Journal of Pediatric Rehabilitation Medicine

Physical rehabilitation after spinal cord injury (SCI) in adult and pediatric populations has traditionally compensated for paralysis and weakness using wheelchairs, assistive devices, and braces to achieve seated mobility, upright standing, or bracewalking. Recent evidence indicates efficacy of activity-based therapies in adults with SCI, specifically locomotor training (LT), to activate the neuromuscular system below the injury level and improve walking and postural control by restoring pre-morbid movements. The purpose of this paper is to demonstrate the feasibility of LT, using repetitive stepping practice on a treadmill and translated to over ground and the community, to meet the unique needs and demands of pediatric, adolescent rehabilitation. Three outpatient adolescents, T5 AIS D, age 15 (primary wheelchair user), T5 AIS C, age 14 (primary wheelchair user), and C2, AIS D, 14 years (primary ambulator), received a standardized protocol of LT 4–5 times per week for 75, 293, and 40 total sessions, respectively, across 1–3 episodes of care. Two adolescents became full-time ambulators, and one adolescent improved locomotor skills, kinematics, and endurance with two individuals lacking significant increases in strength to account for the benefits. Motivational strategies were developmentally specific, parental involvement critical for carryover, and musculoskeletal considerations paramount with growth and maturation. In comparison to adults, adolescents' continued musculoskeletal, cognitive, and social growth and maturation necessitate repeated episodes of therapy and bi-annual re-evaluations to identify needs and address new goals. The use of activity-based therapies, i.e. LT, represents a paradigm shift in pediatric rehabilitation towards activation of the neuromuscular system below the lesion via task-specific training and experience, minimizing compensation strategies, and targeting recovery of function achieved via use of pre-morbid movement patterns.

Background and methods: Children who experience spinal cord injuries (SCI) may develop many complications, including loss of bone mass, osteoporosis, and pathological fractures. Additionally, patients with SCI often rate their quality of life as poor compared to non-injured peers. We examined the effect of functional electrical stimulation (FES) cycle exercise on bone mineral density (BMD) and quality of life (QOL) in six patients ranging in age from 9 to 20 years. BMD was determined using Dual X-ray Absorptiometry scans, and QOL was measured using the Pediatric Quality of Life Inventory (PedsQL™ 4.0).

Results: While patients experienced difficulty in attending sessions consistently, we found a tendency toward improved BMD and QOL associated with the number of months using the FES cycles. In addition, a positive relation was seen between improved BMD and the total number of cycling sessions, as well as between the final rating of QOL and time from injury.

Conclusion: FES cycle exercise has the potential to increase BMD, possibly leading to a decrease in pathologic fractures, as well as to improve QOL, in children and adolescents with SCI. Further investigation is warranted on a larger population of children with SCI in order to establish the full benefits of FES cycle exercise.

Objective: The objective of this study was twofold: 1) to evaluate the reliability of the Walking Index for Spinal Cord Injury II (WISCI-II) and Spinal Cord Independence Measure (SCIM) indoor mobility item (#12) when used with children with spinal cord injury (SCI) and 2) to examine the concurrent validity between the WISCI-II and the SCIM indoor mobility item in children with SCI.

Methods: A convenience sample of 10 children with SCI between 4–16 years of age was recruited to complete 2 videotaped trials of ambulation for 10 meters. Six licensed physical therapists trained in the use of the WISCI-II and SCIM served as raters; each rater independently scored the WISCI-II and SCIM indoor mobility item for each of the subjects' two trials by reviewing the videotape. The viewing and scoring of Trial 1 and Trial 2 were separated by at least 3 weeks. Inter- and intra-rater reliability was calculated using Intraclass Correlation Coefficients (ICC) and 95% Confidence Intervals (CI). Concurrent validity was evaluated using the Spearman Correlation Coefficient (r $_{s}$ ).

Results: Intra-rater and inter-rater reliability of repeated WISCI-II scores was high (ICC=0.98, CI=0.95–0.99; ICC=0.97, CI=0.96–0.99, respectively). Intra- and inter-rater reliability for the SCIM mobility score was equally high (ICC=0.96, CI=0.95–0.98, ICC=0.97, CI=0.95–0.98). There was strong correlation between WISCI-II scores and the SCIM indoor mobility item (r $_{s}$ =0.99).

Conclusion: In this sample of 10 children and six trained raters, intra- and inter-rater reliability of WISCI-II scores and the SCIM mobility indoors scores was high, providing preliminary indication for their utility with children. The high correlation between the WISCI-II and SCIM mobility item further supports concurrent validity.

Transverse myelitis is diagnosed based on the presence of spinal cord inflammation and the absence of infection to the central nervous system. In support of these criteria, patients undergo lumbar puncture to determine Cerebrospinal Fluid (CSF) pleocytosis and un-enhanced or Gadolinium-enhanced spinal Magnetic Resonance Imaging (MRI). We present the case of an 11~year-old previously healthy male who underwent a series of lab tests and MRI scans before a definite diagnosis of transverse myelitis four years prior to this study. The patient still shows deficits at the C4 cord level according to International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination, however, his MRI results are negative, and his Diffusion Tensor Imaging (DTI) results are close to values reported in healthy subjects.

Spinal cord injury (SCI) often results in a sudden, devastating loss of function. SCI is particularly challenging for the pediatric and adolescent populations who, under normal circumstances, are still achieving developmental milestones, but following SCI face additional barriers posed by paralysis and the accompanying secondary complications. Advancing technology in rehabilitation is changing the course of how people with spinal cord injury participate in rehabilitation. Technology plays an ever-increasing role in both restorative and compensatory rehabilitative interventions. While the practical or functional needs of the pediatric patient may differ from those of the adult, technology can and does play a role in restoring function for this population. Applications of technology span broad areas, providing improved options for care in grasp and manipulation, seating and mobility, augmentative and alternative communication, electronic aids to daily living, and computer access and use. This article reviews select applications of technology that have great impact on the functional needs of people with spinal cord injury (SCI): therapeutic and functional stimulation, EMG biofeedback and EMG-triggered stimulation, assistive technology for computer access, and implanted functional electrical stimulation systems. Some of these technologies are already in use in the pediatric population, while some are not – yet have great potential for restoring function in this group. The challenges and potential solutions for implementing these technologies in the pediatric population are discussed.

Spinal cord injury is a life transforming condition that is thought to have an impact on the entire family of the affected individual. The needs and psychological outcomes of siblings of children with spinal cord injury (SCI) have not been researched. The current study focuses on the experiences of children living with a brother or sister with SCI. Eight participants (4 male, 4 female) aged between 7 and 18 years were interviewed using a semi-structured interview, concentrating on their unique experiences and understandings of having a brother or sister with SCI. The qualitative method of Interpretative Phenomenological Analysis (IPA) was used to analyze the data and three main themes were identified: "Life interrupted", "What about me?" and "My safety net". Results are discussed in relation to attachment and coping and adjustment theories. The discussion also highlights the clinical implications for siblings and parents of children affected by SCI, and for professionals who work within pediatric SCI settings.

Aim: Examine relationships between participation and quality of life (QOL) among youth with spinal cord injury (SCI).

Method: Youth ages 6–18 years with SCI completed the Children's Assessment of Participation and Enjoyment, which measures participation frequency (diversity/intensity) and context (with whom/where), and the Pediatric Quality of Life Inventory, which measures emotional, social, school, and overall psychosocial QOL. Analyses were conducted separately for children (ages 6–12) and adolescents (ages 13–18) and included correlations and multiple regression.

Results: 340 youth participated; the participants were 56% male with an average age of 13.33 years (SD=3.75), 66% had paraplegia, and their average injury duration was 5.13 years (SD=4.31). Among children, participating further from home was related to increased social, school, and overall QOL. Among adolescents, participating with a more diverse group was related to greater emotional QOL. In general, participation context was more closely related to QOL, but among physical (for all youth) and social (for children) activities, frequency of participation was related to QOL.

Interpretation: Relationships between participation and QOL differ with child age. Among children, encouraging participation out of the home may be most beneficial to QOL. Among adolescents, fostering participation with a more varied group may be most beneficial to QOL.