Handicap Inventory Research Articles

Percutaneous electrical nerve field stimulation compared to standard medical therapy in adolescents with functional abdominal pain disorders.

Standard medical therapy (SMT) in children with functional abdominal pain disorders (FAPD) includes cyproheptadine and amitriptyline. While percutaneous electrical nerve field stimulation (PENFS) has shown benefit, no study has compared outcomes of PENFS to SMT. We aimed to examine changes in abdominal pain, nausea and disability before and after treatment and compare outcomes between treatments. The records of FAPD patients ages 11-21 years, treated with 4 weeks of PENFS, cyproheptadine or amitriptyline were reviewed. Outcomes were evaluated using validated questionnaires [Abdominal Pain Index (API), Nausea Severity Scale (NSS), and the Functional Disability Inventory (FDI)] at baseline and follow-up within 3 months (FU). Of 101 patients, 48% received PENFS, 31% cyproheptadine and 21% received amitriptyline. Median ages were 17 (15-19), 16 (15-18) and 15 (11-16) years respectively and the majority were females (75%, 90% and 52% respectively). In the PENFS group, API (p = 0.001), NSS (p = 0.059) and FDI (p = 0.048) were significantly lower at FU. API (p = 0.034) but not NSS and FDI (p > 0.05) decreased significantly at FU in the amitriptyline group. API, NSS and FDI did not change significantly with cyproheptadine at FU (p > 0.05). FU API scores were lower in PENFS vs. cyproheptadine (p = 0.04) but not vs. amitriptyline (p = 0.64). The FDI scores were significantly lower in the amitriptyline vs. cyproheptadine group (p = 0.03). Therapy with PENFS showed improvements in abdominal pain, nausea and disability while amitriptyline showed improvements in abdominal pain within 3 months of treatment. PENFS was more effective than cyproheptadine in improving abdominal pain. Amitriptyline improved disability scores more than cyproheptadine and showed promise for treatment. PENFS may be a good non-pharmacologic alternative for FAPD.

Correlating Vestibular Migraine Patient Assessment Tool and Handicap Inventory to Daily Dizziness Symptoms.

Investigate the relationship between Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores and daily dizziness symptoms. Prospective cohort analysis of 52 patients with vestibular migraine (VM). Tertiary referral center. Fifty-two patients diagnosed with VM or probable VM according to Barany Society criteria. Subjects reported their dizzy symptoms (on a scale of 0 [no symptoms], 1 [mild], 2 [moderate], and 3 [severe]) every day for 1 month via automated text messaging linked to a cloud-based research database. Subjects completed VM-PATHI and Dizziness Handicap Inventory (DHI) scores at the end of the month. We examined the correlation between a composite of daily dizziness scores with VM-PATHI and DHI scores through linear regression and correlation analysis. Pearson correlation coefficient, R2 value. VM-PATHI showed a moderate correlation with daily dizziness symptoms (correlation coefficient, 0.51). DHI showed a lower correlation with daily dizziness (correlation coefficient, 0.38). VM-PATHI score was a strong predictor of daily dizziness with univariate linear regression (R2 = 0.26, p = 0.001). In a multiple linear regression model with age, history of anxiety and/or depression, and VM-PATHI, the VM-PATHI score was the only statistically significant predictor of daily dizziness (p < 0.001). Daily dizziness symptoms are better correlated with VM-PATHI score than the DHI, providing further validation of VM-PATHI as a disease-specific outcome measure for patients with VM.

Pediatric Complex Regional Pain Syndrome With and Without a History of Prior Physical Trauma at Onset.

To determine whether differences exist between children with complex regional pain syndrome (CRPS) who identify an inciting physical traumatic event (group T) versus those without such history (group NT). We performed a single-center, retrospective study of children diagnosed with CRPS, 18 years old or younger, presenting between April 2008 and March 2021 and enrolled in a patient registry. Abstracted data included clinical characteristics, pain symptoms, Functional Disability Inventory, psychological history, and Pain Catastrophizing scale for children. Charts were reviewed for outcome data. We identified 301 children with CRPS, 95 (64%) reported prior physical trauma. There was no difference between the groups regarding age, sex, duration, pain level, function, psychological symptoms, and scores on the Pain Catastrophizing Scale for Children. However, those in group T were more likely to have had a cast (43% vs 23%, P < 0.001). Those in group T were less likely to experience complete resolution of symptoms (64% vs 76%, P = 0.036). There were no other outcome differences between the groups. We found minimal differences in children with CRPS who report a prior history of physical trauma to those who do not. Physical trauma may not play as significant a role as immobility, such as casting. The groups mostly had similar psychological backgrounds and outcomes.

Functional measures on PEDI are associated with BSID-3 scales at 2 years, following neonatal surgery

BackgroundNeonates requiring early surgical intervention for major non-cardiac congenital anomalies are at high risk of adverse neurodevelopmental outcomes. Early recognition of potential neuro-developmental delay is critical to facilitate access to early childhood intervention services and therefore maximise the functional capabilities of these children. AimsThis study aims to compare Bayley's Scales of Infant and Toddler Development (BSID-3) and the Paediatric Evaluation of Disability Inventory (PEDI) as early screening tools in predicting neuro-developmental disability across multiple domains. In addition, it looks at determining which pre, peri and post-operative risk factors lend themselves to more adverse outcomes. Study designRetrospective cohort study. SubjectsNeonates requiring surgical intervention at the Royal Children's Hospital from 2012 to 2018 who subsequently underwent neurodevelopmental assessment at 2 years of age. Outcome measuresThe main outcome was the relationship between performance on the PEDI compared with the BSID-3, in 2-year-olds following neonatal surgery. ResultsParent -reported functional measures across all domains on PEDI strongly related to the more formal measures of cognition, language, and motor development assessed on BSID-3 (p < 0.05). ConclusionsThe questionnaire-based PEDI tool could be considered a reliable replacement to the formal Bayley (BSID-3) scale in low-risk infants and provide a more accessible means of assessment where there are deficiencies in availability of suitably trained clinicians or limited resource centres.

Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the ‘F′-words: Function, family, fitness, fun, friends and future

BackgroundThe impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words. MethodsCross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2–4, 5–13 and 14–18 years) based on the 6 F-words (mobility of PEDI for ‘fitness’; four classification systems and self-care of PEDI for ‘functioning’; social functions of PEDI for ‘friends’; demographic information by parents for ‘family’; the recreation of LIFE-H for ‘fun’; and different stages of development for ‘future’). ResultsThe most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2–4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5–13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14–18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2–4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5–13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14–18 y. ConclusionsSix F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family’s expectations, life requirements, environmental needs, and cultural differences.

A Prospective, Longitudinal Study of Caregiver-Reported Adaptive Skills and Function of Individuals with HNRNPH2-related Neurodevelopmental Disorder

ObjectivesThis study presents a cohort of individuals in a natural history study with de novo pathogenic missense variants in HNRNPH2 causative of HNRNPH2-related neurodevelopmental disorder (NDD) to describe individuals’ adaptive functional abilities.MethodsWe measured adaptive function using the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) and the Vineland Adaptive Behavior Scale (VABS-III). Results were compared using inferential statistics and regression analysis.ResultsSixty-seven individuals carried known pathogenic or likely pathogenic variants in HNRNPH2. Thirty-five participants (2.89–42.04 years, 83% female) and caregivers completed PEDI-CAT assessments with 25 of these participants completing the VABS-III. Sixteen, three and two participants completed a follow-up PEDI-CAT assessment at one, two and three years respectively. Individuals had mean normative scores less than age-matched peers across all domains on both PEDI-CAT and VABS-III measures, with 91% participants < 5th percentile on both the PEDI- CAT and VABS-III. Verbal and ambulatory participants had significantly higher PEDI-CAT scores across all domains, using both raw and normative data. There was no significant change in PEDI-CAT scores over 3 years.ConclusionsOverall scores, both raw and normative, are low across all individuals with HNRNPH2-related NDD using both the PEDI-CAT and VABS-III. PEDI-CAT normative scores do not likely represent the clinical variability, but raw scores may be able to capture functional variability. In a small sample, longitudinal data from the PEDI-CAT domain scores demonstrate stability in performance at 3 years.Trial Registration: ClinicalTrials.gov NCT03492060.

Factors associated with capability and performance in children with neurodevelopmental disorders: an exploratory cross-sectional study

Background Children with neurodevelopmental disorders (NDD) have a lower level of independence and major need of assistance to perform daily living skills is one the main concerns of caregivers and therapists of children, adolescents and adults with these disabilities. Aim To identify factors associated with capability and performance in self-care, mobility and social activities in children with NDD. Method A cross-sectional study was performed with 96 children with NDD, most were male (69.8%), with a mean age of 8.53 (± 1.83) years. The Pediatric Evaluation of Disability Inventory was used to evaluate capability and performance outcomes. The explanatory variables were intellectual function, motor skills, economic level, and maternal education. Stepwise multiple linear regression models were used. Results The motor skills were the main factor that explained self-care, mobility and social function capability outcomes and, self-care and mobility performance outcomes (p < 0.05). The intellectual function explained only the social function performance outcome (p < 0.05). Moreover, highest economic extracts increased the explanation of outcomes. Conclusion The findings are relevant to understanding the factors associated with performance and capability and performance in self-care, mobility and social activities to help clinicians to make an informed decision based on the best practice evidence for these children. An expanded assessment of functioning and of the environmental factors is necessary to help the planning interventions to improve capability and performance of the children with NDD.

Effect of Swiss Ball Stabilization Training on Trunk Control, Abdominal Muscle Thickness, Balance, and Motor Skills of Children With Spastic Cerebral Palsy: A Randomized, Superiority Trial

ObjectivesTo compare the effects of Swiss ball stabilization training (SBST) and stable surface stabilization training (SSST) on the trunk control, abdominal muscle thickness, balance, and motor skills of children with spastic cerebral palsy (CWSCP). DesignSingle-blind, randomized superiority trial. SettingGeneral Community and Referral Center. ParticipantsThirty CWSCP, aged 6-12 years, with Gross Motor Function Classification System levels I-III were randomly assigned to the SBST and SSST groups (N=30). InterventionsThe participants were randomized to receive either SBST or SSST for 5 weeks, 3 days a week. Outcome MeasuresThe Trunk Control Measurement Scale (TCMS), abdominal muscle thickness, Pediatric Balance Scale (PBS), standing and walking sections of Gross Motor Function Measure (GMFM-88), and mobility section of the Pediatric Evaluation of Disability Inventory (PEDI) were assessed. ResultsAfter 5 weeks of the intervention and 9 weeks of follow-up, the SBST group showed statistically significant improvements in the TCMS, GMFM-88, PEDI, thickness of the internal oblique muscle at rest and contraction, and thickness of the transverse abdominis muscle at rest and contraction compared with the SSST group (P<.0001). Contrarily, the thickness of the external oblique muscle increased statistically significantly in the SSST group compared with the SBST group after 5 weeks of the intervention and 9 weeks of follow-up both at rest (P<.0001 and P=.0001, respectively) and contraction (P=.015 and P=.017, respectively). No statistically significant difference was found between the groups regarding the PBS score after 5 weeks of intervention. ConclusionThe SBST could improve the trunk control, balance, and motor skills of CWSCP and increase the thickness of local abdominal muscles. Also, SBST was more effective than SSST for CWSCP.

Effectiveness of Behavior Management Intervention in Migraine With a Focus on Comorbid Depressive

Background: Migraine negatively affects sufferers’ physical and mental health and social and economic status. Objectives: This study compared the effectiveness of behavior management therapy and pharmacotherapy in reducing migraine-related disabilities with and without focusing on comorbid depressive symptoms. Materials &amp; Methods: This quasi-experimental study has a pre-test-post-test design with a control group. The study was conducted on migrainous patients with comorbid depressive symptoms referred to neurology clinics in Rasht City, Iran, in 2021. A total of 18 female patients were selected using purposive sampling based on neurological diagnosis and the diagnostic and statistical manual of mental disorders (DSM-5) criteria for depressive disorder. The participants were randomly assigned to two groups after matching regarding age and severity of depression. Combined therapy (behavior management intervention [BM] and pharmacotherapy [P]) was performed in two groups during eight sessions, with (case group) and without (control group) focusing on comorbid depressive symptoms. The data were collected using the Beck depression inventory (BDI-II), the headache disability inventory (HDI) , and the headache diary (HD) and analyzed using multivariate analysis of covariance. Results: The first therapeutic approach was significantly superior to the second in reducing migraine-related disabilities (F(2, 13)=10.43, P&lt;0.05, Wilks Lambda=0.384, partial Ƞ2=0.616). Conclusion: Combined therapy (BM &amp; P) focusing on comorbid depressive symptoms can be an alternative or complementary therapeutic method to reduce various disabilities in migraine patients.

The Investigation of Relationship between Functional Mobility Levels of Children with Chronic Disability and Caregivers’ Quality of Life

Purpose: This study aims to look at the relationship between carers' quality of life and the functional mobility levels of children with chronic disabilities.Methods: The study included 30 children (22 boys, 8 girls) with chronic disabilities and their caregivers. The socio-demographic characteristics of the children and caregivers were collected.Caregivers' quality of life was evaluated with the Adult Carer Quality of Life Questionnaire (AC-QoL), and children’s functional mobility was evaluated with the mobility subscale of the Pediatric Evaluation Of Disability Inventory (PEDI-Mobility). Results: The age of the children included in the study was 7.0 (5.0-12.0) years and the age of their caregivers was 38.00 (32.75-41.25) years. The AC-QoL score of caregivers was 85.00 (72.00-93.50) out of a total of 120 points, and the PEDI-Mobility score was 33.00 (3.75-53.00) out of a total of 58 points. In the correlation analysis, no significant correlation was found between the PEDI-Mobility total score and the AC-QoL total score (p&amp;gt;0.05).However, there was a negative correlation between the PEDI-Mobility total score and the AC-QoL “ability to care” subscale score(r= -0.403; p=0.027). Conclusion: According to the results of the study, no relationship was found between the functional levels of children and the quality of life of their caregivers. Studies with a larger sample size and consideration of aspects including sociocultural level, economic considerations, and health services that may affect the quality of life of families are regarded to be necessary in order to achieve more conclusive findings on this subject.

Combining Unimanual and Bimanual Therapies for Children with Hemiparesis: Is There an Optimal Delivery Schedule?

Constraint-induced movement therapy (CIMT) and bimanual therapy (BT) are among the most effective hand therapies for children with unilateral cerebral palsy (uCP). Since they train different aspects of hand use, they likely have synergistic effects. The aim of this study was to examine the efficacy of different combinations of mCIMT and BT in an intensive occupational therapy program for children with uCP. Children (n = 35) participated in intensive modified CIMT (mCIMT) and BT, 6 weeks, 5 days/week, 6 h/day. During the first 2 weeks, children wore a mitt over the less-affected hand and engaged in functional and play activities with the affected hand. Starting in week 3, bimanual play and functional activities were added progressively, 1 hour/week. This intervention was compared to two different schedules of block interventions: (1) 3 weeks of mCIMT followed by 3 weeks of BT, and (2) 3 weeks of BT followed by 3 weeks of mCIMT. Hand function was tested before, after, and two months after therapy with the Assisting Hand Assessment (AHA), Pediatric Evaluation of Disability Inventory (PEDI), and Canadian Occupational Performance Measure (COPM). All three groups of children improved in functional independence (PEDI; p < 0.031), goal performance (COPM Performance; p < 0.0001) and satisfaction (COPM Satisfaction; p < 0.0001), which persisted two months post-intervention. All groups showed similar amounts of improvement, indicating that the delivery schedule for mCIMT and BT does not significantly impact the outcomes.

Impact of auricular percutaneous electrical nerve field stimulation on gut microbiome in adolescents with irritable bowel syndrome: A pilot study.

Percutaneous electrical nerve field stimulation (PENFS) has documented efficacy for irritable bowel syndrome (IBS) via plausible vagal neuromodulation effects. The vagus nerve may affect gut microbiome composition via brain-gut-microbiome signaling. We aimed to investigate gut microbiome alterations by PENFS therapy in adolescent IBS patients. A prospective study of females with IBS aged 11-18 years receiving PENFS therapy for 4 weeks with pre- and post-intervention stool sampling was conducted. Outcome surveys completed pre-therapy, weekly, and post-therapy included IBS-Severity Scoring System (IBS-SSS), Visceral Sensitivity Index (VSI), Functional Disability Inventory (FDI), and the global symptom response scale (SRS). Bacterial DNA was extracted from stool samples followed by 16S rRNA amplification and sequencing. QIIME 2 (version 2022.2) was used for analyses of α and β diversity and differential abundance by group. Twenty females aged 15.6 ± 1.62 years were included. IBS-SSS, VSI, and FDI scores decreased significantly after PENFS therapy (P < 0.0001, P = 0.0003, P = 0.0004, respectively). No intra- or interindividual microbiome changes were noted pre- versus post-therapy or between responders and non-responders. When response was defined by 50-point IBS-SSS score reduction, α diversity was higher in responders compared with non-responders at week 4 (P = 0.033). There was higher abundance of Blautia in excellent responders versus non-responders. There were no substantial microbial diversity alterations with PENFS. Subjects with excellent therapeutic response showed an enrichment of relative abundance of Blautia, which may indicate that patients with specific microbial signature have a more favorable response to PENFS.

Intensive Neurophysiological Rehabilitation System for children with cerebral palsy: a quasi-randomized controlled trial

BackgroundRecent research indicates that intensive rehabilitation tends to be effective for children with cerebral palsy (CP). Intensive Neurophysiological Rehabilitation System (INRS) is a multi-component approach that combines various interventions and addresses different functional goals.. This study aimed to examine the effectiveness of the INRS treatment in children with bilateral CP.MethodsIn this quasi-randomized controlled study, 48 children with spastic bilateral CP (age 5–12 years, GMFCS Levels I-IV, MACS Levels I-IV) were assigned to an experimental or control group in order they have been enrolled. The experimental group underwent INRS treatment in the tertiary care facility for about four hours daily for ten days and continued routine home treatment for four weeks. After the first evaluation, participants from the control group stayed on the waiting list for four weeks receiving home treatment and then starting the INRS treatment. Thereby, all participants were assessed three times. The primary outcome measure was a Gross Motor Function Measure 66 Item Set (GMFM). The secondary outcome measures included the Jebsen-Taylor Hand Function test, Box and Blocks test, ABILHAND-Kids Questionnaire, Self-care and Mobility domain of the Pediatric Evaluation of Disability Inventory, and the ankle dorsiflexion passive range of motion.ResultsThere was a statistically significant increase in the GMFM score after the INRS treatment in both the experimental group (mean difference (MD) 2.0, P < 0.01) and control group (MD 1.5, P < 0.05), with a large size effect (partial eta squared (η2) = 0.21 and η2 = 0.14). The mean difference between groups during the first study period was 2.89 points (p < 0.01) in the GMFM score with a medium effect size (η2 = 0.12). Statistically significant superiority of the INRS treatment over home treatment was also obtained by Jebsen-Taylor Hand Function Test and the Box and Blocks Test in both dominant and non-dominant hands.ConclusionsThe study indicates that the INRS treatment can be beneficial for improving both gross motor functions and hand function in children with bilateral CP. Further longitudinal studies are required to evaluate the effects of the INRS treatment on the participation level of children with CP.Trial registrationThe study protocol was registered on ClinicalTrials.gov under the identifier: NCT04093180 on 17/09/2019.

Effect of Photobiomodulation Combined with Physiotherapy on Functional Performance in Children with Myelomeningo-Cele-Randomized, Blind, Clinical Trial.

This study aimed to evaluate the electrical activity of the rectus femoris, tibialis anterior, and lateral gastrocnemius muscles during the sit-to-stand task and functional mobility after a neurofunctional physiotherapy protocol associated with PBM. Twenty-five children were randomly allocated to either Active PBM + physiotherapy (n = 13) or PBM sham + physiotherapy (n = 12). PBM was carried out with a LED device (850 nm, 25 J, 50 s per point and 200 mW) at four points over the area with absence of a spiny process. Both groups completed a twelve-week supervised program with two weekly 45-60 min sessions. Pre-training and post-training assessments involved the Pediatric Evaluation of Disability Inventory (PEDI). Muscle activity was assessed using portable electromyography (BTS Engineering) and the electrodes were positioned on the lateral gastrocnemius, anterior tibialis, and rectus femoris muscles. The RMS data were recorded and analyzed. After 24 sessions of the treatment protocol, improvements were found in the PEDI score. The participants presented greater independence in performing the tasks, requiring less assistance from their caregivers. More significant electrical activity was found in the three muscles evaluated between the rest period and execution of the sit-to-stand tasks, both in the more compromised or less compromised lower limbs. Neurofunctional physiotherapy with or without PBM improved functional mobility and electrical muscle activity in children with myelomeningocele.

Comparing Predictive Effects of Sensory Processing and Executive Functions on Self-care Activities in Pre-school Children with Autism Spectrum Disorder

Background: Children with autism spectrum disorder (ASD) face some challenges with performing self-care. Many performance components, including sensory and cognitive functions, are effective in performing self-care. Objectives: This study aimed to compare the role of sensory processing and executive functions in performing self-care among preschool children with ASD. Methods: In this cross-sectional study, 70 children with ASD aged 3-6 years were selected and investigated by adopting convenience sampling. The instruments included the Short Sensory Profile-2 (SSP-2), Behavior Rating Inventory of Executive Function (BRIEF), and Pediatric Evaluation of Disability Inventory (PEDI). The data were analyzed using Pearson correlation and linear regression tests. Results: The results of the correlation revealed that executive functions (P≤0.01) and sensory processing (P ≤ 0.005) had a small yet significant inverse relationship with performing self-care activities. The results of stepwise linear regression showed that executive functions and sensory processing were equally capable of predicting self-care activities. Conclusions: It was recommended that therapists should pay enough attention to both executive functions and sensory processing in order to solve the self-care problems of preschool children with ASD. Due to the low correlation between variables, it was also suggested that a multifactorial approach to self-care activities should be employed as well as the role of other factors along with sensory processing and executive function should be considered.

Preparing “the Activities of Daily Living Inventory for Children with Disabilities” (ADLIC-D) and Investigating Its Psychometric Properties in Children with Autism Spectrum Disorder, Intellectual Disability and Cerebral Palsy

Background: The difficulties to perform self-care or basic activities of daily life are among the concerns of families, and rehabilitation professionals. In this issue, culturally adapted assessment tools help in the accurate assessment and treatment planning in rehabilitation. Objectives: The present study aimed to survey the validity, and reliability of Activities of Daily Living Inventory for Children with Disabilities (ADLIC-D) in preschool children with autism spectrum disorder (ASD), cerebral palsy (CP), intellectual disability (ID), and typical children. Methods: The face validity examined by 60 parents of children with disabilities. Content validity studied by 10 occupational therapists. The sample included 205 (70 normal, 45 ASD, 45 CP, and 45 ID) children aged 3 - 6 years whose parents completed ADLIC-D. Face and content validity, convergent validity with the Pediatric Evaluation of Disability Inventory (PEDI), discriminant validity, test-retest reliability, and the internal consistency of instrument were examined. Result: Intra-class correlations coefficient for test-retest reliability was excellent (above 0.9). Cronbach's alpha for all items was excellent (0.977). The ADLIC-D had convergent validity with the PEDI (r = 0.95). The discriminant validity demonstrated that the measure distinguishes between normal and disabled groups. In addition, the number of final items on the new scale grew from 73 in the original to 76. Conclusions: ADLIC-D had validity, and reliability for children with ASD, CP, and ID. It measured the desired construct, i.e., the activities of daily living in children with the disabilities and differentiated between normal groups, and groups with disabilities.

FOOD ACCESS AND MENTAL HEALTH IN PEDIATRIC INFLAMMATORY BOWEL DISEASE

It has been estimated that about 25% of patients with inflammatory bowel disease (IBD) are diagnosed before the age of 18. Food insecurity, limited or lack of access to enough food, has been associated with poor outcomes in childhood health including mental health problems. United States Department of Agriculture (USDA) defines a food desert as a census tract that meets criteria for low access to a grocery store and low income. Depression and anxiety have been well documented in pediatric patients with IBD. Functional Disability Inventory (FDI) is a measure of limitations in both physical and psychosocial functioning secondary to physical health. Our hypothesis is that patients in low access areas to healthy food will have more evidence of depression, anxiety and higher disability scores.

FUNCTIONAL DISABILITY INVENTORY AND ASSOCIATIONS WITH RACE, ETHNICITY, INCOME AND FOOD INSECURITY

Inflammatory bowel disease (IBD) is an autoimmune disease that consists of Crohn’s Disease (CD) and ulcerative colitis (UC). Food insecurity is defined as limited or uncertain access to enough food. It is estimated that 1 in 7 children in the United States experience food insecurity or about 13 million children. Louisiana has one of the higher rates of food insecurity in the country with over 249,000 children affected. Food insecurity has been associated with worse health outcomes in children including developmental risks, poor mental health, and poor educational outcomes. Functional Disability Inventory (FDI) is a measure of limitations in both physical and psychosocial functioning secondary to physical health. Our hypothesis is that patients in food insecure homes will have higher FDI scores compared to those in food secure homes.

Association of activities of daily living and cognitive function with thickness of the upper extremity muscles in children and adults with cerebral palsy

We examined the association of activities of daily living (ADL) and cognitive function with the upper extremity muscle thickness and upper extremity range of motion (ROM) and spasticity in children and adults with cerebral palsy (CP). The subjects were 20 children and adults with CP. The ADL performed using the upper extremities and cognitive function were assessed using the self-care domain of the Pediatric Evaluation of Disability Inventory (PEDI) and the full-scale intelligence quotient (FSIQ) of the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV), respectively. The WISC-IV was assessed in only seven of 20 subjects able to undergo evaluation. The thickness of the upper extremity muscles was measured using an ultrasound imaging device. Moreover, ROM and spasticity of the upper extremities were assessed using the Modified Ashworth Scale (MAS). Manual manipulation ability was also assessed using the Manual Ability Classification System (MACS). Stepwise regression analysis revealed that the extensor digitorum muscle thickness and MACS level were significant and independent factors of self-care in the PEDI. Partial correlation analysis with MACS level and age as control variables showed that the FSIQ of the WISC-IV was significantly associated with the thickness of the anterior fibers of the deltoid and flexor digitorum superficialis muscles. Reduced ADL performed using the upper extremities is associated with decreased extensor digitorum muscle thickness rather than ROM and spasticity of the upper extremities in children and adults with CP.

Changes in Brain GABA and Glutamate and Improvements in Physical Functioning Following Intensive Pain Rehabilitation in Youth With Chronic Pain

Intensive interdisciplinary pain treatments (IIPT) have been developed to treat youth with unmanaged chronic pain and functional disability. Dysregulation of metabolites gamma-aminobutyric acid (GABA) and glutamate are thought to play a role in the chronification of pain due to imbalances in inhibition and excitation in adults. Using magnetic resonance spectroscopy (MRS), we investigated the effect of IIPT on GABA and Glx (glutamate + glutamine) in 2 pain-related brain regions: the left posterior insula (LPI) and the anterior cingulate cortex (ACC). Data were collected in 23 youth (mean age = 16.09 ± 1.40, 19 female) at entry and discharge from a hospital-based outpatient IIPT. GABA and Glx were measured using GABA-edited MEGA-PRESS and analyzed using Gannet. Physical measures including a 6-minute walk test were recorded, and patients completed the PLAYSelf Physical Literacy Questionnaire, PROMIS Pain Interference Questionnaire, and Functional Disability Inventory. LPI GABA (P < .05) significantly decreased, but not ACC GABA (P > .05), following IIPT. There were no significant Glx changes (P > .05). The decrease in LPI GABA was associated with increased distance in the 6-minute walk test (P < .001). IIPT may decrease GABAergic inhibitory tone within the LPI, thereby promoting plasticity and contributing to improvements in physical outcomes with IIPT. PerspectiveRegional GABA changes are associated with a reduction in pain interference and improvement in physical function in youth following intensive pain rehabilitation. GABA may serve as a possible biomarker for IIPT; and may also further aid in the development of IIPT, and other treatments for chronic pain in youth.