Τα νέα του Pediatric Physical Therapy Journal
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Health-Related Quality of Life in Children With Chronic Illness Compared to Parents: A Systematic Review
Purpose: The purpose of this systematic review is to identify quality-of-life issues that affect participation in age-appropriate activities in chronically ill children, as reported by the children and their families. Summary of Key Points: Social and emotional functioning scores on the Pediatric Quality of Life Inventory (PedsQL) 4.0 were found to have the greatest frequency of poor agreement between parents and children in 4 of the 6 studies included in this review, suggesting parents and children have wide variation in their assessment in these areas of psychosocial function. Conclusions: Cumulative evidence appears to indicate that parents of children with chronic illness perceive their children as having a poorer quality of life than the children report for themselves. Recommendations for Clinical Practice: Identifying differences and commonalities between these reports can guide health care practitioners to specific activities that should be the focus of caring for children; specifically, functional goal development can become more personalized and appropriate.
Purpose: A case study of a 12-year-old boy with Irlen syndrome illustrates the overlapping symptoms of Irlen syndrome and vestibular-related dizziness. Summary of Key Points: Individuals with Irlen syndrome have eyestrain and headache, and often report visual perceptual distortions of blurring, doubling, and movement of print on the page. These symptoms can be relieved with the use of individually prescribed tinted lenses or overlays. Visually induced dizziness, also known as visual vertigo, is characterized by dizziness and/or unsteadiness that is triggered by complex, distorted, large field/moving visual stimuli. Visually induced dizziness can be effectively treated with progressive, controlled exposure to optokinetic visual stimuli. The child with Irlen syndrome had impaired balance, impaired gaze stability, and symptoms of visual vertigo. His complaint of visually induced dizziness resolved following vestibular rehabilitation. Conclusions and Recommendations for Clinical Practice: When an individual with Irlen syndrome complains of dizziness, ruling out a concomitant diagnosis of a central and/or peripheral vestibular disorder is warranted. What This Adds to the Evidence: The visual symptoms associated with Irlen syndrome can overlap with those of visually induced dizziness. This case report is the first to describe overlapping visual and vestibular complaints of dizziness in an individual with Irlen syndrome.
Informal Dance Intervention Improves BMI and Functional Gait in an Adolescent With Cerebral Palsy: A Case Report
Purpose: This case study examined the effects of incorporating Informal Dance Intervention into traditional therapy sessions on body mass index and functional walking in an adolescent girl with cerebral palsy. Case Description: A 15-year-old adolescent girl, Gross Motor Function Classification System Level II, participated in Informal Dance Intervention twice weekly in 2, 16 session phases. Sixty-minute sessions focused on waltzing, contra dancing, square dancing, and belly dancing to improve timing, endurance, vestibular functioning, and core strength. Conclusions: Waist circumference decreased, walking speed increased on the 6-Minute Walk Test and Timed Up and Down Stairs, balance confidence increased per the Activities-specific Balance Confidence Scale, and vestibular functioning improved per changes in the Functional Gait Assessment. Recommendations for Clinical Practice: Incorporating Informal Dance Intervention, in conjunction with therapy, may be motivating and improve overall health for adolescents with cerebral palsy to combat their tendency of increased sedentary lifestyle.
Purpose: Children who use manual wheelchairs encounter pain and injury risks to the upper body. Current literature does not describe how propulsion pattern and physiotherapeutic training methodologies impact response to treatment. Methods: This study assesses the effect of community-based intensive physical and occupational therapy on functional outcomes over a 7-week period in pediatric manual wheelchair users. Results: Key results include significant joint and musculotendon kinematic differences at the shoulder, improved speed and propulsion effectiveness, and changed propulsion pattern. Conclusions: Statistics also revealed that propulsion pattern was a predictor of response to therapy, as was weekly therapeutic duration, wheelchair-specific focus by the therapists, and stretching.
Purpose: The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese. Methods: This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions. Results: Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes. Conclusions: Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.
Purpose: This study reports the respiratory muscle training effect on strength and endurance in individuals with Duchenne muscular dystrophy. Methods: Articles published from 1984 to 2017 were reviewed. Six articles met the inclusion criteria that included within-subject control or between-subject control group, participants with a diagnosis of only Duchenne muscular dystrophy, participation in respiratory muscle training intervention, and outcome measures of endurance and strength. Effect sizes were calculated for each study and overall, weighted mean effect sizes for strength and endurance outcome measures. Results: There was a large effect for improving respiratory endurance and a moderate effect for muscle strength. However, these effects were not significant. Conclusion: Findings justify further exploration of the potential benefits of respiratory muscle training for individuals with Duchenne muscular dystrophy.
Effect of Plantar Flexor Muscle Strengthening on the Gait of Children With Idiopathic Toe Walking: A Study Protocol
Purpose: To evaluate the effect of plantar flexor strengthening associated with conventional physical therapy treatment in participants with idiopathic toe walking. Methods: Thirty participants, of both sexes diagnosed with idiopathic toe walking, aged 5 and 11 years, will be recruited and randomized into 2 groups: the control group, who will undergo gait training, triceps surae muscle stretching, anterior tibial muscle strengthening, and motor sensory training, and the intervention group, who will undergo the same training as the control group and, additionally, triceps surae muscle strengthening. The intervention will be performed twice a week for 8 weeks. The participants will undergo a 3-dimensional gait kinematic analysis, passive amplitude of dorsiflexion movement, isometric dynamometry of the anterior tibial and triceps surae muscles, motor coordination, quality of life, and perception of the parents regarding the equinus gait at baseline and at the end of treatment. Quality of life will be reevaluated during a 24-week follow-up.
A Physical Therapy Intervention to Advance Cognitive and Motor Skills: A Single Subject Study of a Young Child With Cerebral Palsy
Background: Physical therapy interventions for children with severe motor impairments do not address the relationship between motor and cognitive development. Purpose: Evaluate the potential of a physical therapy intervention focusing on enhancing cognitive and motor outcomes in a child with severe motor impairments. Design: AB phase design without reversal. Methods: One child participated in 8 assessments from 4 to 29 months of age. The START-Play intervention was provided for 3 months following 4 baseline assessments over 12 months. Total Gross Motor Function Measure (GMFM), Sitting, Reaching, and Problem Solving assessments were completed. Visual inspection, 2 standard deviation (SD) Band Method, and percent of nonoverlapping data methods evaluated change. Results: This child had improved GMFM total and sitting scores, increased frequency of toys contacts, and increased rate of problem-solving behaviors following intervention. Conclusion: START-Play shows promise for children with severe motor impairments. Additional research is needed to evaluate efficacy. Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A273. (Pediatr Phys Ther 2019;31:347-352)
Pediatric Physical Therapists' Use of the Congenital Muscular Torticollis Clinical Practice Guidelines: A Qualitative Implementation Study
Purpose: This study is a follow-up to the quantitative survey to examine the perceptions of pediatric physical therapists (PTs) on the application of the 2013 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG). Method: Qualitative semi-structured telephone interviews were completed. Interview questions focused on how the guidelines influenced practice, facilitators and barriers to implementation, and knowledge translation activities. Results: Thirteen pediatric PTs from a variety of practice settings participated. Positive perceptions about the CMT CPG included the use of flow charts, synthesized literature in one place, and validation of examination and intervention approaches. Negative perceptions included its length and that approaches without published evidence were not addressed. Three major themes were identified: knowledge and evidence for practice, education of clinicians, and the CPG structure and components that influenced practice. Conclusions: The CMT CPG provided a number of benefits. Recommendations for future enhancement and development are provided.
Knowledge Translation Lecture: Providing Best Practice in Neonatal Intensive Care and Follow-up: A Clinician-Researcher Collaboration
Knowledge translation is the process by which we take new information that is evidence based and incorporate it into our practice. While we can each incorporate evidence into our practice, the collaboration between a researcher and a clinician can advance the implementation of evidence-based practice. We highlight the use of the Plan-Do-Study-Act cycle that includes a researcher and clinical partner on a journey of research question development, knowledge generation, clinical implementation, and policy change that advances the care to infants in the neonatal intensive care unit and in a developmental follow-up clinic. The team provides examples of implementation and highlights the clinical care differences following a decade of collaboration. Pediatric physical therapists have a responsibility to embrace and support knowledge translation to advance our profession and the care of infants, children, and families.