Pediatric Neurorehabilitation Research Articles

Defining paediatric neurorehabilitation: You cannot improve what you cannot characterize.

Neurorehabilitation is the primary therapy for neurological impairment in children, yet its potential to achieve change remains incompletely understood and probably underestimated. Understanding 'the difference neurorehabilitation can make' against a background of neurological repair and recovery as well as ongoing neurological development is an enormous challenge, exacerbated to no small extent by the lack of a 'common currency' for the description and measurement of the neurorehabilitation services a child is receiving. This review addresses attempts to parse neurorehabilitation treatment content in theoretically and mechanistically valid ways that might help address this challenge.

Current Status of Neurorehabilitation Services in the OIC Countries: Results of an International Online Survey

Objectives: Neurorehabilitation services are not widely available to most persons with disability (PWD) in the Organization of Islamic Cooperation countries. This study aimed to document status of neurorehabilitation services in OIC countries. Study Design and Setting: Cross-sectional online survey. Methods: Self-administered online survey conducted using Google Forms. Key resource persons for each OIC country working in field of neurorehabilitation were identified from various databases. The questionnaire was emailed to 20 identified resource persons. The response rate was 60% (12/20). Results: Neurorehabilitation services were available in 9 out of 12 surveyed countries. Only 2 countries reported providing access to neurorehabilitation services to 76-100% of their population. Five countries reported less than 25% of population had access to these services. Most commonly available neurorehabilitation services included services for stroke, spinal cord injury, pediatric neurorehabilitation, brain injury, and neuromuscular rehabilitation. Three countries had none of these specialized services. Five countries had neurorehabilitation training programs for physicians and other rehabilitation professionals. Patients had to pay out of pocket for these services in most of surveyed countries, followed by public funding and private insurance. Tele-neurorehabilitation and local disease-specific neurorehabilitation guidelines were not available in most of surveyed countries. Conclusion: Neurorehabilitation services in OIC region are not widely available, with significant variability in availability and quality. There is a need to develop and improve these services. Sharing knowledge and expertise through various forms, such as exchange visits and online sessions, can help improve neurorehabilitation services in these countries

Motor imagery for paediatric neurorehabilitation: how much do we know? Perspectives from a systematic review.

Motor Imagery (MI) is a cognitive process consisting in mental simulation of body movements without executing physical actions: its clinical use has been investigated prevalently in adults with neurological disorders. Review of the best-available evidence on the use and efficacy of MI interventions for neurorehabilitation purposes in common and rare childhood neurological disorders. systematic literature search conducted according to PRISMA by using the Scopus, PsycArticles, Cinahl, PUBMED, Web of Science (Clarivate), EMBASE, PsychINFO, and COCHRANE databases, with levels of evidence scored by OCEBM and PEDro Scales. Twenty-two original studies were retrieved and included for the analysis; MI was the unique or complementary rehabilitative treatment in 476 individuals (aged 5 to 18 years) with 10 different neurological conditions including, cerebral palsies, stroke, coordination disorders, intellectual disabilities, brain and/or spinal cord injuries, autism, pain syndromes, and hyperactivity. The sample size ranged from single case reports to cohorts and control groups. Treatment lasted 2 days to 6 months with 1 to 24 sessions. MI tasks were conventional, graded or ad-hoc. MI measurement tools included movement assessment batteries, mental chronometry tests, scales, and questionnaires, EEG, and EMG. Overall, the use of MI was stated as effective in 19/22, and uncertain in the remnant studies. MI could be a reliable supportive/add-on (home-based) rehabilitative tool for pediatric neurorehabilitation; its clinical use, in children, is highly dependent on the complexity of MI mechanisms, which are related to the underlying neurodevelopmental disorder.

Intelligent Robotics in Pediatric Cooperative Neurorehabilitation: A Review

The landscape of neurorehabilitation is undergoing a profound transformation with the integration of artificial intelligence (AI)-driven robotics. This review addresses the pressing need for advancements in pediatric neurorehabilitation and underscores the pivotal role of AI-driven robotics in addressing existing gaps. By leveraging AI technologies, robotic systems can transcend the limitations of preprogrammed guidelines and adapt to individual patient needs, thereby fostering patient-centric care. This review explores recent strides in social and diagnostic robotics, physical therapy, assistive robotics, smart interfaces, and cognitive training within the context of pediatric neurorehabilitation. Furthermore, it examines the impact of emerging AI techniques, including artificial emotional intelligence, interactive reinforcement learning, and natural language processing, on enhancing cooperative neurorehabilitation outcomes. Importantly, the review underscores the imperative of responsible AI deployment and emphasizes the significance of unbiased, explainable, and interpretable models in fostering adaptability and effectiveness in pediatric neurorehabilitation settings. In conclusion, this review provides a comprehensive overview of the evolving landscape of AI-driven robotics in pediatric neurorehabilitation and offers valuable insights for clinicians, researchers, and policymakers.

Parents’ experience of children with acquired brain injury undergoing neurorehabilitation: a systematic review

BackgroundThis systematic review aims to synthesise the qualitative evidence exploring parents’ experiences of children with acquired brain injury (ABI) undergoing neurorehabilitation during the first year post-injury.MethodsA systematic review of qualitative...

35 Preliminary reliability of the Coma Recovery Scale, Revised (CRS-R) in children with a history of disorders of consciousness after acquired brain injury

Objective:The Coma Recovery Scale-Revised (CRS-R) is the gold standard assessment of adults with disorders of consciousness (DoC); however few studies have examined the psychometric properties of the CRS-R in pediatric populations. This study aimed to demonstrate preliminary intra-rater and inter-rater reliability of the CRS-R in children with acquired brain injury (ABI).Participants and Methods:Participants included 3 individuals (ages 10, 15, and 17 years) previously admitted to an inpatient pediatric neurorehabilitation unit with DoC after ABI who were followed in an outpatient brain injury clinic due to ongoing severe disability. ABI etiology included traumatic brain injury (TBI; n=2) and encephalitis (n=1). Study participation took place on average 4.6 years after injury (range 2-9). The Glasgow Outcome Scale-Extended, Pediatric Version (GOS-E Peds), a measure of outcome after pediatric brain injury, was administered as part of screening. Two participants were placed in the GOS-E Peds “lower severe disability” category (i.e., score of 6) and one was placed in the “upper severe disability” category (i.e., score of 5). The CRS-R includes 6 subscales measuring responsivity including Auditory (range 0-4), Visual (range 05), Motor (range 0-6), Oromotor/Verbal (range 03), Communication (range 0-2), and Arousal (range 0-3) with higher scores indicating higherlevel function. Subscales are totaled for a CRS-R Total score. Behaviors shown during the CRS-R are used to determine state of DoC [Vegetative State (VS), Minimally Conscious State (MCS) or emergence from a minimally conscious state (eMCS)] based on 2002 Aspen Guidelines. Participants were administered the CRS-R three consecutive times on the same day. Administrations were completed by two raters in this order: Rater 1 (1A), Rater 1 (1B) and Rater 2. Intra-rater reliability was deemed by percent agreement across the 6 subscales between Rater 1A and 1B. Inter-rater reliability was deemed by percent agreement across the 6 subscales between 1A and 2.Results:Mean CRS-R Total score for Rater 1A was 22 (SD=1.73, range 20-23), Rater 1B was 22 (SD=1.73, range 20-23), and Rater 2 was 21.33 (SD=2.08, range 19-23). Intra-rater reliability was 100% and inter-rater reliability was 94% across all subscales. All participants were deemed eMCS at all 3 ratings.Conclusions:Data from this very small sample of children suggests that the CRS-R demonstrates both intra-rater and inter-rater reliability in patients with a history of DoC after ABI. Given that all children were at the high end of the scale (eMCS), further research is needed with a larger sample of children with a range of states of DoC.

31 Characterizing Sociodemographic Factors Associated with the Cognitive and Linguistic Scale (CALS) Among Pediatric Rehabilitation Patients Admitted for Traumatic Brain Injury

Objective:Extant literature suggests significant heterogeneity in recovery trajectories after experiencing a moderate to severe traumatic brain injury (TBI) during childhood (Moran et al., 2016). The Cognitive and Linguistic Scale (CALS) is a promising non-norm-referenced measure designed for serial monitoring within an inpatient rehabilitation setting that may optimize prediction of acute recovery and long-term neuropsychological functioning. To date, the CALS has primarily been examined in the context of injury characteristics such as severity and etiology (e.g., Slomine et al., 2016), and it is unclear what non-injury factors may be relevant to consider. Using archival data gathered from an inpatient pediatric neurorehabilitation program, this study examined associations between the CALS and select sociodemographic factors to better inform the clinical utility of the measure.Participants and Methods:Participants included 56 youth (46% BIPOC, 66% male) aged 2-17 years (M = 12.40, SD = 3.99) who were admitted for moderate to severe TBI to an inpatient rehabilitation program at a regional tertiary care children’s hospital. Data extracted from medical records included demographic information (i.e., age at injury, sex, ethnoracial identity, address, initial Glasgow Coma Scale (GCS) rating, CALS at admission, and full-scale IQ (FSIQ) at discharge. GCS was used as a proxy for injury severity. Residential addresses were geocoded and area-level median income was used as a proxy for familial socioeconomic status (SES). A multiple regression model was utilized to parse the individual contributions of demographic variables) on initial CALS performance while accounting for injury severity. Parallel regression models were used to determine whether patient characteristics moderate the association between initial CALS performance and cognitive functioning at discharge.Results:Preliminary analyses demonstrated that there were no significant associations between GCS and demographic variables, ps > .05. Patient age at injury was significantly associated with CALS total score at admission above and beyond injury severity and other demographic characteristics, t (31) = 2.55, p = .016, such that older age was associated with higher initial CALS scores. Results of moderator analyses between CALS and patient characteristics showed a significant main effect of injury severity, such that higher GCS was associated with higher FSIQ at discharge across models, ps < .05. No significant interactions were identified.Conclusions:These findings provide additional evidence for the generalizability of the CALS and further characterize its associations with non-injury factors, which is important for better understanding aspects that contribute to recovery trajectories and outcomes after moderate to severe TBI. Given the longstanding challenges in regard to the validity of neuropsychological assessment for diverse groups, it is critical to explicitly examine cultural context when considering the clinical utility of a measure. A limitation of the current study is the utilization of broad demographic information due to limited availability of sociocultural data. Future research should examine more granular and culturally-specific variables that may impact CALS performance (e.g., educational attainment, linguistic considerations), beyond using broad-based demographic data as a proxy for sociocultural factors. Another important next step is to utilize serial administrations of the CALS to examine the impact of sociocultural factors on recovery trajectories following TBI.

Efficacy of videogames and exergames in pediatric neurorehabilitation: a systematic review.

In recent years, the rehabilitation of children with neurological disorders has taken into account the possibility of using videogaming consoles and virtual reality systems to make children's therapy more enjoyable, motivating, participated and effective. This study aims at conducting a systematic review about the use and the efficacy of digital games in pediatric neurorehabilitation. In accordance with the PRISMA approach, a rather wide-ranging search was conducted on PubMed, Scopus, and Web of Science databases by using different combinations of keywords based on MeSH terms. Fifty-five papers have been included into this review, namely, 38 original studies and 17 reviews. The total number of children and adolescents is 573, with 58% of them being affected by cerebral palsy. Despite a wide variability in the adopted protocols, devices, assessment tools, and a more frequent focus on motor aspects than on cognitive ones, the results of the majority of the analyzed studies support the safety (i.e., absence of severe adverse effects) and efficacy of the videogame-based therapy. Videogames, when administered by means of commercial consoles or ad-hoc digital systems, seem to be a valid support for physical therapy. Further researchers are needed to deeply investigate the role of this approach in cognitive therapy and cognitive outcomes.

Differences in gait parameters when crossing real versus projected everyday life obstacles in healthy children and adolescents

Practicing complex everyday life walking activities is challenging in paediatric neurorehabilitation, although it would prepare patients more comprehensively for the requirements of daily life. Floor projections allow simulation and training of such situations in therapy. Twenty healthy youths aged 6–18 years stepped over a tree trunk and balanced over kerbstones in a real and projected condition. Spatiotemporal and kinematic parameters of the two conditions were compared by equivalence analysis, using the medians of the differences between the two conditions with their bootstrapped 95% confidence intervals. Velocity, step and stride length, step width, and single support time were generally equivalent between the two conditions. Knee and hip joint angles and toe clearance decreased substantially during the execution phase of the projected tree trunk condition. The largest differences were found at the end of the execution phase in both tasks for the ankle joints. As spatiotemporal parameters were equivalent between the conditions, floor projections seem suitable to train precise foot placement. However, differences in knee and hip joint kinematics and toe clearance revealed that floor projections are not applicable for obstacles with a vertical extension. Therefore, exercises aiming at knee and hip flexion improvement should favourably be trained with real objects.

Widespread clinical implementation of the teen online problem-solving program: Progress, barriers, and lessons learned.

We describe the clinical implementation in North America of Teen Online Problem Solving (TOPS), a 10+ session, evidence-based telehealth intervention providing training in problem-solving, emotion regulation, and communication skills. Twelve children's hospitals and three rehabilitation hospitals participated, agreeing to train a minimum of five therapists to deliver the program and to enroll two patients with traumatic brain injuries (TBI) per month. Barriers to reach and adoption were addressed during monthly calls, resulting in expansion of the program to other neurological conditions and extending training to speech therapists. Over 26 months, 381 patients were enrolled (199 TBI, 182 other brain conditions), and 101 completed the program. A total of 307 therapists were trained, and 58 went on to deliver the program. Institutional, provider, and patient barriers and strategies to address them are discussed. The TOPS implementation process highlights the challenges of implementing complex pediatric neurorehabilitation programs while underscoring potential avenues for improving reach and adoption.

Conceptual framework of the recovery of self-awareness following a severe traumatic brain injury in childhood

ABSTRACT Introduction Self-awareness following a TBI in childhood is an under-represented area of research in the pediatric literature. The issue is well described in the adult literature but the theories and practice recommendations in this body of literature are not easily transferable to pediatric neurorehabilitation. Children and young people sustain a TBI at a time when the brain is yet to fully develop. This paper outlines a conceptual framework that incorporates and adapts knowledge from the adult and pediatric literature of self-awareness. Methods The content and the structure of the framework is constructed from clinical experience, existing literature and the findings from an empirical study. Findings A conceptual framework is presented with 3 key components: self-awareness knowledge, self-awareness in context, self-awareness for the future. The components are explained and the relationship between the concepts is highlighted. Conclusion The framework provides a common language for clinicians and academics to explore the concepts that impact self-awareness during recovery. The framework captures the dynamic developmental and recovery trajectory of self-awareness following a TBI in childhood.

Outcome Measurement in Children With a History of Disorders of Consciousness After Severe Brain Injury: Telephone Administration of the Vineland Adaptive Behavior Scales, Third Edition, and Glasgow Outcome Scale-Extended Pediatric Revision.

Examine initial feasibility and utility of a battery of measures administered via telephone interview with a caregiver for describing long-term outcomes in individuals with a history of disorders of consciousness (DoC) after pediatric acquired brain injury (ABI). Cross-sectional. Caregiver interview administered via telephone. Convenience sample admitted to an inpatient pediatric neurorehabilitation unit with DoC after ABI at least 1 year prior to assessment (n = 41, 5-22 yr old at assessment). None. The Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), and Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds) were examined. Administration time of the Vineland-3 ranged from 13 to 101 minutes (m = 50) and the GOS-E Peds ranged from 2 to 10 minutes (m = 3). Vineland-3 Adaptive Behavior Composite (ABC) ranged from standard scores (SSs) of 20 (exceptionally low) to 100 (average) and GOS-E Peds scores ranged from 3 (i.e., upper moderate disability) to 7 (vegetative state). Lower adaptive functioning on the Vineland-3 ABC was strongly associated with greater disability on the GOS-E Peds (r = -0.805). On the Vineland-3 ABC, 19.5% earned the lowest possible score, whereas 12.2% obtained the lowest possible score for survivors on the GOS-E Peds; only 7.3% earned lowest scores on both measures. The Vineland-3 and GOS-E Peds were feasibly administered by telephone and were complementary in this cohort; the GOS-E provided a quick and easy measure of gross functional outcome, whereas the Vineland-3 took longer to administer but provided a greater level of detail about functioning. When both measures were used together, the range and variability of scores were maximized.

Using therapy outcome measures to identify the speech and language therapy needs of children and young people with severe acquired brain injury

Background/Aims Children and young people often require speech and language therapy input following severe acquired brain injury. However, there is limited understanding of the impact of post-acute neurorehabilitation on children and young people's communication and swallowing, and how to measure this. The aim of this study was to evaluate the initial and ongoing speech and language therapy needs of children and young people in one specialist paediatric neurorehabilitation centre, and to determine the usefulness of therapy outcome measures for this population. Methods A retrospective review was performed of routinely collected data, including therapy outcome measures for children and young people admitted to the centre. Descriptive analysis was completed for all therapy outcome measures data, and statistical significance of change during rehabilitation was determined on those with sufficient data using Wilcoxon signed-rank tests. Results A total of 165 records of children and young people aged between 1 and 17 years were reviewed. The average length of stay at the centre was 19.7 weeks. The most prevalent therapy outcome measures were cognition and dysphagia. Highly significant differences were found between admission and discharge in all therapy outcome measures scores, including participation (Wilcoxon Z=-9.523, P<0.001) and wellbeing (Wilcoxon Z=-7.656, P<0.001). Median discharge scores did not exceed 4 (from a maximum of 5) for any scales. Conclusions Therapy outcome measures were able to capture the complex profiles of these children and young people and could measure changes during post-acute neurorehabilitation. Children and young people presented with a range of speech and language therapy needs following severe acquired brain injury. They made significant improvements in impairment, activity, participation and wellbeing scales during rehabilitation. Children and young people left with ongoing speech and language therapy needs in all areas, which require input from community services.

Sensor-based outcomes to monitor everyday life motor activities of children and adolescents with neuromotor impairments: A survey with health professionals.

In combination with appropriate data processing algorithms, wearable inertial sensors enable the measurement of motor activities in children's and adolescents' habitual environments after rehabilitation. However, existing algorithms were predominantly designed for adult patients, and their outcomes might not be relevant for a pediatric population. In this study, we identified the needs of pediatric rehabilitation to create the basis for developing new algorithms that derive clinically relevant outcomes for children and adolescents with neuromotor impairments. We conducted an international survey with health professionals of pediatric neurorehabilitation centers, provided them a list of 34 outcome measures currently used in the literature, and asked them to rate the clinical relevance of these measures for a pediatric population. The survey was completed by 62 therapists, 16 doctors, and 9 nurses of 16 different pediatric neurorehabilitation centers from Switzerland, Germany, and Austria. They had an average work experience of 13 ± 10 years. The most relevant outcome measures were the duration of lying, sitting, and standing positions; the amount of active self-propulsion during wheeling periods; the hand use laterality; and the duration, distance, and speed of walking periods. The health profession, work experience, and workplace had a minimal impact on the priorities of health professionals. Eventually, we complemented the survey findings with the family priorities of a previous study to provide developers with the clinically most relevant outcomes to monitor everyday life motor activities of children and adolescents with neuromotor impairments.

An Integrated Music and Artificial Intelligence System in Support of Pediatric Neurorehabilitation.

This study aims at the implementation of an Artificial Intelligence approach to the use of music for supporting the neurorehabilitation of children with brain injuries or neurological difficulties.The output of this study will be the implementation of an app for mobile devices with games to be played by pediatric patients, allowing time for their cognitive and motor abilities to recover while enjoying pleasant activities. In particular, a Neural Network Classification approach is proposed in order to automatically adapt the game difficulty to the current cognitive capabilities of the child.

Remotely monitored transcranial direct current stimulation in pediatric cerebral palsy: open label trial protocol

BackgroundPediatric applications of non-invasive brain stimulation using transcranial direct current stimulation (tDCS) have demonstrated its safety with few adverse events reported. Remotely monitored tDCS, as an adjuvant intervention to rehabilitation, may improve quality of life for children with cerebral palsy (CP) through motor function improvements, reduced treatment costs, and increased access to tDCS therapies. Our group previously evaluated the feasibility of a remotely monitored mock tDCS setup in which families and children successfully demonstrated the ability to follow tDCS instructional guidance.Methods and designHere, we designed a protocol to investigate the feasibility, safety, and tolerability of at-home active transcranial direct current stimulation in children with CP with synchronous supervision from laboratory investigators. Ten participants will be recruited to participate in the study for 5 consecutive days with the following sessions: tDCS setup practice on day 1, sham tDCS on day 2, and active tDCS on days 3-5. Sham stimulation will consist of an initial 30-second ramp up to 1.5 mA stimulation followed by a 30-second ramp down. Active stimulation will be delivered at 1.0 - 1.5 mA for 20 minutes and adjusted based on child tolerance. Feasibility will be evaluated via photographs of montage setup and the quality of stimulation delivery. Safety and tolerability will be assessed through an adverse events survey, the Box and Blocks Test (BBT) motor assessment, and a setup ease/comfort survey.DiscussionWe expect synchronous supervision of at-home teleneuromodulation to be tolerable and safe with increasing stimulation quality over repeated sessions when following a tDCS setup previously determined to be feasible. The findings will provide opportunity for larger clinical trials exploring efficacy and illuminate the potential of remotely monitored tDCS in combination with rehabilitation interventions as a means of pediatric neurorehabilitation. This will demonstrate the value of greater accessibility of non-invasive brain stimulation interventions and ultimately offer the potential to improve care and quality of life for children and families with CP.Trial RegistrationOctober 8, 2021(https://clinicaltrials.gov/ct2/show/NCT05071586)

Virtual Reality as a Therapy Tool for Walking Activities in Pediatric Neurorehabilitation: Usability and User Experience Evaluation.

BackgroundMany essential walking activities in daily life, such as crossing a street, are challenging to practice in conventional therapeutic settings. Virtual environments (VEs) delivered through a virtual reality (VR) head-mounted display (HMD) would allow training such activities in a safe and attractive environment. Furthermore, the game-like character and high degree of immersion in these applications might help maintain or increase children’s motivation and active participation during the rehabilitation process.ObjectiveThis study aimed to investigate the usability, user experience, and acceptability of an immersive VE experienced through a VR HMD to train everyday life walking activities in pediatric neurorehabilitation.MethodsIn a cross-sectional study, 21 youths (median age 12.1 years; range 6.8-17.7 years) with a neuromotor impairment undergoing inpatient or outpatient neurorehabilitation tested a VE experienced through the VR HMD Oculus Quest. The participants, accompanied by their physiotherapists, moved freely around a 4.4 by 10-meter VE, displaying a magical forest and featuring various gamified everyday activities in different game designs. Using their hands, represented in the VE, the participants could interact with the virtual objects placed throughout the VE and trigger visual and auditory feedback. Symptoms of cybersickness were checked, and usability, user experience, and acceptability were evaluated using customized questionnaires with a visual analog scale for youths and a 5-point Likert scale for their therapists.ResultsNone of the participants reported any signs of cybersickness after 20 minutes of VR HMD exposure time. They rated comfort (median 10/10) and movement ability (median 10/10) with the VR HMD as high. The VE was perceived as being really there by the majority (median 8/10), and the participants had a strong feeling of spatial presence in the VE (median 9.5/10). They enjoyed exploring the virtual world (median 10/10) and liked this new therapy approach (median 10/10). Therapists’ acceptance of the VR HMD was high (4/5). There were 5 patients that needed more support than usual, mainly for supervision, when moving around with the VR HMD. Otherwise, therapists felt that the VR HMD hardly affected their patients’ movement behavior (median 4.75/5), whereas it seemed to increase their level of therapy engagement (median 4/5) compared to conventional physiotherapy sessions.ConclusionsThis study demonstrates the usability of an immersive VE delivered through a VR HMD to engage youths in the training of everyday walking activities. The participants’ and therapists’ positive ratings on user experience and acceptance further support the promising application of this technology as a future therapeutic tool in pediatric neurorehabilitation.

Walking activities beyond gait training: Priorities in everyday life for parents and adolescents in pediatric neurorehabilitation.

PURPOSE:This study aimed to gain knowledge about which walking-related everyday life activities and situations are relevant for parents of children with a neuromotor disorder and adolescents undergoing inpatient neurorehabilitation.METHODS:Two focus group interviews with purposive samples were performed, one with seven parents of children with acquired or congenital neuromotor disorders, and one with four adolescents undergoing inpatient neurorehabilitation. Data were analyzed with a qualitative descriptive research approach.RESULTS:Parents identified 120 activities that they considered as relevant in their everyday life and the adolescents identified 113 activities. Based on these activities, ten different categories that have a direct relation to walking in everyday life were identified. “Dealing with obstacles,” “moving in public areas,” “moving in a group,” and “walking in general” were perceived as the highest priority categories by the focus group participants.CONCLUSION:Activities incorporating walking tasks related to moving in a group or public areas and dealing with obstacles are perceived as meaningful by adolescents and parents in their everyday life. Addressing these categories in the goal setting process with families could facilitate the definition of walking-related goals aimed at increasing children’s and adolescents’ independence in daily life.

Can serious play and clinical cognitive assessment go together? On the feasibility and user-experience of virtual reality simulations in paediatric neurorehabilitation.

Cognitive impairments frequently occur in children and adolescents with acquired brain injury (ABI), causing significant disabilities in daily life. Current paper-and-pencil neuropsychological tests do not capture the complexity of daily life activities, often failing to objectify subtle cognitive impairments. Virtual Reality (VR) simulations might overcome this discrepancy, as it resembles daily life situations. The aim of this study was to evaluate the feasibility, user-experience and preference of a VR simulation with a non-immersive (computer monitor; CM)) and immersive (head mounted display; HMD)) VR setup. Children and adolescents with ABI (n = 15) and typically developing children and adolescents (n = 21) completed a VR-task with a CM and HMD. Both VR setups were feasible for children and adolescents with ABI. User-experience was enhanced with the HMD compared to CM in both groups. Side effects were low and comparable for both groups, and there were no differences between setups (HMD and CM). The majority of the children and adolescents with ABI preferred the HMD. VR simulations appear feasible to use in paediatric rehabilitation. The preference for a VR setup should be discussed with the child. Further research is needed to develop more sensitive measures to further explore the potential of VR for cognitive assessment.

The role of the Neuropsychologist across the stages of recovery from acquired brain injury: a summary from the pediatric rehabilitation Neuropsychology collaborative

ABSTRACT Neuropsychologists working in a pediatric neurorehabilitation setting provide care for children and adolescents with acquired brain injuries (ABI) and play a vital role on the interdisciplinary treatment team. This role draws on influences from the field of clinical neuropsychology and its pediatric subspecialty, as well as rehabilitation psychology. This combination of specialties is uniquely suited for working with ABI across the continuum of recovery. ABI recovery often involves a changing picture that spans across stages of recovery (e.g., disorders of consciousness, confusional state, acute cognitive impairment), where each stage presents with distinctive characteristics that warrant a specific evidence-based approach. Assessment and intervention are used reciprocally to inform diagnostics, treatment, and academic planning, and to support patient and family adjustment. Neuropsychologists work with the interdisciplinary teams to collect and integrate data related to brain injury recovery and use this data for treatment planning and clinical decision making. These approaches must often be adapted and adjusted in real time as patients recover, demanding a dynamic expertise that is currently not supported through formal training curriculum or practice guidelines. This paper outlines the roles and responsibilities of pediatric rehabilitation neuropsychologists across the stages of ABI recovery with the goal of increasing awareness in order to continue to develop and formalize this role.