PurposePediatric telerehabilitation has become increasingly common with the advent of simple video-conferencing technologies and following the COVID-19 pandemic. This research aimed to ascertain the impact of the technology-facilitated shift in therapy format from in-person to remote (at home) settings, as experienced and described by families and therapists.MethodsTwo focus groups were conducted, one with 10 families who received telerehabilitation and another with 14 therapists who provided these services for children in care at two rehabilitation institutions. A six-phase inductive thematic analysis was conducted.ResultsThree themes were generated, describing the dynamic processes set in motion when remote rehabilitation was introduced: (1) reconstructing conventional therapy, (2) deconstructing conventional therapy, and (3) home as a new therapeutic opportunity.DiscussionInspired by actor-network-theory, we contend that "technology", and "home" are added as actors when the pediatric therapeutic alliance is conducted remotely. This new therapeutic alliance network has the intended consequences of rehabilitating function and skills, but it also impacts the relationships, roles, and self-perceptions of all participants (unintended consequences). A deeper understanding of these changes facilitates a rethinking of pediatric telerehabilitation's goals and toolboxes. Practically, we suggest a remapping of roles, goals, and relationships in the light of the new therapeutic opportunities offered by telerehabilitation.
Study DesignAmbispective study.ObjectivesTo determine the long-term natural history of non-surgically treated patients with myopathy and spinal deformity.MethodsData were analyzed from 118 files from a children's rehabilitation hospital. Seventeen patients were operated on; the remaining 101 patients (86%) were managed conservatively. Retrospective data included demographics, medical history, respiratory and mobility status, Cobb angle (CA), and pelvic obliquity (PO). Prospective data were obtained via telephone interviews and included the Scoliosis Research Society (SRS-22r), World Health Organization Quality of Life (QoL) (WHO-QoL) and Functional Independence Measure for Children (WeeFIM).ResultsOne hundred and one patients with myopathy and scoliosis did not have surgery and were followed for up to 33 years. Their mean age at first visit was 5.45 ± 5.27 years. CA and PO at the first visit were 27.05 ± 27.07 and 7.74 ± 9.81°, worsening to 46.95 ± 39.26 and 15.61 ± 8.57° at last visit. Respiratory data for 67 patients showed 45 who remained stable and 14 who worsened moderately and 5 severely. Mobility status worsened but not significantly. Of the 24 participants who responded to the survey (mean age 17.41 ± 10.84 years), 92% are single or divorced. They reported being generally satisfied with their QoL, although their functional scores indicated limited independence.ConclusionsDespite worsening of scoliosis and limited independence, participants were generally satisfied with their QoL.
PURPOSE:This study aimed to explore parent-reported perceptions of the usability and functional impact of wheelchair headrests among children with severe physical disabilities. METHOD:Participants included children and youth with severe physical disabilities who assessed either retrospectively (49 children, ages 2-25 years) or prospectively (30 children, ages 2-18 years). Parents completed structured questionnaires evaluating user experience, satisfaction, and perceived changes in daily function following a two-week trial with a borrowed headrest. RESULTS:Data from 79 participants were analysed together as the groups did not differ significantly (gender, mean age). Most participants were male (64%) with cerebral palsy (55%). Three types of headrests were most commonly used: the Headaloft (30%), headrests with posterior support only (24%), and the 360 system by Headovations (16.5%). Overall usability, as reported by a parent from the prospective group, was high (System Usability Scale = 82.4 ± 11.3) for all headrests. Most parents reported improvements in their child's communication (73%), eye contact (68%) and position in transportation (68%). There were also improvements (mean = 4/5) in feeding, breathing and decreased fatigue. No statistically significant differences were found between headrest types. CONCLUSION:Parents perceived high usability and functional value across headrest designs, particularly when devices were selected through individualised fitting by experienced therapists. The findings highlight the importance of incorporating parent feedback when evaluating head support systems for children with severe disabilities.
Objective The study purpose was twofold: (1) to develop the Children's Amputee Mobility Predictor and establish its content and social validity and (2) to determine its intra and inter-rater reliability.Design A reliability and validity study.Setting Pediatric rehabilitation hospital.Participants Content validity study: 10 clinical experts; Social validity study: 24 stakeholders (i.e., children's parents); Reliability study: 3 physical therapists.Intervention Not applicable.Main measure The functional capability of 30 children with leg length discrepancy was evaluated using the Children's Amputee Mobility Predictor. The Intraclass Correlation Coefficient, two-way mixed model, and absolute agreement for a single measure were used to establish intra and inter-rater reliability.Results Experts reached a consensus on the relevancy and clarity of all 26 tasks included in the Children's Amputee Mobility Predictor. The intra- and inter-rater reliability were excellent, Intraclass Correlation Coefficient (ICC)2,1 = .95, with 95% CI ranging from 0.88-0.98; and ICC3,1 = 0.96 with 95% CI ranging from 0.93-0.98, respectively. Parent feedback indicated the relevancy of tasks for children with leg length discrepancies.Conclusions The Children's Amputee Mobility Predictor is a comprehensive outcome measure that requires minimal equipment or space. It appears stable over time when used by the same physical therapist and results suggest that it may be used by multiple physical therapists. The Children's Amputee Mobility Predictor appears to measure important and relevant aspects of functional capability and be a meaningful and relevant assessment tool, helping to guide the determination of medical necessity for specific prosthetic and physical therapy interventions.
INTRODUCTION:Individuals with cerebral palsy (CP) often present with altered motor control. This can be assessed selectively during sitting/lying with the Selective Control Assessment of the Lower Extremity (SCALE), or dynamically with the dynamic motor control index during walking (walk-DMC). Both approaches suggest that altered selective motor control relate to larger gait deviations. RESEARCH QUESTION:Does the walk-DMC provide valuable information in addition to the SCALE for estimating gait deviations in individuals with CP. METHODS:Retrospective, treadmill-based gait analysis data of 157 children with spastic CP (mean 11.4±3.5 years) and Gross Motor Function Classification System levels I (n=45), II (n=88) or III (n=24) were extracted. Gait kinematic deviations were evaluated using the Gait Profile Score (GPS). The SCALE, walk-DMC and GPS were extracted for the more clinically involved leg (unilateral-analysis), and for both legs together (bilateral-analysis). RESULTS:GPS moderately correlated with both SCALE and walk-DMC scores, unilaterally and bilaterally (r≥0.4; p<0.001). Multivariate linear regression analyses were conducted, taking into account potential confounding factors. In the unilateral analysis, 54% of the GPS variance was explained (p<0.001), with both walk-DMC and SCALE significantly contributing to the GPS variance (p=0.006 and p=0.008, respectively). In the bilateral analysis, 61% of the GPS variance was explained (p<0.001), with both walk-DMC and SCALE significantly contributing to the GPS variance (p=0.006 and p<0.001, respectively). Dimensionless walking speed and use of assistive devices were the only confounding factors included in each analysis. SIGNIFICANCE:Both SCALE and walk-DMC significantly contribute to GPS variance, suggesting that they likely measure different components of motor control, and both may be useful in understanding the underlying relationship between motor control and deviations in gait kinematics.
