Functional Recovery In Children Research Articles

(152) - Explantation of Durable Ventricular Assist Device for Myocardial Functional Recovery in Children: A Report from The Action Registry

(152) - Explantation of Durable Ventricular Assist Device for Myocardial Functional Recovery in Children: A Report from The Action Registry

Prognostic factors for functional recovery in children with moderate to severe acute disseminated encephalomyelitis

BackgroundAcute disseminated encephalomyelitis (ADEM) is an immune-mediated encephalopathy with heterogeneous disease courses. However, clinical characteristics for a prognostication of functional recovery from acute episodes of ADEM remain limited. The study aims to characterize the clinical presentations and neuroimaging findings of children with poor functional recoveries from acute episodes of moderate to severe ADEM. MethodsThe multicenter retrospective cohort study included children under 18 years of age who presented with moderate to severe ADEM (modified Rankin Scale [mRS] ≥ 3 at nadir) from 2002 to 2019. Children were assigned to a good recovery group (mRS ≤ 2) and a poor recovery group (mRS ≥ 3) after mean 4.3 months of follow-up. The clinical presentations and the distribution of brain lesions on magnetic resonance imaging were compared between the two groups by the t-test for numerical variables and Fisher's exact test for categorical variables. Analyses of logistic regression were conducted and significant variables in the multivariate model were examined by the receiver operating characteristic curve for the prediction of functional recovery. ResultsAmong the 73 children with moderate to severe ADEM, 56 (77%) had good functional recoveries and 17 (23%) showed poor functional recoveries. Children with poor recoveries had a lower rate of prodromal headache (12% vs. 39%, p = 0.04), and presented with higher proportions of dystonia (29% vs. 9%, p = 0.046), myoclonus (24% vs. 2%, p = 0.009), and cerebellar lesions on neuroimages (59% vs. 23%, p = 0.01). The multivariate analyses identified that a lack of prodromal headache (OR 0.1, 95% CI 0.005 - 0.7, p = 0.06) and the presentations of myoclonus (OR 21.6, 95% CI 1.7 – 874, p = 0.04) and cerebellar lesions (OR 4.8, 95% CI 1.3 - 19.9, p = 0.02) were associated with poor functional recoveries. These three factors could prognosticate poor outcomes in children with moderate to severe ADEM (area under the receiver operating characteristic curve 0.80, 95% CI 0.68 – 0.93, p = 0.0002). ConclusionNearly one-fourth of children with moderate to severe ADEM had a poor functional recovery from acute episodes, who were characterized by a lack of prodromal headache, the presentation of myoclonus, and the neuroimaging finding of cerebellar lesions. The clinical variables associated with poor functional recoveries could assist in the planning of immunotherapies during hospitalization for a better outcome in moderate to severe ADEM.

Effect of Upper Limb Rehabilitation Robot Therapy on Functional Recovery in Children With Upper Limb Movement Disorder: A Meta-analysis and Systematic Review

Effect of Upper Limb Rehabilitation Robot Therapy on Functional Recovery in Children With Upper Limb Movement Disorder: A Meta-analysis and Systematic Review

Possible Risk Factors Related to Malnutrition in 6-59-Month Children with Severe Acute Malnutrition in District Pakpattan, Punjab

Background: Malnutrition is responsible for one third of the mortality rate among children less than 5 years old. Worldwide, 54% of the child deaths are due to malnutrition and the caseload in Pakistan is equal to 46%. In the current study, we attempted to identify the possible risk factors related to malnutrition among 6-59-month children in Pakpattan, Punjab province.
 Methods: A total of 500 severe acute malnourished (SAM) 6-59-month children were assessed during a period of 12 months (March 2018 to Feb 2019) to find out the possible risk factors for SAM.
 Results: Based on the findings, significant possible determinants risk factors related to acute malnutrition include edema, blurred vision, illness history, birth interval, mother body mass index (BMI), complementary feeding, family size, and family member working status.
 Conclusion: Malnutrition risk factors depend upon children nutrition status and early detection of these risk factors may improve the nutrition status and functional recovery in children.

Measuring functional recovery in somatic symptom and related disorders: a scoping review

ObjectiveSomatic symptom and related disorders (SSRDs) are prevalent, heterogenous conditions that have the potential to profoundly affect normative function in children and adolescents. Yet there is little understanding of pathways...

Improved 6 Minute Walk Distance and Brain-Type Natriuretic Peptide After Continuous-Flow Ventricular Assist Device Placement in Children.

Despite increasing continuous-flow ventricular assist device (CF-VAD) use in children, minimal data exist regarding the functional recovery and rehabilitation potential after device placement. We hypothesized that after CF-VAD implantation, children would demonstrate a time-limited improvement in 6 minute walk distance (6MWD) and brain-type natriuretic peptide (BNP). A retrospective cohort study of 27 patients was conducted, those <18 years of age at a tertiary-care center during the study period. Seventy-four percent were male; median age was 12.7 years. Six minute walk distance and BNP were evaluated within 365 days of implantation. Associations were examined before and after 90 days postimplantation because a plateau in both values was seen after 90 days. Data included 92 6MWD and 341 BNP values. In the first 90 days, 6MWD increased by 12 percent predicted (%P) per 30 days (P < 0.01); with no significant change thereafter, increasing 0.6 %P per 30 days (P = 0.482). In the first 90 days, BNP decreased by 59% per 30 days (P < 0.01); with no significant change thereafter, increasing 1.2% per 30 days (P = 0.561). Six minute walk distance and BNP improved after CF-VAD implantation, with a significant improvement only in the first 90 days. Routine use of 6MWD and BNP can help in assessment of functional recovery in children after CF-VAD placement.

Ventricular assist devices in a contemporary pediatric cohort: Morbidity, functional recovery, and survival

Limited availability of donor organs has led to the use of ventricular assist devices (VADs) to treat heart failure in pediatric patients, primarily as bridge to transplantation. How effective VAD therapy is in promoting functional recovery in children is currently not known. We report morbidity and mortality as defined by the Interagency Registry for Mechanically Assisted Circulatory Support Modified for Pediatrics (PediMACS) and the use of the Treatment Intensity Score to assess functional status for 50 VAD patients supported at a single pediatric program from 2004 to 2013. In this cohort, 30-day survival on VAD was 98%, and 180-day survival was 83%. Stroke occurred in 11 patients (22%), with 8 (16%) resulting in persistent neurologic deficit or death. The adverse event rate was 2-fold to 3-fold higher in the first 7 days of support compared with the subsequent support period. Functional status, as measured by the Treatment Intensity Score, improved with duration of support. Successful bridge to transplantation was associated with fewer adverse events during support and greater improvement in the Treatment Intensity Score during the period of support. Overall survival in this cohort is excellent. The risk of serious adverse events decreases over the first month of support. However, a clinically significant risk of morbidity and mortality persists for the duration of pediatric VAD support. Measures of functional status improve with duration of support and are associated with survival to transplantation.

Wrist range of motion and motion frequency during toy and game play with a joint-specific controller specially designed to provide neuromuscular therapy: A proof of concept study in typically developing children

Upper extremities affected by hemiplegic cerebral palsy (CP) and other neuromuscular disorders have been demonstrated to benefit from therapy, and the greater the duration of the therapy, the greater the benefit. A great motivator for participating in and extending the duration of therapy with children is play. Our focus is on active motion therapy of the wrist and forearm. In this study we examine the wrist motions associated with playing with two toys and three computer games controlled by a specially-designed play controller. Twenty children (ages 5–11) with no diagnosis of a muscular disorder were recruited. The play controller was fitted to the wrist and forearm of each child and used to measure and log wrist flexion and extension. Play activity and enjoyment were quantified by average wrist range of motion (ROM), motion frequency measures, and a discrete visual scale. We found significant differences in the average wrist ROM and motion frequency among the toys and games, yet there were no differences in the level of enjoyment across all toys and games, which was high. These findings indicate which toys and games may elicit the greater number of goal-directed movements, and lay the foundation for our long-term goal to develop and evaluate innovative motion-specific play controllers that are engaging rehabilitative devices for enhancing therapy and promoting neural plasticity and functional recovery in children with CP.

(216) Presurgical predictors of pain, physical activity, and quality of life in children 4 months after surgery

Over 4.5 million children undergo surgery annually in the U.S. and recent studies indicate that many children have pain persisting beyond the expected recovery period. Limited research has examined the impact of surgery on functional recovery in children after surgery, and furthermore, limited data are available regarding factors that predict poorer recovery in this context. We conducted a longitudinal study examining baseline predictors of postsurgical pain, physical activity, and health-related quality of life (HRQOL) in 60 children (66.7% female, 83.4% white) undergoing major surgery (spinal fusion, pectus deformity repair) using a multi-method assessment approach.

Evaluation of pediatric upper extremity peripheral nerve injuries

IntroductionThe evaluation of motor and sensory function of the upper extremity after a peripheral nerve injury is critical to diagnose the location and extent of nerve injury as well as document functional recovery in children. PurposeThe purpose of this paper is to describe an approach to the evaluation of the pediatric upper extremity peripheral nerve injuries through a critical review of currently used tests of sensory and motor function. MethodsOutcome studies on pediatric upper extremity peripheral nerve injuries in the Medline database were reviewed. ResultsThe evaluation of the outcome in children less than 10 years of age with an upper extremity peripheral nerve injury includes careful observation of preferred prehension patterns, examination of muscle atrophy and sudomotor function, provocative tests, manual muscle testing and tests of sensory threshold and tactile gnosis. ConclusionThe evaluation of outcome in children with upper extremity peripheral nerve injuries warrants a unique approach.

The Role of Myocardial Viability Assessed by Perfusion/F-18 FDG Imaging in Children With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

Although surgical treatments evolved, the short-term postoperative mortality is still high in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and long-term survivors may suffer from restrained functional recovery. Therefore, an optimal means in predicting postoperative reversal is demanded. In this study, we assess the utility of myocardial perfusion/F-18 fluorodeoxyglucose (FDG) imaging in the evaluation of myocardial viability and postsurgery functional recovery in children with ALCAPA. A retrospective study was performed in 7 children with diagnosed ALCAPA who underwent myocardial perfusion/F-18 FDG imaging preoperatively. Global viability index was used to evaluate myocardial viability and was compared with the preoperative deviations of left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) from age-matched healthy children and with the postoperative durations of intensive care. Children with more viable myocardium had less severe clinical symptoms. The viability index was correlated well with the preoperative deviations of LVEF (r = -0.98, P = 0.001) and LVEDD (r = 0.87, P = 0.02) and postoperative durations of intensive care hospitalization (r = 0.77, P = 0.04) and mechanical ventilation (r = 0.83, P = 0.02). LVEF and LVEDD reached normal range within 5 months in viable children, whereas incomplete reversal was observed in partial- and nonviable children. In children with ALCAPA, myocardial viability evaluated by perfusion/F-18 FDG imaging is related to the preoperative clinical manifestations and cardiac function. Additionally, it may predict functional recovery after surgical repair.

Functional Recovery in Children and Adolescents With Spinal Cord Injury

Functional Recovery in Children and Adolescents With Spinal Cord Injury

Functional Recovery in Children and Adolescents With Spinal Cord Injury

To examine functional recovery in mobility and self-care measured using the Pediatric Evaluation of Disability Inventory (PEDI) in children with spinal cord injury (SCI) during an inpatient rehabilitation stay and to identify how demographic and clinical variables relate to functional recovery. PEDI scores were collected through retrospective chart review for 32 children and adolescents with SCI (mean age, 10.6 +/- 6.2 years; range, 1-19 years) admitted to an inpatient physical rehabilitation program between 1995 and 2007. Children with SCI showed significantly improved functional skill recovery and reduced caregiver assistance for the PEDI mobility and self-care domains after rehabilitation. Item analyses suggested more recovery in mobility than in self-care skills. Children with incomplete injury gained more independence in self-care than those with complete injury. Children with SCI showed improved functional skills and reduced need for caregiver assistance as measured by the PEDI during inpatient rehabilitation.

Functional Assessment for Children Hospitalized for Sickle Cell Pain: A New Paradigm.

Abstract 2561Poster Board II-538 Background:Functional assessment methods have not been previously utilized in the acute care setting for children with sickle cell disease, but may provide a more valid means to evaluate pain and recovery in children hospitalized with vasoocclusive episodes (VOE). Objective:To evaluate the FIMTM instrument, a well validated measure of motor and cognitive functioning, as a measure of functional recovery in children hospitalized with sickle cell pain, by correlating it with established measures of pain and affect. This information will be used to inform subsequent research, with the goal of generating a functional assessment instrument specific to sickle cell disease. Design/Methods:Patients between 7 and 21 years of age admitted for a VOE were eligible to participate. During their hospitalization, patients were evaluated daily for opiate use, pain (11 point numerical rating score (NRS), and adolescent pediatric pain tool [APPT]), mood (Positive and Negative Affect Scale for Children [PANAS-C]), and function (FIM instrument). Results:Twenty-four patients were enrolled in the study. Mean age was 16.3±3.1 (range: 7.3 – 20.3) years, and mean length of stay was 6.9±5.6 (range: 2.2 – 28.3) days. Most patients were female (N=18) and most were African American (N=18). Over the course of the hospitalization (from day 1 to study completion), patients showed: decreases in total opiate use (mg/kg/hr) (.05±.02 vs. .04±.03; p=.03) and average pain intensity on the NRS (6.3±1.4 vs.5.0±2.4; p=0.005); improvement in function as measured by the FIM instrument (86.1±16.2 vs. 99.5±14.2; p=0.004) and FIM motor sub-score (53.8±12.1 vs. 64.6±14.3; p=.005). No significant change was found in the FIM cognitive sub-scale (34.9±.3 vs. 34.9±.3; p=.33), positive affect (23.8±11.5 vs. 28.9±15.6; p=0.074), negative affect (29.8±10.6 vs. 25.5±14.1; p=.134), or pain as measured by the APPT (10.7±10.6 vs. 10.0±11.0; p=.607).Bivariate correlations using Pearson Correlation Coefficients were performed to assess the association between the change (Day 1 vs. study completion) in FIM total scores and each of the validity indicators. (Table 1)Table 1– Association between Change in FIM total scores and Clinical Validity IndicatorsOutcomesR ValueP ValueΔ Average Pain Score−.435.034Δ Total Opiate Use−.297.158Δ APPT−.155.469Δ PANAS-Positive.617.001Δ FIM-Cognitive.024.910Δ FIM-Motor.784.000 Conclusions:These findings suggest that functional assessment may provide a valid method to evaluate physical recovery in children with sickle cell disease hospitalized with VOE. Our data demonstrate preliminary evidence for the responsiveness of the FIM‘, in particular the motor scale, for detecting changes in clinical course of children hospitalized with VOE. Correlations were demonstrated between change in the FIM score and change in pain scores as well as positive affect. These analyses suggest that our future evaluations of function in children hospitalized with VOE and development of functional assessment measures should focus on motor activities. Our long term goal is to develop a new functional assessment instrument which would be utilized in clinical and research settings as an outcome measure of VOE in patients with sickle cell disease. Disclosures:No relevant conflicts of interest to declare.

Right Hemisphere Brain Damage in Children

Abstract Adults with right hemisphere (RH) damage have a characteristic cognitive profile of impaired facial recognition and visual spatial skills, contralateral neglect, and aprosodia, with relatively intact propositional language. The adverse effects of childhood RH damage are more subtle and do not follow the adult pattern following RH injury. This article reviews evidence that the RH is specialized early in life for certain cognitive functions, including comprehension of affective prosody and visual spatial analysis. Other cognitive functions such as facial recognition, language, and expressive prosody appear to have more bilateral representation during early development. There is also strong evidence for plasticity in the developing RH that allows reorganization to take place following focal injury. Such differences in neural networks during development may account for the good functional recovery in children with perinatal RH brain damage.

Association of therapeutic occasion, gross motor function grading and developmental level with gross motor functional recovery in children with cerebral palsy

Background The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed. Objective To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy. Design A case-controlled analysis. Setting Qilu Children's Hospital of Shandong University. Participants Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children's Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0–2 years old, 47 cases of 2–4 years and 36 cases of 4–6 years. Informed contents were obtained from relatives of all the children. Methods ▪ Comprehensive rehabilitation treatment: Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub, pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ▪ Prognosis assessment: The gross motor functional grading of the children with cerebral palsy at admission was assessed using the Chinese version of gross motor function classification system (GMFCS). The gross motor functions of the children with cerebral palsy were assessed before rehabilitation treatment and 12 months after rehabilitation treatment by using gross motor function measure (GMFM). The improved GMFM total score was calculated. Developmental quotient was evaluated using Gesell developmental schedules (GDS) after 12-month rehabilitation treatment. Univariate analysis of variance was performed using the improved GMFM total score with age, GMFCS grade and developmental level (developmental quotient). Main outcome measures Effects of age started to accept rehabilitation treatment, GMFCS grade and developmental level on the recovery of gross motor function in children with cerebral palsy. Results All the 138 children with cerebral palsy were involved in the analysis of results. The improved GMFM total scores were significantly different among the children with cerebral palsy of different ages started to accept treatment, GMFCS grades and developmental levels ( F=13.464, 37.283, 30.814, P < 0.01). The younger the children started to accept treatment, the lower the their GMFCS grades and the higher their developmental levels, then the higher their improved GMFM total scores. Conclusion The recovery of gross motor function is better in younger children started to accepted treatment with cerebral palsy with lower GMFCS grades and higher developmental levels.

Item-Specific Functional Recovery in Children and Youth with Acquired Brain Injury

The purpose of this study was to examine changes in item-specific functional activities and caregiver support in children and youths with acquired brain injury (ABI) in an inpatient setting using the Pediatric Evaluation of Disability Inventory (PEDI). The PEDI was administered by therapy staff at admission and discharge to a consecutive sample of 94 children and youths with brain injury (62 males and 32 females; age range = one to 19 years of age) admitted to the inpatient service at Franciscan Children's Hospital and Rehabilitation Center during a two-year, 10-month period. Individual PEDI item scores were abstracted from the medical records. Using the Wilcoxon matched-pairs signed rank test (two-tailed), significant differences between admission and discharge scores were found for most mobility, self-care, and social activity item groups and for all domains of caregiver support. Patterns of activity-specific improvements were contrasted between children with traumatic ABI and those with nontraumatic ABI. Recovery in children with ABI can be detected during inpatient rehabilitation across many areas of functioning as represented by item content of the PEDI. Changes at the item level may serve as a guide for defining specific physical therapy goals for inpatient episodes. Item groups in which changes are not detected provide information about sections of the PEDI that are less relevant for hospital-based recovery of children with ABI.

Injury severity and functional outcome following paediatric trauma in war conditions.

Trauma causes substantial morbidity and functional impairments among children. The aim of this study was to investigate injuries of children, type of injuries, injury severity, functional impairments and relation between functional impairments and mechanisms of severe injuries in children following trauma in war conditions. This study followed 193 children with trauma, aged 1-16 years, who were admitted and treated in a regional rehabilitation centre from 1992-1995. The degree of injury seriousness was determined according to Injury Severity Scores (ISS). Functional status was measured by means of the own functional assessment scale. Higher ISS was noted for severe injuries caused by firearms than by other means. There was significantly minor functional recovery in children with firearms severe trauma at discharge than with other types of severe injuries (t = 2.04, p < 0.05). The number of all paediatric trauma and firearms injuries decreased by length of war duration. ISS and functional status in children injured by fall at the discharge also decreased. These results show that there are direct and long-term consequences in children age, especially in children with severe traumas caused by firearms, and indicate assessment of psychosocial status of each injured child together with severity of injury.

Evaluation of renal function and prediction of renal functional recovery in children with unilateral hydronephrosis using renal pelvic urine

In 29 children with unilateral hydronephrosis who underwent surgery at the age from 2 months to 15 years (27 patients with ureteropelvic junction stenosis and 2 with obstructive megaureter), beta 2-microglobulin (beta 2-MG), alpha 1-microglobulin (alpha 1-MG), N-acetyl-beta-D-glucosaminidase (NAG) and albumin were determined in renal pelvic urine from the hydronephrotic kidney to evaluate renal dysfunction accompanying urinary tract obstruction. Moreover, it was also examined whether it is possible to predict functional recovery of the hydronephrotic kidney on the basis of relation between these indices and pre- and postoperative changes in renal dimercaptosuccinic acid (DMSA) uptake rate. The values of beta 2-MG, alpha 1-MG, NAG and albumin in urine from the renal pelvis were high in 48%, 50%, 75% and 83% of the patients, respectively. Among the patients of one year and up, those with low preoperative DMSA uptake rate tended to have high values of beta 2-MG, alpha 1-MG and NAG. On the contrary, albumin level was high in 78% of patients who had good preoperative DMSA uptake rate. With respect to the relation between pre- and postoperative changes in DMSA uptake rate and each index, beta 2-MG and alpha 1-MG were high in 73% and 62% of patients who exhibited a marked increase in postoperative DMSA uptake rate. In patients without a remarkable change in DMSA uptake rate before and after surgery, on the other hand, the values of these were high only in 25% and 36%.(ABSTRACT TRUNCATED AT 250 WORDS)