Pediatric Inpatient Rehabilitation Research Articles

The feasibility and acceptability of integrating dogs into inpatient rehabilitation therapy with children with acquired brain injury.

Children with acquired brain injury (ABI) are at risk for poor therapeutic engagement due to cognitive impairment, affect lability, pain, and fatigue. Animal-assisted therapy (AAT) has the potential to improve patient engagement in rehabilitation therapies; however, the feasibility of integrating AAT into the rigorous therapy schedule of inpatient clinical care or its reception by patients, families, and staff is unknown. To examine the feasibility and acceptability of incorporating dogs into physical therapy and occupational therapy sessions with pediatric patients being treated on an inpatient rehabilitation unit for acquired brain injury. A feasibility study of AAT within the context of a within-subjects crossover study. Pediatric inpatient rehabilitation unit. Sixteen patients, aged 7-28 years (mean = 13.6 years, standard deviation [SD] = 5.2 years; 50% male), being treated on the inpatient rehabilitation unit following ABI. AAT - the integration of dogs into inpatient physical therapy and occupational therapy sessions. Feasibility measures: enrollment rate, the proportion of AAT sessions a dog attended, adverse events, instances where therapist or handler ended session early, patient animal closeness, and utilization of dog in session. Satisfaction measures: parent satisfaction questionnaires and therapist feedback. Feasibility was supported by high enrollment rate (88.9%) and dog attendance rate of 93%-95%; 84.3% of sessions used the dog in multiple ways and patients reported a high level of closeness with the dog in session, indicating that the dogs were integrated in meaningful ways. No adverse events were noted, therapists reported that intervention was convenient, and clinical care was not negatively impacted. A high level of satisfaction was reported by families and therapists. Findings suggest that AAT is feasible and acceptable, and it may be a valuable tool for therapists working with patients with ABI on an inpatient rehabilitation unit.

Preliminary assessment of a standardized vision screening guideline in a pediatric inpatient rehabilitation unit

Preliminary assessment of a standardized vision screening guideline in a pediatric inpatient rehabilitation unit

Long-Term Outcomes of Pediatric Traumatic Brain Injury Following Inpatient Rehabilitation.

Assess residual disability in youth with traumatic brain injury (TBI) treated in a pediatric inpatient rehabilitation unit and examine associations of disability with inpatient status and measures of concurrent functioning. Large, urban, quaternary care children's hospital in the Midwestern United States. Forty-five youth aged 6 to 18 years treated in an inpatient rehabilitation unit for mild-complicated to severe TBI at a minimum of 12 months postdischarge (mean = 3.5 years). Retrospective chart review of clinical data collected from standard clinical care at admission and discharge combined with follow-up data examining current functioning at the time of study enrollment. Glasgow Outcome Scale-Extended, Pediatric Revision (GOS-E Peds), Neurology Quality of Life Measurement System Short Form (NeuroQOL) Social Interaction with Peers and Cognitive Short Forms, Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale, Strengths and Difficulties Questionnaire, and the Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2). Based on parent report at follow-up, 62% of the children had residual TBI-related disabilities on the GOS-E Peds, while 38% reported "good recovery." Children with residual disability also reported more long-term problems in overall health, social relationships, emotional regulation, behaviors, and executive functioning than those with no residual disability. Measures of functional independence and cognitive recovery at discharge were associated with these impairments. More than half of the children with TBI in this study had residual disability more than 1 year after inpatient rehabilitation. Findings highlight the associations between measures of functional independence and cognitive recovery during inpatient rehabilitation with later outcomes and underscore the need for continued services to support the needs of children with TBI following their inpatient rehabilitation stay.

Preliminary assessment of a standardized vision screening guideline in a pediatric inpatient rehabilitation unit.

This study aimed to evaluate the impact of a standardized vision screen guideline on occupational therapy vision screens in a pediatric inpatient rehabilitation unit. Charts of patients admitted to a pediatric inpatient rehabilitation before guideline implementation (n = 47) versus charts after implementation (n = 47) were randomly, retrospectively reviewed to explore differences in visual skills screened and use of standardized assessments. Significant improvements (p <  = 0.05) were found in the number of visual skills screened (p = 0.034), use of standardized assessments (p = 0.005), and screening of the specific visual skills of accommodative amplitude (p = 0.05), suppression (p = 0.015), and double vision (p <  0.001). Implementation of a standardized vision screen guideline improved the frequency of vision screens during occupational therapy evaluations in a pediatric inpatient rehabilitation unit. The use of standardized assessments may also improve the quality of vision screens by encouraging staff to complete more comprehensive vision screens, including screening more visual skills, and by prompting use of standardized assessments, which can improve accuracy of screening procedures.

The Use of Methylphenidate During Inpatient Rehabilitation After Pediatric Traumatic Brain Injury: Population Characteristics and Prescribing Patterns.

To understand how methylphenidate (MPH) is used in youth with traumatic brain injury (TBI) during inpatient pediatric rehabilitation. Inpatient pediatric rehabilitation. In total, 234 children with TBI; 62 of whom received MPH and 172 who did not. Patients were on average 11.6 years of age (range, 2 months to 21 years); 88 of 234 were female; the most common mechanism of injury was motor vehicle collision (49%); median (IQR) acute hospital length of stay (LOS) and inpatient rehabilitation LOS were 16 (10-29) and 23 (14-39), respectively; 51 of 234 were in a disorder of consciousness cognitive state at time of inpatient rehabilitation admission. Multicenter, retrospective medical record review. Patient demographic data, time to inpatient pediatric rehabilitation admission (TTA), cognitive state, MPH dosing (mg/kg/day). Patients who received MPH were older (P = .011); TTA was significantly longer in patients who received MPH than those who did not (P =.002). The lowest recorded dose range by weight was 0.05 to 0.89 mg/kg/d, representing an 18-fold difference; the weight-based range for the maximum dose was 0.11 to 0.97 mg/kg/d, a 9-fold difference. Patients in lower cognitive states at admission (P = .001) and at discharge (P = .030) were more likely to receive MPH. Five patients had side effects known to be associated with MPH; no serious adverse events were reported. This multicenter study indicates that there is variable use of MPH during acute inpatient rehabilitation for children with TBI. Children who receive MPH tend to be older with lower cognitive states. Dosing practices are likely consistent with underdosing. Clinical indications for MPH use during inpatient pediatric rehabilitation should be better defined. The use of MPH, as well as its combination with other medications and treatments, during inpatient rehabilitation needs to be further explored.

Parent psychosocial adjustment to inpatient pediatric rehabilitation, and the role of uncertainty and self-care.

The stressors experienced by parents of children admitted for inpatient rehabilitation likely place parents at high risk for poor psychosocial adjustment; however, no research to date has described parent adjustment during the acute phase of a child's inpatient rehabilitation hospitalization. The present study evaluates parent adjustment processes through the lens of the transactional stress and coping model by assessing a specific cognitive process (i.e., illness uncertainty) and coping methods (i.e., self-care), which may influence parent adjustment during the inpatient rehabilitation. Forty-two parents (47.6% White, 86% female) of children newly admitted to a pediatric inpatient rehabilitation hospital were recruited. Parents completed self-report measures of demographics, illness uncertainty, self-care, and depressive, anxious, and posttraumatic stress symptoms. Sixty-six percent of parents reported clinically significant symptoms in at least one domain of distress. Illness uncertainty accounted for 22.2%-42.4% of the variance in parent distress symptoms, after controlling for parent and child age, parent trauma history, and income. Self-care accounted for 35.1%-51.9% of the variance in parent distress symptoms, when accounting for parent and child age, parent trauma history, and income. More than half of parents endorsed clinical elevations in anxiety, depression, and/or posttraumatic stress. Illness uncertainty and self-care are likely very important clinical topics to discuss with parents. Future research should seek to not only assess how parent distress changes across time, but also how other cognitive processes, as well as environmental and family factors influence the parent adjustment process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Parent Psychosocial Adjustment to Inpatient Pediatric Rehabilitation, and the Role of Uncertainty and Self-Care

Supplemental Material for Parent Psychosocial Adjustment to Inpatient Pediatric Rehabilitation, and the Role of Uncertainty and Self-Care

Screening for Delirium during Pediatric Inpatient Rehabilitation

<h3>Research Objectives</h3> Delirium, an acute and fluctuating change in awareness and cognition, is a frequent and serious complication of severe pediatric illness yet is difficult to assess after acquired brain injury (ABI). Our primary objective was to implement delirium screening using the Cornell Assessment of Pediatric Delirium (CAPD) and describe the rate of positive delirium screens. Our secondary objective was to explore longitudinal trends in CAPD scores in children with ABI, to discriminate between static encephalopathy and gradual improvement. <h3>Design</h3> Prospective cohort study. <h3>Setting</h3> Pediatric inpatient rehabilitation unit. <h3>Participants</h3> Consecutive children with ABI admitted over 3 years. <h3>Interventions</h3> Children were screened for delirium twice daily with the CAPD throughout their rehabilitation hospitalization. A positive screen was not considered diagnostic for delirium, as longitudinal assessment was required to establish fluctuation and acuity versus static encephalopathy due to ABI. <h3>Main Outcome Measures</h3> Percentage of positive delirium screens and individual patient-level CAPD patterns. <h3>Results</h3> There were 14,280 CAPD administrations across 143 children with ABI (Mean Age = 10.86, SD = 4.72, Range = 1.3 - 19.9, Female = 64). The prevalence of positive screens was 27% (n = 3,861) and 60.8% (n = 87) of the children had at least one positive screen. Two raters independently identified four primary patterns for all children in this cohort: i. no delirium (n = 71, 49.7%), ii. improving (n = 45, 31.5%), iii. static encephalopathy (n = 18, 12.6%) and iv. episodic delirium (n = 9, 6.3%). <h3>Conclusions</h3> Delirium occurs frequently in children with ABI during inpatient rehabilitation. Routine delirium screening facilitates early detection and intervention that may maximize functional outcomes. Longitudinal screening allows for differentiation of children with varying patterns of recovery. Future research can use group-based trajectory modeling to identify distinct patterns that may predict outcomes. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.

Gross motor change after inpatient rehabilitation for children with acquired brain injury: A 10-year retrospective review.

To estimate gross motor change in inpatient school-aged children with subacute acquired brain injury (ABI), identify factors associated with gross motor change, and describe inpatient physiotherapy focus. This retrospective chart review involved inpatient children (5-18 years) with subacute ABI who had either two Gross Motor Function Measure (GMFM-88) assessments or one GMFM-88 with another pre/post gross motor outcome measure. Outcome change scores and Goal Attainment Scaling (GAS) T scores were calculated. Regression analyses examined factors predicting gross motor change. GAS goal areas were analysed to determine physiotherapy focus. Of the 546 charts screened, 266 (118 female) met study criteria. The GMFM-88 was generally administered first, followed by other measures. GMFM-88 (n=202), Community Balance and Mobility Scale (n=89), and Six-Minute Walk Test (6MWT) (n=98) mean change scores were 18.03% (SD 19.34), 17.85% (SD 10.77), and 142.3 m (SD 101.8) respectively. The mean GAS T score was 55.06 (SD 11.50). Lower baseline scores and increased time between assessments were most predictive of greater GMFM-88 change (r ≥ 0.40). Twenty-five percent of GAS goals were ambulation-based. Appropriate outcome measure selection is integral to detecting gross motor change in pediatric inpatient ABI rehabilitation. Mean change score estimates can be used to compare standard inpatient rehabilitation with new treatment approaches.

Clinician perspectives on the implementation of inpatient cycling-based exergames for children with cerebral palsy: A qualitative study

ABSTRACT Objective To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation. Methods Sixteen clinicians (nurses, physiotherapists, recreational therapists) that participated in a study exploring the feasibility of implementing cycling-based exergames for inpatient children with CP were interviewed. Clinicians’ responses were coded using the Theoretical Domains Framework (TDF). Beliefs were generated from each response and relevant domains were identified. Results Ten domains from the TDF were identified as relevant. Key enablers to clinician participation in future implementation included revision of clinician roles and responsibilities, the belief that children with CP will benefit from exergames, and the belief in potential applicability to other pediatric populations. Barriers included clinician limited time and exergame responsibilities not aligning with perceived clinician roles. Conclusions This study identifies key barriers and enablers that future inpatient pediatric rehabilitation settings should consider when incorporating exergames into rehabilitation practice.

Impact of Occupational Therapy on Self-Care After Selective Dorsal Rhizotomy Among Children With Cerebral Palsy.

Selective dorsal rhizotomy (SDR) is an established treatment for spastic cerebral palsy (CP). The effects and predictors of occupational therapy's benefit for self-care after SDR in children with CP have not been thoroughly investigated. To identify changes in self-care after occupational therapy post-SDR and determine whether changes were affected by age, Gross Motor Function Classification System (GMFCS) level, and number of occupational therapy dressing sessions. In this retrospective cohort study, we collected outcomes pre-SDR, at discharge, and at 1-yr follow-up. Paired t tests and regression analysis were performed. Commission on Accreditation of Rehabilitation Facilities-accredited pediatric inpatient rehabilitation facility. Seventy-three children (GMFCS Levels I-III, ages 4-17 yr) diagnosed with spastic CP who underwent SDR from 2014 to 2018. After having SDR, each child received an average of twice daily occupational therapy for an average of 37.3 days. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) and Functional Independence Measure for Children® (WeeFIM) were used to assess self-care performance. The mean WeeFIM dressing (upper and lower body) and mean PEDI-CAT daily activities scores from baseline to discharge and mean WeeFIM lower body dressing at 1-yr follow-up improved significantly. The improvement in lower body dressing correlated with GMFCS level and the number of occupational therapy dressing sessions. The improvement in upper and lower extremity dressing and PEDI-CAT daily activities scores suggests that inpatient occupational therapy post-SDR may provide benefits. What This Article Adds: Children diagnosed with CP may undergo surgical interventions to improve their ability to walk. This article demonstrates the benefit of occupational therapy services after SDR to improve upper and lower body dressing skills.

A survey of inpatient pediatric rehabilitation practices across the United States1.

Objectives included identifying programs that provide pediatric inpatient rehabilitation services (IPRs) across the United States (US), describing differences in location, admission criteria, available resources, personnel and staffing, and populations served between pediatric rehabilitation programs with the overall goal to evaluate rehabilitation needs in geographical areas with limited access for targeted program development. Online survey emailed to pediatric physiatrists who worked or directed IPRs and completed between December 2018 to March 2019. Fifty respondents completed the survey of the seventy-one distributed. Fifty percent of pediatric inpatient rehabilitation services are within a free-standing pediatric hospital with an average of 14 beds. Twenty-eight programs provide acute services with almost half providing accredited specialized programming. All respondents reported that inpatient rehabilitation treatment teams included pediatric physiatry, nursing, social work, and core therapy disciplines. Although characteristics of pediatric inpatient rehabilitation services vary, similarities exist with respect to team composition, clinical coverage, admission or documentation criteria, and outcome measures. The geographic distribution of pediatric IPRs including available specialty programming reveals resource-limited areas. Results from this study emphasize how practice standards or fiscal limitations impact program structure, resources, and ultimately short- and long-term healthcare outcomes among the population of pediatric rehabilitation patients.

Large Improvements in Health-Related Quality of Life and Physical Fitness during Multidisciplinary Inpatient Rehabilitation for Pediatric Cancer Survivors.

Simple SummaryAfter cancer treatment, children often suffer from various health problems. Rehabilitation can improve their quality of life. We present data for 236 children and 478 parents who filled out questionnaires before and after inpatient rehabilitation. In our sample, both children and parents reported that the quality of life of the children had substantially improved during rehabilitation, especially their physical and psychosocial quality of life. Children also improved in physical exercises and their functional status. Parents and children showed better agreement regarding the child’s health status after rehabilitation than before. A specific method of statistical analysis (performance score) helped to reduce disagreement between parents and children. We therefore conclude that inpatient rehabilitation is effective for children after cancer treatment and that the performance score should be used in research on rehabilitation for children after cancer treatment to have the most accurate results.Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5–21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09–0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children’s PROs and parents’ proxy ratings was lower before (rICC = 0.72) than after (rICC = 0.86) rehabilitation. While the concordance between children and parents’ assessment of changes during rehab was low to moderate (r = 0.19–0.59), the use of the performance score led to substantially increased scores (r = 0.29–0.68). The results of this naturalistic observational study thus highlight the benefits of multidisciplinary pediatric inpatient rehabilitation for childhood cancer survivors. The use of the performance score is recommended in this field.

A survey of pediatric neuropsychologists serving inpatient rehabilitation, Part II: billing, time allocation and tracking, and professional identity and perceptions

ABSTRACT Professional challenges have been documented in broad surveys of neuropsychologists. While previous surveyors have included pediatric neuropsychologists, few, if any, have specifically examined practices among those who primarily work in pediatric inpatient rehabilitation settings. Therefore, the aim of this study was to survey neuropsychologists in this setting. Thirty neuropsychologists from the U.S. and one from Canada that work in inpatient pediatric rehabilitation participated in an online survey. Most respondents (83.3%) billed for their inpatient time. Sixty-four percent indicated that payor type (private vs. public) affected services a moderate amount to a lot; this was primarily due to payor’s influence on length of stay. Most providers had productivity expectations (66.7%). Among those that had productivity expectations, three-quarters used “hours billed;” 37.5% were solely or additionally tracked by relative value units (RVUs). The majority of respondents conducted some type of clinical data collection, usually for research purposes. With respect to professional identity, most respondents indicated positivity about their role. The top challenges endorsed were related to workload/ability to meet the patients’ needs and billing/productivity. Issues related to billing and payor may influence aspects of pediatric inpatient rehabilitation neuropsychological care. Managing challenges related to billing and the time demands associated with providing inpatient services were top concerns for many respondents. Most sites surveyed were involved in data collection, usually for research purposes; increased data collection efforts are needed to aid with program development and evaluation and to demonstrate the added value of neuropsychological services from a patient care perspective.

Determining school reintegration needs of acquired brain injury patient through the use of a novel school simulation rubric.

Determining when a child returns to school after an acquired brain injury is difficult to assess. Many factors affect a successful hospital-to-school reintegration. The hospital school simulation allowed the Acute Pediatric Inpatient Rehabilitation Unit (IRU) interdisciplinary team to assess how the patient was functioning at specific stages of the patient healing process to target goals that explicitly helped the patient safely reintegrate into school. A patient with an acquired brain injury (ABI) participated in a hospital school simulation where a novel school simulation rubric (SSR) tool was used to evaluate completion of specific activities the patient would experience in a traditional classroom. Results were shared with the IRU team so accommodations and modifications could be made to the IRU school recommendations letter based on the results of the final SSR. Preliminary results were found to benefit the patient as they reintegrated back to school. This study highlights the need for ongoing communication between hospital providers and educational personnel to provide patients with academic supports for school reintegration.

Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment.

To examine predictive utility of the Glasgow Coma Scale (GCS), time to follow commands (TFC), length of posttraumatic amnesia (PTA), duration of impaired consciousness (TFC+PTA), and the Cognitive and Linguistic Scale (CALS) scores in predicting outcomes on the Glasgow Outcome Scale-Extended, Pediatric Revision (GOS-E Peds) for children with traumatic brain injury (TBI) at 2 months and 1 year after discharge from rehabilitation. A large, urban pediatric medical center and inpatient rehabilitation program. Sixty youth with moderate-to-severe TBI (mean age at injury = 13.7 years; range = 5-20). A retrospective chart review. Lowest postresuscitation GCS, TFC, PTA, TFC+PTA, inpatient rehabilitation admission and discharge CALS scores, GOS-E Peds at 2-month and 1-year follow-ups. CALS scores were significantly correlated with the GOS-E Peds at both time points (weak-to-moderate correlation for admission scores and moderate correlation for discharge scores). TFC and TFC+PTA were correlated with GOS-E Peds scores at a 2-month follow-up and TFC remained a predictor at a 1-year follow-up. The GCS and PTA were not correlated with the GOS-E Peds. In the stepwise linear regression model, only the CALS at discharge was a significant predictor of the GOS-E Peds at the 2-month and 1-year follow-ups. In our correlational analysis, better performance on the CALS was associated with less long-term disability, and longer TFC was associated with more long-term disability, as measured by the GOS-E Peds. In this sample, the CALS at discharge was the only retained significant predictor of GOS-E Peds scores at 2-month and 1-year follow-ups, accounting for roughly 25% of the variance in GOS-E scores. As previous research suggests, variables related to rate of recovery may be better predictors of outcome than variables related to severity of injury at a single time point (eg, GCS). Future multisite studies are needed to increase sample size and standardize data collection methods for clinical and research purposes.

The Stoplight Mobility Alert System for Safety and Prevention of Falls in Children With Physical and Cognitive Impairments.

This study aimed to decrease the rate of falls in children with cognitive and physical impairments on a pediatric acute inpatient rehabilitation unit (IRU) using a novel tool, the Stoplight Mobility Alert System (SMAS). We conducted a pilot, prospective, quality improvement study in an 8-bed (increased to 12 beds; October 1, 2019) acute inpatient pediatric IRU at a level 1 trauma center. All patients admitted between October 1, 2012, and October 1, 2020, were included as participants. Interventions used were as follows: (1) SMAS, a colored alert system placed on door slides and in-room for visual cues (red, assistance/hands on; yellow, supervision/eyes on; green, independent/hands off), and (2) handouts and one-on-one education for staff and patients/families. Main outcome measures included fall rate on the IRU. Using the SMAS, the total fall rate decreased from 10.78 to 4.36 falls per 1000 patient-days. Longitudinally, the intrinsic fall rate decreased from 8.36 to 5.60 falls per 1000 patient-days, and the extrinsic fall rate decreased from 4.56 to 1.36 falls per 1000 patient-days. The implementation of the SMAS is effective in decreasing total, intrinsic, and extrinsic fall rates in an acute pediatric inpatient rehabilitation program both acutely and longitudinally.

Factors associated with Multidisciplinary Healthcare Resource Utilization Following Discharge from Pediatric Rehabilitation: A One-year Follow-up Study

Aims To characterize multidisciplinary healthcare resource utilization (mHRU), including physical, occupational, speech and psychosocial therapy one-year following discharge from prolonged inpatient and outpatient pediatric rehabilitation in Israel and to identify factors associated with long-term mHRU. Methods According to Andersen’s model of health service use, predisposing (child's age and sex), enabling (district of origin, income level, parental education, insurance) and need factors (injury type, functional status, family psychosocial risk) were collected from parents of children hospitalized for >1 month in a large rehabilitation hospital in Israel, and phone interviews were held 3-months (T1), 6-months (T2) and 12-months (T3) post-discharge. The effect of time and the role of various factors on mHRU, operationalized as number of therapy sessions in the previous 2 weeks, were evaluated. Results Sixty-one families participated at T1 and T2, and 46 participated at T3. HRU was similar over time. Predisposing factors (age) and need factors (functional status and psychosocial risk) were associated with specific disciplines of mHRU, but enabling factors were not. Conclusions mHRU is high and stable 12-months post-discharge. The lack of impact of enabling factors on mHRU, and the discipline-specific impact of predisposing and need factors, support equity of care provision for children following prolonged rehabilitation.

Trends and Disparities in Inpatient Rehabilitation of Adolescents: The Effect of Demographics, Injury Characteristics, and Facility Type.

Intensive rehabilitation of adolescents occurs in general and pediatric inpatient rehabilitation facilities (IRFs), but differences in admission and outcomes by facility type have not been thoroughly investigated, particularly among persons with spinal cord injury (SCI). To investigate factors related to admission to pediatric or adult IRFs among adolescents and compare the rehabilitation outcomes between facility types. Using a single-center retrospective cohort study design, demographic information, medical data, and rehabilitation outcomes were obtained by chart review of patients aged 15 to 18 years who received a rehabilitation medicine consultation at an urban level 1 trauma center between 2017 and 2019 (N = 96). Analysis was performed using R statistical software. SCI was the second most common diagnosis (21% of patients) and accounted for 36% of inpatient rehabilitation admissions. SCI patients were more likely to undergo rehabilitation at the level 1 trauma versus pediatric facility (relative risk [RR] = 2.43; 95% confidence interval [CI] = 1.08-5.44) compared to traumatic brain injury patients. Admission to trauma versus pediatric IRF was also associated with Black compared to White race (RR = 2.5; CI = 1.12-5.56), violence compared to other etiologies of injury (RR = 2.0; CI = 1.10-3.77), and Medicaid compared to private insurance (RR = 2.15; CI = 1.01-4.59). Admission to pediatric IRF was associated with longer length of stay than admission to adult IRF when adjusted for diagnosis (30.86 ± 21.82 vs. 24.33 ± 18.17 days; p = .046), but Functional Independence Measures did not differ. Adolescents with SCI and those experiencing systemic disadvantages, including racism and poverty, were more likely to be admitted to trauma compared to pediatric IRF.

Clinical and training practices: A survey of pediatric neuropsychologists serving inpatient rehabilitation

ABSTRACT Neuropsychologists in inpatient pediatric rehabilitation settings collaborate with an interdisciplinary team to educate, evaluate, and provide intervention to patients with acquired brain injury and their families, but there are no known studies that describe or define these clinical services. Thirty-one neuropsychologists in pediatric inpatient rehabilitation settings completed an online survey. Neuropsychologists (68.2% female; 86.4% with PhD versus PsyD) from the U.S. and Canada, who represented 22 pediatric inpatient rehabilitation sites comprised the final sample. Most sites (63.6%) were embedded within medical centers, with providers dedicating 2 to 32 hours (M = 14.25, SD = 9.26) weekly to onsite inpatient rehabilitation efforts. Providers most often saw patients with traumatic brain injury and other acquired brain injuries, including stroke and brain tumor. Trainees from various levels, most commonly post-doctoral fellows, provided clinical services on inpatient units, many with some degree of independence. Clinical practices that were standard across all or most sites included targeted discharge evaluations, serial cognitive monitoring, neuropsychology consultation to rehabilitation and non-rehabilitation units, and follow-up clinics. Provision of services was influenced by multiple factors including patient diagnosis, timing of return to school, inpatient census, and payor’s effect on length of stay. Findings highlight many programmatic consistencies across sites and serve as an important initial step to guiding pediatric neuropsychology providers seeking to understand the current landscape of clinical care. Future efforts are needed to establish a true clinical guideline for practice. Although preliminary, data also support establishment of neuropsychology training programs, justify administrative resources, and serve to educate recipients of neuropsychology services.