Pediatric Rehabilitation Medicine Research Articles

A call for action: Increasing the pediatric rehabilitation medicine workforce.

Pediatric Rehabilitation Medicine (PRM) is a unique blend of traditional medical rehabilitation knowledge and skills primarily focused on temporary and/or permanent disability conditions of childhood onset throughout the age continuum, with an emphasis on promoting function and participation. Although there are two established pathways to enhance knowledge and skills in PRM, one a combined residency with Pediatrics and the other a PRM fellowship, there has been a relative decline in participants in this training, as has been seen across other subspecialties in Physical Medicine and Rehabilitation (PM&R) and other medical specialties. Based on pediatric rehabilitation physician surveys and the increasing prevalence of children with disabilities, there has been a call to consider opening PRM fellowships to physicians not trained in PM&R. This commentary proposes establishing a commission to lead a transparent and inclusive process to assure that all options to address issues related to optimizing PRM care are considered and provide a course of action to address the needs of children and adults with childhood onset disabilities.

Pediatric physical medicine and rehabilitation: Fellowship website content comprehensiveness evaluation.

This cross-sectional analysis of Pediatric Rehabilitation Medicine (PRM) fellowship program websites in the United States assesses their comprehensiveness based on 43 variables commonly sought by applicants. The study found that 30% of programs had a direct link to the PRM fellowship page, with limited information on criteria such as education resources, research stipend, mentorship opportunities, and fellow wellness. The results underscore the need for improved accessibility, content expansion, and yearly link maintenance. These improvements could enhance the applicant experience, foster informed decisions, and streamline the application process. The findings offer a roadmap for PRM fellowships to better align their online platforms with applicant needs, reflecting the current shift toward virtual interactions in the post-pandemic era.

The complete acute and post-acute care course of children affected by acute flaccid myelitis in Western Pennsylvania: A case series.

Acute flaccid myelitis (AFM) is a "polio-like" neurologic disorder of the spinal cord gray matter characterized by asymmetric, flaccid limb weakness of rapid onset following prodromal viral illness. It has affected the pediatric population of the United States since 2014, but there is a paucity of literature describing the post-acute comprehensive rehabilitation management that maximizes functional outcomes for patients. This case series attempts to mitigate this by describing the complete acute and post-acute care course of six children diagnosed with AFM in Western Pennsylvania. It is critical that pediatric rehabilitation medicine providers be knowledgeable about the complex medical and rehabilitation management for patients with AFM.

Pediatric Rehabilitation Medicine: It’s Go Time

Pediatric Rehabilitation Medicine: It’s Go Time

Focus on Functioning: The Field of Pediatric Rehabilitation Medicine

Focus on Functioning: The Field of Pediatric Rehabilitation Medicine

Cerebral Palsy classification based on multi-feature analysis using machine learning

Cerebral Palsy (CP) is an umbrella name for disorders caused by abnormal brain development or damage to the developing brain. It affects the child's ability to move and maintain balance and posture. CP is the most common cause of motor disability in childhood. CP has various classification systems based on body structure and function, such as the topographic classification into quadriplegia, diplegia, and hemiplegia, or based on activities such as the gross motor function classification system (GMFCS). Classifying children with CP is challenging for clinicians due to the homogeneous nature of the clinical presentations of children with CP. Classifications of CP can guide the planning of services that enhance the quality of life of children and their families. There are a few studies about children with CP in Jordan. Data about children with CP in Jordan are also lacking. This study, therefore, aims to compile a comprehensive, concise, and fully annotated national dataset for Jordanian children with CP and to provide a benchmark for related studies in the field of pediatric rehabilitation medicine (PRM). This work presents the methodology implemented to compile and analyze the dataset and the experiments conducted on this dataset. We evaluated the dataset using a set of five commonly used machine learning classification algorithms, namely, K-Star, Multilayer Perceptron (MLP), Naïve Bayes (NB), Random Tree (RT), and Support Vector Machine (SVM). The MLP classifier successfully classified CP-type cases with an accuracy rate of 84% and GMFCS cases with an accuracy rate of 53%. The obtained results were promising and encouraging to put the compiled CP dataset into practice for clinicians, researchers, and policymakers working in the field of PRM.

First year impacts of the COVID-19 pandemic on pediatric physiatrists.

The objective of this study was to determine how the COVID-19 pandemic impacted the work and compensation of pediatric physiatrists during the first year of the pandemic. Pediatric physiatrists were surveyed in the spring of 2021 about how the first year of the COVID-19 pandemic impacted their practices as a part of a larger survey examining pediatric rehabilitation medicine practices. The COVID-19 specific questions covered three topic areas: 1) personal experiences with COVID-19; 2) occupational workflow changes due to COVID-19, including telehealth; and 3) employment consequences of the COVID-19 pandemic. Thirteen of 259 pediatric physiatrists reported having a COVID-19 infection, of whom none required hospitalization. Nearly all (96.5%) of pediatric physiatrists reported using telehealth during the pandemic compared to 14% prior to the pandemic. They reported numerous changes to their clinical operations, and 50% reported not having adequate personal protective equipment available for themselves or their staff all of the time. Fifteen pediatric physiatrists (5.9%) reported being furloughed, and three reported job loss during the first year of the pandemic. While only a small percentage of pediatric physiatrists contracted COVID-19 during the first year of the pandemic, nearly all experienced workflow changes.

Functional level of lesion scale: Validating fourteen years of research with the national spina bifida patient registry.

Functional level of lesion (FLOL) is a grading of the level of neurological function in patients with myelomeningocele and other forms of spina bifida. It has been widely used as an independent variable in studies of spina bifida, but its inter-rater reliability has not previously been tested. The purpose of this study was to measure inter-rater reliability of FLOL testing and compare testing performed by a non-medically trained research associate to testing performed by a pediatric rehabilitation medicine specialist. Children in a multi-disciplinary spina bifida clinic underwent FLOL grading by a non-medically trained research associate. On the same day, these children were also graded by a pediatric rehabilitation medicine specialist. Cohen's weighted kappa statistic was used to compare grading, with the rehabilitation medicine specialist considered the gold standard. A total of 71 patients participated. FLOL was graded for left and right leg for each participant, resulting in 142 measurements. Cohen's weighted kappa was κ= 0.809, with a standard error of 0.034 and 95% confidence interval 0.723-0.875, indicating substantial agreement. FLOL as measured according to the instructions of the National Spina Bifida Patient Registry by a non-medically trained researcher is a reliable method to grade lower extremity function in spina bifida.

Advancing our field by academically advancing pediatric rehabilitation medicine physicians.

Academic promotion is desired by many faculty practicing at academic medical institutions, but the criteria for promotion often appear opaque to many physician faculty. In nearly all cases, evidence of scholarship is required regardless of academic track. Academic advancement can be stymied by unclear expectations, lack of protected time to engage in scholarly projects, insufficient evidence of dissemination, and limited guidance, mentorship and sponsorship. In addition to being important for promotion, scholarship is an essential aspect of academic medicine because it helps inform and advance the science. Pursuing academic excellence is an important goal for pediatric rehabilitation medicine faculty members because it helps advance the care of children with disabilities and the field itself. Pediatric rehabilitation medicine faculty in the clinician educator or clinician leader tracks are encouraged to understand the criteria for advancement, seek out mentorship, scholarize their career ikigai and identify opportunities to demonstrate academic excellence.

Gabriella E. Molnar MD: Grandmother of pediatric rehabilitation medicine.

Gabriella E. Molnar MD: Grandmother of pediatric rehabilitation medicine.

Current status and trends in subspecialty certification in physical medicine and rehabilitation.

There is a need to better understand the overall state of sub-specialization in physical medicine and rehabilitation (PM&R). To examine the status and trends in subspecialty certification for each of the seven subspecialties approved for American Board of Physical Medicine and Rehabilitation (ABPMR) diplomates. Retrospective analysis of deidentified information from the ABPMR database. Physicians certified by ABPMR through 2019. Not applicable. For each subspecialty, we examined: (1) the number of certificates issued to ABPMR diplomates; (2) the recertification rate; (3) the yearly trends for total active, new, and expired certificates; and (4) for ABPMR-administered subspecialties, recertification rates for those entering the subspecialty through fellowship completion versus a "grandfathered" practice pathway. Of 11,421 ABPMR diplomates in the United States in 2019, a total of 3560 (31.2%) had 3985 active subspecialty certificates. Pain Medicine (PM) was the most common subspecialty certification (15.5% of all ABPMR diplomates) followed by Sports Medicine (SM, 6.6%), Brain Injury Medicine (BIM, 4.8%), Spinal Cord Injury Medicine (SCIM, 4.2%), Pediatric Rehabilitation Medicine (PRM, 2.5%), Neuromuscular Medicine (NMM, 0.7%), and Hospice and Palliative Medicine (HPM, 0.5%). For diplomates with more than one subspecialty certification, PM and SM was the most frequent combination. Both the recertification rate and the end of practice track eligibility influenced certification trends differently for individual subspecialties. The average number of new certificates added annually for every subspecialty was higher before than after the temporary practice track-based eligibility ended; the difference was statistically significant (p < .05) for SCIM, PM, SM, and NMM. The recertification rate for all subspecialties combined was 73.4%. For the subspecialties (SCIM, PRM) for which these data were available, fellowship candidates had higher recertification rates than those grandfathered through a practice track. This report informs stakeholders about the state and evolution of subspecialty certification in PM&R over time.

Performance on the American Board of Physical Medicine and Rehabilitation certifying examinations: Rural and urban physicians.

Over 60 million people in the United States live in a rural community making up approximately 20% of the population. Data are minimal about the physiatrists who serve this rural population, their performance on certification examinations and how the American Board of Physical Medicine and Rehabilitation (ABPM&R) serves their ongoing educational, assessment, and practice needs. To compare the performance of rural and urban physicians on the Part I, Part II, and maintenance of certification (MOC) examinations along with subspecialty preference and continuance of primary certification. Retrospective cross-sectional study. Board-eligible PM&R physicians and certified diplomates of the ABPM&R. Physicians who participated in an initial certification or maintenance of certification examination with the ABPM&R between 2010 and 2019. Comparisons of physician pass rates, mean scaled scores (aggregates), and program pass rates on ABPM&R certifying examinations were completed. Cross-reference to national database and ABPM&R practice site zip codes provided sociogeographic linkage. Not applicable MAIN OUTCOME MEASURES: Physician mean scaled scores, pass rates, subspecialty preferences, and primary certification status. There were no meaningful differences in performance on the ABPM&R Part I, II, and MOC examinations between rural and urban physiatrists. Most common subspecialty is the pain medicine certification whose diplomates most frequently drop their primary certification. Pediatric rehabilitation medicine certification is rare in rural localities and a health care disparity. The study found no meaningful differences in the performance of rural and urban physicians on the ABPM&R certifying examinations.

Spinal Cord Dysfunction Secondary to a Sports/Exercise Event

Purpose: The objective of this paper is to present two young patients with SCDys after participation in a sports/exercise event. The authors aim to raise awareness of these unusual causes with potentially fatal results. The authors want to review literature regarding the diagnosis and treatment and particular rehabilitation issues of SCDys. Methods: Two cases of young patients with a history of SCDys consulted the pediatric rehabilitation medicine service. Results: Physical examination revealed incomplete paraparesis and neurogenic bladder. Both final diagnoses were confirmed by magnetic resonance imaging or computerized tomography scan. Treatment was aimed at avoiding further/permanent neurological complications in both cases, taking into consideration their respective etiologies. Conclusion: SCDys is a nontraumatic spinal cord injury that has different etiologies. This paper presents a SCDys due to an unusual etiology.

Assessing the Field of Pediatric Rehabilitation Medicine's Interest in Expanding Fellowship Training to Pediatricians.

Training opportunities to pursue a career in pediatric rehabilitation medicine (PRM) have evolved over the last 40 years, with the most recent change being the development and accreditation of PRM fellowships and subspecialty certification in PRM. Currently the American Board of Physical Medicine & Rehabilitation (ABPMR) requires all candidates for PRM subspecialty certification to have completed a physical medicine and rehabilitation (PM&R) residency. The small number of certified PRM physicians has prompted debate within the field about permitting pediatricians to enter PRM fellowships without having to complete a PM&R residency. To assess the level of interest within the field of PRM in creating a pathway to PRM for pediatricians. Survey of pediatric physiatrists in the United States in 2017. National. Pediatric physiatrists. Not applicable. Favorability toward pediatricians becoming certified in PRM. Most respondents (62%) were in favor of pediatricians having the opportunity to pursue training in PRM, with an increase in support (70%) after being introduced to workforce issues in PRM. Training time for pediatricians was the largest concern identified by respondents who were not in favor (80%), with additional themes identified including dilution of the essence of the field and operationalization issues. With a small number of practicing pediatric physiatrists, the growing number of children with disabilities, and the limited access to our services, most pediatric physiatrists are in agreement that it is time to consider the opportunity to expand the PRM workforce by creating a fellowship pathway to subspecialty board certification in PRM after pediatric residency.

Children with Disabilities, Eighth Edition.

After being first introduced in 1979, Children with Disabilities is now in its eighth edition. This esteemed medical textbook has content from a host of well-known experts in the fields of Neurodevelopmental Disabilities, Developmental-Behavioral Pediatrics, Neurology, Genetics, Pediatric Rehabilitation Medicine, Pediatric and School Psychology, and the many related interprofessional disciplines that serve children with disabilities. It provides students and professionals across multiple disciplines and levels of training, as well as family members and friends of children with disabilities, an in-depth review of developmental disabilities and their impact on childhood development and functioning. This edition expanded on the seventh edition to reflect the changes that have happened in this rapidly progressing field, with edits of existing chapters to reflect the most up-to-date evidence and practices and the incorporation of 7 new chapters. The book has associated Online Companion Materials to supplement this text, which include study questions and activities to reinforce knowledge of key concepts and customizable PowerPoint presentations for every chapter to assist instructors. The tome is thorough in both the breadth and depth of topics covered. The wealth of information is organized in a manner that is logical and easy to follow: Chapters are divided into 7 sections starting with the fundamentals in “As Life Begins” and “A Child's Body: Physiology,” to “Developmental Assessments,” “Developmental disabilities,” “Associated disabilities,” “Interventions,” and “Outcomes.” Each chapter is structured to optimize learning. There are clear learning objectives listed at the beginning of each chapter, followed by a case study. Images and tables are clear and easy to understand, and the reader will appreciate the boxes highlighting interdisciplinary care and evidence-based approaches incorporated throughout. The information provided in this textbook has been presented with care to represent children with disabilities as people first. The online materials include a series of personal letters written by Andrew Batshaw, son of the editor, at age 12 through the present, concerning the effect of attention deficit/hyperactivity disorder (ADHD) on his own life. The wording used in this text truly does emphasize the human perspective of a person with a disability, rather than identifying the individual by their diagnosis. In addition, extra steps have been taken to make this textbook inclusive for all children with disabilities, with the addition of a chapter on ethnic and racial disparities. This textbook is often part of the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) curriculum. It has been targeted to reach a large and diverse audience. As such, some readers may find areas too detailed for their own learning purposes. However, it is relatively easy to navigate, so readers may find the sections that are most applicable to their needs. Learners who are more visual may have a difficult time in the areas of the book that are text-heavy and could benefit from further diagrams or tables in these areas. Although there are tips on counseling families interspersed in the text, it may increase utility for practicing clinicians to highlight these points in a box or summary for easy access and review. For future editions, the editors may want to include chapters on emerging technology and the use of telehealth, especially in light of the changes to practice because of the current coronavirus disease 2019 (COVID-19) pandemic. In summary, the updated edition of a well-known textbook provides an in-depth and respectful resource to understand the effects of disabilities on children's development and functioning. This book is essential for professionals or learners who will be working with children with disabilities. It will also be beneficial for advocates of these individuals including friends and family.

Telehealth in pediatric rehabilitation medicine: A survey of clinician reported utilization and experience.

Telehealth services have been touted to improve access to specialty pediatric care. COVID-19 accelerated the adoption of telehealth across many medical specialties. The purpose of this study was to examine telehealth utilization and satisfaction among pediatric physiatrists. Using Google Forms, a voluntary survey was created and administered to pediatric physiatrists. The survey collected information on practice setting, telehealth utilization, provider satisfaction, perceived satisfaction of patients and families, and the anticipated role of telehealth in pediatric rehabilitation going forward. Seventy-eight respondents completed the survey. There was a significant reported increase in telehealth utilization since COVID-19 from 14.5% to 97.4%. Eighty-two percent of participants reported feeling comfortable utilizing telehealth, 77% felt confident in the quality of the care provided, and 91% believed patients were satisfied with telehealth visits. Responses indicate that telehealth is expected to play a role in future pediatric physiatry and interest in telehealth continuing medical education is prevalent. Most pediatric physiatrists plan to continue or expand telehealth offerings after COVID-19. Telehealth adoption has been expedited by COVID-19. Physician interest in and satisfaction with telehealth is high. Patient and family perceptions, outcomes of care, and barriers to implementation limiting program expansion deserve further study.

COVID-19 pandemic: Early effects on pediatric rehabilitation medicine training.

The COVID-19 pandemic hastened the need for graduate medical education (GME) innovation, resulting in the creation of multiple pediatric rehabilitation medicine (PRM) e-learning initiatives. There has been a paucity of data regarding trainee perceptions regarding quickly developed new methods of learning during the pandemic. This study explored PRM trainee perceptions of e-learning and effects of the pandemic on education. Questionnaire study with data collected via REDCap. Greater than half of PRM trainees (56.6%, 30/53) responded. Most respondents reported that the virtual lectures series (79.3%), journal club (78.9%), and virtual arts initiatives (75.0%) were valuable to their education. Common benefits noted included access to subject experts, networking, lecture recording, and location flexibility. Common concerns included lack of protected time, virtual platform fatigue, and decreased engagement. Most respondents were not redeployed. Relative to before the pandemic, less satisfaction with clinical education (70.0%) and greater satisfaction with non-clinical education (60.0%) was reported. The majority of graduating trainees felt positively (83.3%) and 16.7% were neutral regarding confidence to graduate. Trainees perceived national e-learning as valuable to their education, especially due to the access to expert leaders around the nation. Future work should explore ways to overcome barriers and optimize benefits of GME and PRM e-learning.

Pediatric telerehabilitation medicine: Making your virtual visits efficient, effective and fun.

The COVID-19 pandemic has accelerated many changes in medicine including the transition from providing care in person to providing care via technology enabled telemedicine. The benefits of telemedicine visits with a Pediatric Rehabilitation Medicine (PRM) provider, also known as telerehabilitation medicine visits, are numerous. Telerehabilitation medicine provides an opportunity to deliver timely, patient and family-centric rehabilitation care while maintaining physical distance and reducing potential COVID-19 exposure for our patients, their caregivers and medical providers. Telerehabilitation medicine also allows for access to PRM care in rural areas or areas without medical specialty, virtual in-home equipment evaluation, and reduced travel burden. Because of these and many other benefits, telerehabilitation medicine will likely become part of our ongoing model of care if barriers to telemedicine continue to be lowered or removed. This paper is intended to establish a foundation for pediatric telerehabilitation medicine visit efficiency and effectiveness in our current environment and into the future.

Normal childhood development curriculum in a pediatric rehabilitation training program: An interactive, novel approach.

Though knowledge of normal childhood developmental milestones, essential for physician subspecialists, begins in medical school, it continues in pediatric subspecialty residency and fellowship training. Despite widespread education in developmental milestones, published curricula related to this content area are lacking. This pilot curriculum was developed to address the lack of published developmental curricula. Participants included pediatric rehabilitation trainees who completed 8-12 sessions per year of a novel, adult-learner centered child development curriculum, for two consecutive years. Outcome measures included a novel survey, knowledge based test, verbal feedback sessions, and the end of the year program evaluation committee meeting. Trainees were successfully able to attend curricula sessions within their typical fellowship and residency responsibilities. Pediatric rehabilitation medicine fellows reported improved competence in normal growth and development. Pediatric rehabilitation residents rated the curriculum as a high value to their education (3.5 ± 0.58 on a 1-4 point scale). While not statistically significant, ratings of perceived knowledge of developmental milestones, structured educational sessions attended related to development, and overall interest in the topic increased from pre-curriculum to post-curriculum. This study introduces a novel approach to developmental milestones education that is tailored to the adult learner and pediatric rehabilitation trainees.

Gender-Based Salary Inequities Among Pediatric Rehabilitation Medicine Physicians in the United States

ObjectiveTo assess whether gender inequities exist for pediatric physiatrists and, if affirmative, what factors account for this difference. DesignCohort study. SettingOnline REDCap survey administered via e-mail. ParticipantsPediatric physiatrists practicing in the United States in 2017. InterventionsNot applicable. Main Outcome MeasuresRespondents reported on their gender, training, practice type and location, leadership positions, years in practice and years at their current location, salary, research, and clinical productivity. ResultsOf the 307 surveys sent, 235 individuals responded, yielding a response rate of 76.5%. Pediatric physiatrists who identified as women were more likely to work part-time but were demographically similar to their colleagues who identified as men. The odds of having no leadership role were higher for women (odds ratio=2.17; P=.02) than men. Pediatric physiatrists who identified as men made on average (in US dollars ± SD) 244,798±52,906 annually compared with those who identified as women 224,497±60,756. The average annual difference in full-time salary was $20,311 in favor of those who identified as men (95% confidence interval, $3135-$37,486). The set of predictors in the multivariable model explained about 40% of the total variability in annual full-time salary (R2=0.389; adjusted R2=0.339; F15,197=7.734; P<.001). Gender was not a significant predictor in the model, but model prediction of the salaries of pediatric physiatrists who identified as men was better than model prediction of the salaries of those who identified as women. ConclusionsDespite representing a majority of the field, pediatric physiatrists who identified as women were paid less than their counterparts who identified as men. The traditional predictors associated with the salaries of men were not enough to explain salary variation among those who identified as women, thereby providing evidence of the importance of intangible and unmeasured aspects of a women’s career, such as bias and institutional culture.