Journal of Pediatric Rehabilitation Medicine

BACKGROUND: Symptoms of a neonatal brachial plexus palsy (NBPP) can vary widely among individuals and numerous clinical studies have been performed to identify the natural history and to improve treatment. The aim of this study was to identify and describe all outcome measures used in clinical studies on patients with an NBPP and categorize these outcome measures according to the International Classification of Functioning, Disability and Health (ICF).

METHOD: Electronic searches of different databases were carried out. All clinical studies describing one or more outcomes of NBPP were selected. Data on outcome measures was systematically extracted and the contents were analyzed and linked to the ICF.

RESULTS: A total of 217 full texts were selected and 59 different outcome measures were identified. The 5 most frequently used outcome measures included range of motion of the shoulder (n= 166 studies, 76%), range of motion of the elbow (n= 87 studies, 40%), the Mallet scale (n= 66 studies, 30%), Magnetic Resonance Imaging (n= 37 studies, 17%) and the Medical Research Council motor grading scale (n= 31 studies, 14%). Assessments related to Body functions and Structures were most frequent, whereas assessments associated with Activities and Participation and Environmental Factors were relatively uncommon.

CONCLUSION: There was a high variability among the outcome measures used, with measures within the ICF component Body Functions being most common. These results underscore the need for the development and usage of outcome measures representing all domains of health status in patients with NBPP.

PURPOSE: Shoulder function in children with Neonatal Brachial Plexus Palsy (NBPP) can be impaired. Functional gain is possible by an internal contracture release and muscle tendon transfer (ICL+MTT) for external rotation. This study evaluates the functional results of this intervention.

METHODS: Assessments were done pre-operatively and 3, 6 and 12 months thereafter and included joint-mobility (ROM), muscle strength, arm function (Assisting Hand Assessment (AHA) and Mallet-score), Quality of Life (QoL) (Pediatric Outcome Data Collecting Instrument (PODCI)) and parental satisfaction. Changes were examined using Wilcoxon's Signed-Rank test and Cohen's effect size.

RESULTS: Ten children (5 boys) aged 3-10 years who underwent a combined ICL+MTT (mm. Latissimus Dorsi/Teres Major) were included.

Active and passive external rotation ROM and muscle strength improved (p< 0.05). Arm function improved according to the Mallet-score (Hand-to-Head, Hand-to-Mouth, External-Rotation) (p< 0.05) and the arm use and pace scales of the AHA (p< 0.05). The PODCI Upper Extremity/Physical Functioning and Global Functioning subscales also showed improvements (p< 0.05). Parents were highly satisfied concerning daily life activities and sports.

CONCLUSION: ICL+MTT leads to improvement of ROM, strength, arm function, QoL and high parental satisfaction in this studies' patients and is therefore a good intervention to consider in children with NBPP with limited shoulder function.

PURPOSE: In adults with hemiparesis amount of movement of the more-affected arm is related to its amount of use in daily life. In children, little is known about everyday arm use. This report examines the relationships between everyday movement of the more-affected arm and its (a) everyday use and (b) motor capacity in children with hemiparesis.

METHODS: Participants were 28 children with a wide range of upper-extremity hemiparesis subsequent to cerebral palsy due to pre- or peri-natal stroke. Everyday movement of the more-affected arm was assessed by putting accelerometers on the children's forearms for three days. Everyday use of that arm and its motor capacity were assessed with the Pediatric Motor Activity Log-Revised and Pediatric Arm Function Test, respectively.

RESULTS: Intensity of everyday movement of the more-affected arm was correlated with its motor capacity (rs ≥ 0.52, ps ≤ 0.003). However, everyday movement of that arm was not correlated with its everyday use (rs ≤ 0.30, ps ≥$ 0.126).

CONCLUSIONS: In children with upper-extremity hemiparesis who meet the study intake criteria amount of movement of the more-affected arm in daily life is not related to its amount to use, suggesting that children differ from adults in this respect.

PURPOSE: To explore parent experiences with participation in splinting programs for their child with a congenital limb anomaly in the child's first year of life. While parent participation is recognized as integral to successful outcomes of splinting programs for these children, little is known about factors influencing their participation.

METHODS: Through purposive sampling, 10 families recruited from outpatient clinics at a pediatric tertiary care facility participated in semi-structured interviews in this qualitative study utilizing interpretive description methodology. Constant comparative and concurrent data collection and analysis were employed.

RESULTS: Themes identified: (1) An experience of adjustment; (2) The value of timely and comprehensive information; (3) Appreciation of support networks; and (4) Characteristics unique to splinting programs. Practical suggestions for program enhancements are outlined.

CONCLUSIONS: Addressing parents' information, support, and individual needs are keys to promoting active parent participation in their child's splinting program, contributing to positive outcomes for their child.

PURPOSE: This study aimed to translate and cross-culturally adapt the Pediatric Outcome Data Collecting Instrument (PODCI) into the Dutch language and evaluate its measurement properties among children (age 3-10) with Neonatal Brachial Plexus Palsy (NBPP).

METHODS: The PODCI was translated and adapted according to international guidelines and administered to 10 children with NBPP before and after surgery and thereafter twice again. Subsequently, the Mallet-score, Assisting Hand Assessment and active Range of Motion (aROM) were recorded. Cronbach's-α and correlations between the PODCI and other outcome measures were determined, as well as Intraclass Correlation Coefficients (ICC). In addition, effect sizes (ES), Standard Response Means (SRM) and change scores with the 95% Confidence Interval (95% CI) were calculated.

RESULTS: The final Dutch PODCI `Upper Extremity and Physical Function' subscale and total score `Global Functioning' showed good internal consistency (Cronbach's-α 0.695/0.781) and reliability (ICC 0.97/0.80) and were significantly associated with aROM and the Mallet-score. After surgery a significant change of the total score (ES 0.57, SRM 1.23, change 4.22 points, 95% CI 1.04-7.4) was seen.

CONCLUSION: The final Dutch PODCI had good measurement properties and appears useful in evaluating quality of life and functioning in children with NBPP.

OBJECTIVE: Effective physiotherapy intervention for children with cerebral palsy (CP) requires that expectations of their caregivers be incorporated into treatment plans and strategies. This study explored the perceived Quality of Physiotherapy (QoP) for children with CP in Ibadan, Nigeria

METHODS: This cross-sectional survey explored the perceived QoP using the SERVQUAL instrument among informal caregivers of children with CP from two different healthcare facilities. Data was analysed using Mann Whiney U and Wilcoxon Signed Rank tests at p ≤ 0.05.

RESULTS: Fifty-three informal caregivers (50 females, 3 males) of children with CP (32 males, 21 females) were surveyed. Fourth-fifths (81.13%) of the caregivers perceived the QoP service for their children as poor. The highest negative and positive ranks were in the tangible and responsiveness dimensions of the SERVQUAL respectively.

CONCLUSIONS: The study demonstrated that caregivers of children with CP perceived the quality of physiotherapy provided for their children as poor. This poor perception is related more to the tangible dimension of care. Strategies to improve care environment for children with CP and their informal caregivers should be implemented to engender satisfaction with care.

PURPOSE: To determine the impact of the availability of everyday relationships and types of social support among adolescents with spina bifida on overall satisfaction/well-being of relationships and whether these adolescents differ in their ratings of relationships, social support and overall satisfaction, as measured by the My Family and Friends Scale: Teenage Version, social support scale after their participation in a health care transition intervention program, entitled the Transition Preparation Training Program.

METHODS: A mixed design ANOVA was conducted. There were 31 eligible adolescents randomly assigned to the treatment group and 34 were assigned to the control group for a total sample size of 65 adolescents (investigator-blinded randomization).

RESULTS: There were significant main effects for support type, relationship type, and for group. The mean overall satisfaction social support ratings for 31 adolescents in the treatment group slightly increased, pre (M= 38.63), post (M= 39.04), while the mean satisfaction social support ratings for those in the control group (34) did not change, pre (M= 39.95), post (M= 39.95).

CONCLUSIONS: Relationship type and social support are important factors in overall satisfaction/well-being of relationships among adolescents with spina bifida. Discussing social networks, when preparing these adolescents for transition, may help promote evaluation of the types of support needed.

PURPOSE: Describe the case of a spinal arteriovenous malformation (AVM), which represents a rare cause for tetraplegia in the infant population.

TREATMENT: This patient underwent treatment with surgical clipping of an intradural AVM, intravenous steroids, and inpatient rehabilitation.

DISCUSSION: Although AVMs are a congenital vascular malformation, spinal AVMs are extremely rare with only a few case reports published in the pediatric literature. Generally AVMs are diagnosed intracranially which would lead to cerebral infarction; however, in this case, the AVM was in the cervical spinal cord leading to tetraplegia. With medical and rehabilitation interventions, the patient's function improved significantly; however, long-term prognostication remained difficult given the lack of standardized assessments and the inaccuracy of the American Spinal Injury Association (ASIA) examination for this age group.

CONCLUSION: Spinal AVMs are extremely rare in the pediatric population; however, with this case the use of surgical intervention helped prevent further loss of neurologic impairment, and inpatient rehabilitation served to increase the patient's function. She continued to participate in outpatient rehabilitation to improve developmental milestones, mobility, posture, positioning, and upper limb function.

Children with moderate to severe cerebral palsy are at risk for low bone mass for chronological age, which compounds risk in adulthood for progressive deformity and chronic pain. Physical activity and exercise can be a key component to optimizing bone health. In this case report we present a young adult male with non-ambulatory, spastic quadriplegia CP whom began a seated speed, resistance, and power training exercise program at age 14.5 years. Exercise program continued into adulthood as part of an active lifestyle. The individual had a history of failure to thrive, bowel and bladder incontinence, reduced bone mineral density (BMD) for age, and spinal deformity at the time exercise was initiated. Participation in the exercise program began once a week for 1.5-2 hours/session, and progressed to 3-5 times per week after two years. This exercise program is now a component of his habitual lifestyle. Over the 6 years he was followed, lumbar spine and total hip BMD Z-scores did not worsen, which may be viewed as a positive outcome given his level of gross motor impairment. Additionally, the individual reported less back pain, improved bowel and bladder control, increased energy level, and never sustained an exercise related injury. Findings from this case report suggest a regular program of seated speed, resistance, power training may promote overall well-being, are safe, and should be considered as a mechanism for optimizing bone health.