Journal of Pediatric Rehabilitation Medicine - Volume 5, issue 1

Authors: Green, M. | Berliner, J. | Frontera, J.

Article Type: Research Article

Abstract: Objectives: Describe the case of an Anterior Cord Syndrome secondary to transverse myelitis. Anterior Cord Syndrome: Anterior Cord syndrome (ACS) is characterized by a lesion that affects the anterior two thirds of the spinal cord while preserving the posterior columns. Transverse Myelitis: Transverse myelitis (TM) is an inflammatory disorder with a heterogeneous pathogenesis affecting the spinal cord at one or more segments, resulting in motor, sensory, and autonomic dysfunction in the absence of a preexisting …neurological disease or spinal cord compression. Treatment: The patient was treated with methylprednisolone, IV Antibiotics, acyclovir, and inpatient rehabilitation. Rehabilitation: The patient significantly improved her function throughout inpatient rehabilitation and was discharged after achieving modified independent level with ambulation and all activities of daily living. The patient also gained independence with an intermittent catheterization program and a nightly bowel program, which included suppository and digital stimulation. Conclusions: This case illustrates the first documented pediatric patient with a unique case of Anterior Cord Syndrome caused by idiopathic transverse myelitis. Show more

Keywords: Transverse myelitis, acute transverse myelitis, idiopathic transverse myelitis, pediatric transverse myelitis, spinal cord injury, multiple sclerosis, neuromyolitis optica

DOI: 10.3233/PRM-2011-0187

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 1-6, 2012

Authors: Bjornson, Kristie F. | Yung, Delphine | Jacques, Kevin | Burr, Robert L. | Christakis, Dimitri

Article Type: Research Article

Abstract: Introduction: Accuracy and precision of the StepWatch (SW) was tested in typically developing youth (TDY) with the prediction of oxygen consumption derived from stride counts. Methods: Ten TDY (5 boys, 5 girls) with an average age 14.1 years (SD=2.2) enrolled. Participants underwent treadmill cardiopulmonary exercise testing (CPET) wearing two SW devices at 1, 2, 3, and 4 miles per hour (mph). Results: Average sign-corrected disagreement for strides counted between the 2 monitors …was 0.4 (0.52), 0.2 (0.42), 0.1 (0.32), and 0.1 (0.32) for 1, 2, 3, and 4 mph, respectively. The ratio of SW counts to observed manual counts averaged 100.03% with ICC=0.995. Oxygen consumption equations were derived from resting and walking VO_{2} , age, gender, and stride counts. Conclusions: Excellent accuracy and precision was documented for treadmill walking speeds up to 4 mph while VO_{2} per number of strides taken appears to decrease with age and is lower in girls. Show more

Keywords: Accuracy, stride count, StepWatch

DOI: 10.3233/PRM-2011-0186

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 7-14, 2012

Authors: Campbell, Suzann K. | Gaebler-Spira, Deborah | Zawacki, Laura | Clark, April | Boynewicz, Kara | deRegnier, Raye-Ann | Kuroda, Maxine M. | Bhat, Rama | Yu, Jinsheng | Campise-Luther, Rose | Kale, Dipti | Bulanda, Michelle | Zhou, Xiaohong Joe

Article Type: Research Article

Abstract: Background: Preterm infants with periventricular brain injury (PBI) have a high incidence of atypical development and leg movements. Objective: Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age (CA) in children with PBI improves motor function at 12 months CA when compared with control subjects. Method: In a multi-center pilot study for a controlled clinical trial, sixteen infants with PBI were randomly assigned to home exercise consisting of kicking and treadmill stepping …or a no-training control condition. Development was assessed at 2, 4, 6, 10, and 12 months CA with the Alberta Infant Motor Scale (AIMS). At 12 months children were classified as normal, delayed, or with cerebral palsy (CP). Results: At 12 months CA 3 of 7 (43%) of the exercise group children walked alone or with one hand held versus 1 of 9 (11%) in the control group (p=0.262), but no significant differences in AIMS scores were found at any age. Half of the subjects had CP or delay; the outcomes of these infants were not improved by exercise. Compliance with the home program was lower than requested and may have affected results. Conclusion: Although not statistically significant with a small sample size, self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI, but improvements of the protocol to increase and document compliance are needed before a larger study is implemented. Show more

Keywords: Infant motor development, preterm infants, periventricular brain injury, exercise intervention

DOI: 10.3233/PRM-2011-0185

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 15-27, 2012

Authors: Dumas, Helene M. | Fragala-Pinkham, Maria A. | Feng, Tian | Haley, Stephen M.

Article Type: Research Article

Abstract: Objective: To examine the discriminant validity and scoring patterns of the PEDI-CAT Mobility item bank for children who use a walking aid or wheelchair. Methods: Parents whose children use a walking aid (n=35) or a wheelchair (n=31) completed the full PEDI-CAT Mobility item bank (105 items including 13 walking aid and 14 wheelchair items) on-line. An independent sample t-test was used to examine mean scores between the groups. Point spread and placement of the …scores along the overall 20–80 test scale and response patterns for the 27 mobility device items were analyzed descriptively. Results: Mean scaled scores were significantly different (p < 0.001) for the two groups. Mean score for the Wheelchair Group (38.37, SD=7.09) was lower than the Walking Aid Group (46.97, SD=5.10). The Walking Aid Group started and ended higher on the 20 to 80 scale metric than the Wheelchair Group. No floor or ceiling effects were seen for the scoring of the 27 items specifying use of a mobility device. Conclusion: The %scores of the PEDI-CAT Mobility domain could differentiate the functional mobility status between known groups of children who use a walking aid or wheelchair and provides specific items to measure functional mobility with use of a mobility device. Show more

Keywords: Pediatric, disability, computer adaptive, mobility

DOI: 10.3233/PRM-2011-0184

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 29-35, 2012

Authors: Guarany, Nicole Ruas | Schwartz, Ida Vanessa D. | Guarany, Fábio Coelho | Giugliani, Roberto

Article Type: Research Article

Abstract: Introduction: The mucopolysaccharidoses (MPS) are rare genetic disorders caused by a deficiency in lysosomal enzymes that affect the catabolism of glycosaminoglycans and cause their accumulation, resulting in a multisystemic clinical picture. Their clinical manifestations result in limited ability to perform daily life tasks. Objectives: To evaluate functional capacity and joint range of motion (ROM) in patients with MPS followed at the reference center for lysosomal disorders at Hospital de Clínicas de Porto …Alegre, Brazil. Methods: This was a prospective longitudinal study with a convenience sample. The Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure (FIM) were used to evaluate functionality and goniometry was used to evaluate ROM at three times (baseline, 6 months, and 12 months after study inclusion). An exploratory analysis was done of the effect of enzyme replacement therapy (ERT) in both variables; thus, patients were divided into Group 1 (patients without ERT), Group 2 (patients on ERT before and after study inclusion), and Group 3 (patients who started ERT after study inclusion). Results: 21 patients were included: 7 in Group 1 (MPS II: 3, MPS III-B: 2, MPS IV-A: 2), 6 in Group 2 (MPS I: 3; MPS VI: 3), and 8 in Group 3 (MPS I: 3, MPS II: 4, MPS VI: 1). A limitation in the mobility of all joints studied was found especially in MPS I, II, and VI. Functionality compromise was also frequent (PEDI=5/7 patients; MIF=9/14 patients), even in individuals with preserved cognition. No correlation was found between the findings of goniometry and the PEDI domains (self-care, mobility, social function). ERT did not seem to significantly change the parameters analyzed. Discussion/conclusion: The compromise of joint mobility and functionality seems to be common in MPS I, II, III-B, IV-A, and VI. This finding is in line with the fact that, although these types of MPS are caused by different genetic defects, they share metabolic routes and physiopathogenic processes and present similar clinical manifestations. The preservation of functionality is an increasing challenge in the treatment of MPS patients, and maintenance of occupational performance should be defined as an objective to be reached by therapies used. Further studies with a greater sample size are necessary in order to verify the effect of ERT in these variables. Show more

Keywords: Mucopolysaccharidosis, functional capacity, enzyme replacement therapy

DOI: 10.3233/PRM-2012-0194

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 37-46, 2012

Authors: Thiagarajan, Ravi R. | Teele, Sarah A. | Teele, Katharine P. | Beke, Dorothy M.

Article Type: Research Article

Abstract: Extracorporeal Membrane Oxygenation (ECMO) is widely used to support patients who have failed conventional therapies for cardio-respiratory failure. Patient immobility during management of critical illness and ECMO support can result in physical impairment that can lead to prolonged hospitalization and poor functional outcomes for ECMO survivors. Although little information regarding the role of physical therapy in improving functional outcomes for ECMO patients is available, early intervention with physical therapy may decrease duration …of hospitalization and improve functional outcomes for patients supported with ECMO. Show more

Keywords: Extracorporeal Membrane Oxygenation, outcomes, physical therapy, neurological injury, rehabilitation

DOI: 10.3233/PRM-2012-0195

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 47-52, 2012

Authors: Fager, Susan | Bardach, Lisa | Russell, Susanne | Higginbotham, Jeff

Article Type: Research Article

Abstract: Children with severe physical impairments require a variety of access options to augmentative and alternative communication (AAC) and computer technology. Access technologies have continued to develop, allowing children with severe motor control impairments greater independence and access to communication. This article will highlight new advances in access technology, including eye and head tracking, scanning, and access to mainstream technology, as well as discuss future advances. Considerations for clinical decision-making and implementation of …these technologies will be presented along with case illustrations. Show more

Keywords: Children, AAC, alternative access, assistive technology

DOI: 10.3233/PRM-2012-0196

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 53-61, 2012

Article Type: Other

DOI: 10.3233/PRM-2012-0197

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 1, pp. 63-64, 2012