Rehabilitation In Pediatric Patients Research Articles

Trainee Preparedness to Enter Physiatry Residency: Early Findings from a National Cross-Sectional Survey Study

Introduction: This national survey study investigates the transition of PM&R residents from as they transition into residency, aiming to identify associated factors influencing their preparedness. The transition to residency can be stressful, and insufficient preparedness is associated with a higher risk of burnout. While existing research has examined this transition in large specialties like internal medicine and surgery, there is a gap in understanding preparedness for PM&R residency in PGY-2. PM&R residency offers diverse routes, and not all medical schools have PM&R departments, leading to varied exposure and experience among incoming residents. Methods: To address this gap, a voluntary national survey study was conducted, collecting data from 55 residents across the USA from PGY-2 to PGY-4. Results: Participants reported their overall preparedness, with 51% feeling prepared and 49% feeling unprepared for clinical care at the start of residency. The prepared group demonstrated higher emotional and clinical preparedness, particularly in performing neuro/musculoskeletal physical examinations, managing rehabilitation issues, and interpreting imaging. Experience as an intern emerged as the most critical factor influencing preparedness. There were no significant differences between the prepared and unprepared groups in terms of age, gender, medical degree, timing of PM&R exposure, participation in PM&R interest group, type of internship pursued (transitional, medicine, surgery, or categorical), or academic versus community hospital during intern year. Conclusions: Incoming residents who self-identified as unprepared may specifically benefit from early check-ins with residents about wellbeing and early focused education on the neuro/musculoskeletal physical examination, management of common rehabilitation related issues, and interpretation of neuromusculoskeletal imaging, given the differences in responses we observed between prepared and unprepared groups in these domains. Residents trended toward feeling unprepared in handling rapid responses, pediatric rehabilitation patients, and therapy prescriptions and precautions at the start of PM&R residency.

2024 SIAC guidelines on cardiorespiratory rehabilitation in pediatric patients with congenital heart disease

The 2024 Interamerican Society of Cardiology (SIAC) guidelines on cardiorespiratory rehabilitation (CRR) in pediatric patients with congenital heart disease aim to gather and evaluate all relevant evidence available on the topic to unify criteria and promote the implementation of CRR programs in this population in Latin America and other parts of the world. Currently, there is no unified CRR model for the pediatric population. Consequently, our goal was to create these CRR guidelines adapted to the characteristics of congenital heart disease and the physiology of this population, as well as to the realities of Latin America. These guidelines are designed to serve as a support for health care workers involved in the care of this patient group who wish to implement a CRR program in their workplace. The guidelines include an easily reproducible program model that can be implemented in any center. The members of this Task Force were selected by the SIAC on behalf of health care workers dedicated to the care of pediatric patients with congenital heart disease. To draft the document, the selected experts performed a thorough review of the published evidence.

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.

Central Vein Recanalization and Rehabilitation in Pediatric Patients: Changing the Paradigm for Chronic Occlusions.

Chronic total occlusions in the central venous system limit access and increase morbidity in chronically ill pediatric patients. We report the results of transcatheter recanalization of occluded central veins using angioplasty and stenting. Patients undergoing successful intervention for venous chronic total occlusions at our institution between April 2013 and December 2019 were retrospectively reviewed. Sixty-eight occluded central veins in 29 patients underwent recanalization with angioplasty (26 veins) or stenting (42 veins). The indications included limited access for catheterization or central line maintenance (19 patients), limb swelling (4 patients), superior vena cava syndrome (3 patients), and pleural effusion (3 patients). The primary risk factor for occlusion was a history of central venous lines after surgery or extracorporeal membrane oxygenation support in 76% of the patients. The median age and weight at the time of initial intervention were 5.8 years and 14.5 kg, respectively. There were no major complications. Of 10 patients with symptoms of venous congestion, 8 experienced symptomatic improvement. Twenty-two patients (59 veins) underwent 44 recatheterizations during a median follow-up duration of 288 days. Early reintervention was typically planned. The median time to recatheterization was 71 days. Twenty-one veins reoccluded and required repeat recanalization. Reocclusion was associated with persistent upstream collateral vein decompression, as determined using postintervention venography (odds ratio, 14.2; 95% CI, 3.3-62.6; P < .001), which was thought to indicate persistently poor venous inflow. Reinterventions were performed on 40 veins. Fifty-two veins that were followed up (88%) remained patent after the most recent intervention. Invasive transcatheter rehabilitation of occluded central veins has the potential to preserve critical access sites and improve the symptoms of venous congestion in pediatric patients. Reinterventions are common for reocclusion, restenosis, and somatic growth.

Correction to: Developmental Outcomes after Rehabilitation in Pediatric Patients with Global Developmental Delay: A Retrospective Case-Control Study

The author has informed the editor to correct the affliliation in the article as follow: Incorrect affliliation in the article: Sopatip Rerkmoung MD¹ Pornpun Angyureekul MD² Kwanyupa Sukonthamarn MD¹ ¹ Thai Red Cross Rehabilitation Center, Samut Prakan, Thailand ² Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Correct affliliation: Sopatip Rerkmoung, MD¹,² Pornpun Angyureekul, MD² Kwanyupa Sukonthamarn, MD¹,² ¹ Thai Red Cross Rehabilitation Center, Samut Prakan, Thailand ² Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Developmental Outcomes after Rehabilitation in Pediatric Patients with Global Developmental Delay: A Retrospective Case-Control Study

Objective: 1) To study developmental outcomes in patients with global developmental delay (GDD) following rehabilitation. 2) To study associated factors of developmental outcomes in patients with GDD following rehabilitation. Materials and Methods: The present study was a retrospective descriptive study. GDD patients received rehabilitation program at the Thai Red Cross Rehabilitation Center between January 1, 2014 and December 31, 2019. Data were collected from medical records included demographic data, developmental quotient (DQ) calculated from Denver II, and associated factors determining developmental outcomes. Results: There were 54 subjects at 29.7 months old in average. When comparing between before and after rehabilitation program, DQ in gross motor and personal-social domain improved significantly (p=0.002 and &lt;0.001). Female gender (adjusted OR 13.66, p=0.005) and no history of chromosomal abnormalities (adjusted OR 3.49, p=0.048) were associated with DQ improvement in gross motor domain. Music therapy (adjusted OR 33.94, p=0.013), term delivery (adjusted OR 28.28, p=0.020), no history of seizure (adjusted OR 16.80, p=0.008), and program duration (adjusted OR 1.08, p=0.032) were associated with personal-social domain. Conclusion: Following rehabilitation program, patients with GDD improved in gross motor and personal-social domain. Female gender and patients without history of chromosomal abnormalities revealed association with gross motor improvement. In addition, patients without history of seizure, music therapy, term delivery, and program duration were associated with personal-social improvement. Keywords: Global developmental delay; Pediatric rehabilitation; Denver II; Developmental quotient

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.

BIO22: Optimal Speed Control Algorithm for Cardiac Rehabilitation in Pediatric Patients with a Continuous Flow LVAD

BIO22: Optimal Speed Control Algorithm for Cardiac Rehabilitation in Pediatric Patients with a Continuous Flow LVAD

Pediatric intestinal transplantation

Advancements in donor management, organ preservation and operative techniques, as well as immunosuppressive therapies, have provided children with intestinal failure and its complications a chance not only for enteral autonomy but also long-term survival through intestinal transplantation (ITx). First described in the 1960’s, experience has grown in managing these complex patients both pre- and post-transplant. The goals of this review are to provide a brief history of intestinal transplantation and intestinal rehabilitation in pediatric patients, followed by focused discussions of the indications for ITx, induction and maintenance immunosuppression therapies, common post-operative complications, and outcomes/quality of life post-transplant.

Features of Postoperative Rehabilitation of Pediatric Patients

Features of Postoperative Rehabilitation of Pediatric Patients

Unique Techniques Utilizing Rib Grafts for Mandibular Reconstruction in the Pediatric Population.

Pediatric mandibular reconstruction requires a grafted segment of sufficient height and stability to support dental implant placement. Double barreling and mandibular distraction osteogenesis (MDO) after reconstruction are two techniques to achieve this, but they have only been reported with fibular grafts. Rib grafts not only have a lower donor site morbidity than fibular grafts, but they also provide adequate defect coverage in children. As such, we propose their use with either a double barrel technique or with MDO. Three pediatric patients underwent mandibular resection and reconstruction using rib grafting. One patient underwent single rib graft placement with subsequent vertical rib distraction. In the remaining two patients, a double-barreled rib technique was used, stacked horizontally in one patient and vertically in the other. From March 2018 to May 2019, three patients with an average age of 11 underwent resection of mandibular tumors or tumor-like lesions followed by immediate reconstruction with rib graft. Due to postoperative wound complications, the graft was completely removed in one patient. The remaining two patients had an uneventful recovery with dental implants planned for one and fully osseointegrated in the other. None of the patients experienced donor-site complications. This case series supports the utility and versatility of autogenous rib grafts as a reconstructive option in children. Not only is rib an excellent bone source with low donor site morbidity, but its height can be augmented through MDO or double barreling, facilitating the successful placement of implants and oral rehabilitation in pediatric patients.

Displasia ectodérmica en odontopediatría

La displasia ectodérmica (DE) se caracteriza por ser una enfermedad hereditaria que consiste en alteraciones genéticas y ambientales, provocando hipodoncia, distrofia en uñas, cabello escaso y anomalías dentarias. El tratamiento de rehabilitación en pacientes pediátricos con DE es difícil debido al continuo crecimiento y desarrollo cráneo facial de estos niños. El presente trabajo tiene como objetivo relatar un caso clínico de rehabilitación oral en paciente pediátrico diagnosticado con DE. Paciente de sexo femenino, con 5 años y 6 meses de edad que compareció a la clínica de odontopediatría en la UNIDERP. Al examen físico, extra oral, se constató que la paciente era respiradora bucal, y presentaba disminución del tercio inferior de la cara, labios protruidos y evertidos, frente prominente, nariz en “silla de montar”, escasez de cabello, pestañas y cejas, piel fina y seca. En el examen intraoral se observó ausencia de los siguientes dientes: 51/52, 61/62/63, 71/72, 81/82, y aspecto conoide de los dientes 53, 73 y 83. Al examen radiográfico se constató agenesia de 9 dientes primarios y de los gérmenes de los siguientes dientes permanentes: 11/12/13, 21/22/23, 41/42, 31/32, se observó la presencia de los gérmenes de los dientes 33 y 43. Con base en las características físicas y radiográficas se diagnosticó displasia ectodérmica hidrótica. Como conducta clínica, se optó por la instalación de mantenedores estéticos funcionales removibles, con el fin de favorecer la fonación, deglución, tonicidad muscular labial y lingual y el desenvolvimiento social.

Perceptual Cognitive Training Does Not Improve Clinical Outcomes at 4 and 12 Weeks Following Concussion in Children and Adolescents: A Randomized Controlled Trial.

To determine whether a perceptual-cognitive training program using 3D-multiple object tracking (3D-MOT) can improve symptoms following acute pediatric concussion. Research laboratory within a pediatric trauma center. Children and adolescents (n = 62, age= 13.27 ± 2.50) with diagnosed concussion. Randomized controlled trial. Children were randomized into either 3D-MOT, 2048 game, or standard care-only groups. Participants and parents completed the Post-Concussion Symptom Inventory (PCSI) at baseline, 4, 8, and 12 weeks postinjury. Intervention participants completed either the 3D-MOT protocol or the 2048 game at 6 sessions between the baseline and 4-week assessment. A 3 (group) × 10 (time) mixed-model analysis of variance evaluated PCSI total scores. The rate of persistent postconcussive symptom (PPCS) was evaluated at 4 weeks using χ2 analysis. Symptoms decreased throughout the study using both child-reported (F(9,374) = 22.03, P < .001) and parent-reported scores (F(9,370) = 28.06, P < .001). Twenty-four (44.4%) children met the study definition for PPCS using the child-reported PCSI, while 20 (37.7%) children had PPCS using parent reports. The intervention did not significantly affect symptom resolution or PPCS rates. There is no benefit to prescribing 3D-MOT training for acute rehabilitation in pediatric patients with concussion and clinicians should instead focus on more effective programs.

Cardiopulmonary Rehabilitation in Pediatric Patients With Congenital and Acquired Heart Disease.

Heart disease in children and adolescents is common, approaching 1.0% of the population. In those patients with complex physiology and severe cardiac dysfunction, the inability to participate in physical activity results in significant obstacles to normal acts of daily living and significantly diminished quality of life. Attempts to study the practicality and benefits of cardiopulmonary rehabilitation (CR) programs in this population have been hampered by the heterogeneity of lesions, lack of facilities, and trained personnel to supervise these types of programs. Although there are numerous articles on CR in children with cardiac disease, all suffer from the same basic problems of small sample size, short duration of study, and heterogeneous study populations. The purpose of this review was to first evaluate the current rehabilitation literature on both congenital cardiac defects and acquired abnormalities-in this latter group placing a significant emphasis on cardiomyopathies, as well as the special populations in the peri-transplant period and/or mechanical circulatory support. Second, we discussed what is known about practical approaches to CR for the various types of pediatric-specific cardiac conditions. This limited data will be supplemented by the current approach of our institution to CR in these populations with the understanding that this is by no means a consensus approach to these patients. Finally, we summarized research goals for this growing group of patients. Cardiopulmonary rehabilitation in pediatric congenital and acquired heart disease is currently a field in its infancy. Significant strides have been made for complex heart disease and impaired myocardial function. Current research holds the promise for the development of programs that are practical, scalable, and can be implemented in most clinical sites within the foreseeable future.

Mercy TAPE for Calculation-Free Height Estimation in Pediatric Rehabilitation Patients.

In children, height is an essential element of a pediatric assessment, yet this measure is less likely to occur in nonambulatory children or those with unique disabilities. There is compelling support for surrogate measures; however, many of these are accompanied by limitations. This study was conducted to evaluate whether the U.S. Food and Drug Administration (FDA)-cleared Mercy TAPE could be adopted for height estimation. Development and external validation of a height-estimation method were conducted with retrospectively collected data in nonrehabilitation children. Testing of the model was performed prospectively in a pediatric rehabilitation population. U.S. pediatric rehabilitation outpatient clinic. Data from 19 407 children were used to develop the model. Data from an independent cohort of 1472 children were used for external validation, and the model was tested in 195 pediatric rehabilitation patients. Of the 195 patients, 57% required no wheelchair, 18% could ambulate independently for short distances, 17% could ambulate with an assistive device, and 8% were full-time wheelchair users. Not applicable. Relative error (RE), percentage error (PE), and percent predicted within 10% and 20% of actual height. Height estimated with the modified Mercy TAPE was highly predictive of actual height in nonrehabilitation children in the United States (RE [mean ± SD]: 1.1 ± 5.7 cm; PE [mean ± SD]: 1.0 ± 4.7%). In rehabilitation patients, height was underestimated to a greater extent (RE [mean ± SD]: 3.0 ± 7.4 cm; PE [mean ± SD]: -2.1 ± 5.6%). The Mercy TAPE offers a reasonable approximation of height in ambulatory children, although it slightly underestimates height in the pediatric rehabilitation population. Consequently, this and other surrogate measures may be less suited to examining growth against a reference ambulatory population and more suited to following individual children over time.

Dental implants in children

Dental implant placement is one of the possible modes of rehabilitation in pediatric patients, with conditions such as congenital partial anodontia and traumatic tooth loss. Systematic planning of treatment is required to achieve optimum esthetic and functional outcomes. Growth assessment accompanied with alveolar bone evaluation is mandatory at the planning of implant treatment. For greater outcomes of implant treatments, all the surgical and orthodontic procedures should be well initiated about a year prior to the planned implant placement. In children, greater the physiologic harmony that can be created within the dentition, alveolar bone and skeletal growth changes, higher are the chances of successful implant placement. To determine the optimal individual time point of implant insertion, the status of skeletal growth, the degree of hypodontia, and extension of related psychological stress should be taken into account in addition to the status of the existing dentition and dental compliance of a pediatric patient.

Long-Term Follow-up of Intrastromal Corneal Ring Segment Implantation in Pediatric Keratoconus.

To evaluate efficacy, safety, and stability of Ferrara-type intrastromal corneal ring segment (ICRS) implantation for visual rehabilitation in pediatric patients with keratoconus. This study included patients with keratoconus aged 18 years or younger who had received Ferrara-type ICRS implantation. The uncorrected and corrected distance visual acuities, residual refractive errors, and root mean square for coma-like aberration were recorded preoperatively and at 6 months, 1, 3, and 5 years postoperatively. One hundred eighteen eyes of 88 patients (mean age 16.1 ± 1.89; range 10-18) were studied. All patients were examined at a 6-month follow-up after ICRS implantation, and at the 12-, 36-, and 60-month follow-ups, 97, 71, and 23 eyes were evaluated, respectively. Mean uncorrected distance visual acuity (logarithm of minimum angle of resolution) changed from 0.67 ± 0.37 preoperatively to 0.37 ± 0.30, 6 months after ICRS implantation (P < 0.0001). Mean corrected distance visual acuity increased in turn from 0.19 ± 0.15 to 0.10 ± 0.12 (P < 0.0001). The percentage of eyes with a refractive cylinder ≤2.00 D increased from 30.5% before surgery to 70.3% 6 months later, and the root mean square for corneal coma-like aberration showed a statistically significant decrease (P < 0.001). At the follow-up visits, refractive and visual values remained stable compared with those of the 6-month visit. Our long-term results suggest that Ferrara-type ICRS implantation is a safe, effective, and stable procedure for restoring vision in pediatric patients with keratoconus.

Early Functional Outcomes for Pediatric Patients Diagnosed with Anti-N-Methyl-D-Aspartate Receptor Encephalitis during Inpatient Rehabilitation.

The aims of the current study were to characterize the demographic and clinical presentation of pediatric patients diagnosed with anti-N-methyl-D-aspartate receptor encephalitis who require inpatient rehabilitation, to examine early functional outcomes, and to investigate predictors of early recovery. A retrospective chart review was conducted for 27 pediatric patients diagnosed with anti-N-methyl-D-aspartate receptor encephalitis who received intensive inpatient neurorehabilitation. On average, patients were 10.6 yrs of age (range, 2-18 yrs) at the time of symptom onset. Average time to treatment from symptom onset was 27.2 days (range, 5-91 days). Patients displayed significant improvements between admission and discharge Functional Independence Measure for Children (WeeFIM) Developmental Functional Quotient (DFQ) scores across patients (P < 0.01). Mean Functional Independence Measure for Children Total Developmental Functional Quotient score at admission was 28.6 (range, 15.0-62.6) and at discharge was 54.3 (range, 14.2-91.9). Younger age at onset, seizures, and number of treatments received were associated with worse functional outcomes at discharge. Time to initiate treatment was not found to be associated with early functional outcomes. Pediatric patients diagnosed with anti-N-methyl-D-aspartate receptor encephalitis displayed significant functional gains during inpatient rehabilitation, despite persistent functional deficits at discharge, suggesting the need for ongoing monitoring and intervention. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) Recognize the clinical presentation of anti-N-methyl-D-aspartate receptor encephalitis in pediatric patients, (2) Appreciate the role of rehabilitation in the care of the pediatric patient with anti-N-methyl-D-aspartate receptor encephalitis, and (3) Identify demographic and clinical variables that predict poor functional outcomes after rehabilitation in pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Effect of inpatient rehabilitation on activities of daily living in pediatric cancer patients in Japan.

Most pediatric cancer patients decline physical performance therapy, resulting in limitations in the activities of daily living. The objective of this study was to investigate the effects of rehabilitation in pediatric patients with cancer using the functional independence measure (FIM) score. This retrospective study included 25 inpatient children diagnosed with cancer at a single university hospital from January 2016 to December 2016. All patients underwent rehabilitative intervention during their hospital stay. We investigated the contents of the rehabilitation program and the FIM scores before and after the rehabilitative intervention. The average FIM scores improved in all patients; however, only the total-FIM scores (+4.96 points, P=0.009) and motor-FIM scores (+4.04 points, P=0.005) improved significantly. Conversely, cognitive-FIM score did not significantly improve (+0.92 points, P=0.159). In addition, motor-FIM subgroup scores for locomotion (walk/wheelchair and stairs) were significantly higher (+0.36 points, P=0.039 and +0.64 points, P=0.046, respectively) after rehabilitative intervention, regardless of the length of hospital stay. This study showed that FIM score, particularly motor-FIM score and locomotion subgroup scores, significantly improved owing to participation in inpatient rehabilitation. In conclusion, we found that rehabilitative intervention improved physical activity, especially locomotion.

Nutritional Rehabilitation of Pediatric Patients on Ventricular Assist Device Support

Malnutrition is common in pediatric heart failure (HF). We analyzed whether ventricular assist device (VAD) support allows for nutritional rehabilitation in pediatric patients listed for heart transplantation (HT).