM-240045

Citation: Journal of Pediatric Rehabilitation Medicine, vol. Pre-press, no. Pre-press, pp. 1-2, 2024