Motivation in pediatric motor rehabilitation: A systematic search of the literature using the self-determination theory as a conceptual framework

Objective: Motivation is suggested as an important factor in pediatric motor rehabilitation. Therefore, we reviewed the existing evidence of (motivational) motor rehabilitation paradigms, and how motivation influences rehabilitation outcome using self-determination theory as conceptual framework. Methods: PubMed and Web-of-Science databases were systematically searched until June 2015. Data were independently extracted and critiqued for quality by three authors. Studies reporting motivational aspects were included. Most studies examined new technology (e.g., virtual reality [VR]). Results: Out of 479 records, three RCT, six case-control, and six non-comparative studies were included with mixed quality. Motivation was rarely reported. Training individualization to the child’s capabilities with more variety seemed promising to increase motivation. Motivation increased when the exercises seemed helpful for daily activities. Conclusions: Motivation in pediatric rehabilitation should be comprehensively assessed within a theoretical framework as there are indications that motivated children have better rehabilitation outcomes, depending on the aspect of motivation.     

Evaluation of an Intervention to Increase Self-Efficacy for Independent Exercise in Cardiac Rehabilitation

Adherence to independent exercise is an essential outcome of cardiac rehabilitation (CR), yet limited theory-based interventions to improve adherence exist. This study tested the effects of an intervention based on Bandura's conceptualization of self-efficacy. The self-efficacy coaching intervention (SCI), a supplement to standard care, was designed to increase self-efficacy for independent exercise and independent exercise behavior in CR. We examined whether the SCI vs. attention control (AC) resulted in improved exercise self-efficacy (ESE), barriers self-efficacy (BARSE), and minutes of independent exercise for CR participants (n = 65). While between-group differences did not reach significance (p > .10) for any of the outcome measures, significant within-group changes were noted in BARSE scores and independent exercise (p < .001) for the SCI group. Change in independent exercise for the AC group was also significant (p =. 006). Further study is needed to explore whether short-term changes translate into maintenance of independent exercise participation after program completion.     

剖宫产术后应用妇产康复仪催乳的临床疗效分析

目的:探讨剖宫产术后采用妇产康复仪催乳的临床效果。方法:将80例足月剖宫产产妇随机分为对照组和实验组各40例,对照组给予常规母乳喂养指导,实验组则另加妇产康复仪进行催乳治疗。观察比较两组的初始泌乳时间、泌乳量、新生儿哺乳5天后的体重。结果:实验组的初始泌乳时间多在术后24～48 h,明显早于对照组的72 h(P<0.05);术后24h、48 h、72 h实验组的泌乳量均明显多于对照组(P<0.05);术后5天实验组新生儿的平均体重明显重于对照组(P<0.05)。结论:妇产康复仪用于剖宫产后产妇催乳的效果显著,值得推广。     

“精准医学”理念下康复治疗人才培养的思考与实践

随着精准医学理念不断深入人心和"健康中国"国家战略的深入实施,患者对医疗水平的要求越来越高,康复医疗已向"精准康复"方向发展。作为人才培养的高等医学教育也必须顺应这种新的医学模式。我国康复治疗人才培养起步较晚,目前仍以"综合"康复治疗师培养为主,这种"庞杂"的康复治疗人才培养模式,与国际上专业分化培养的现状不接轨,导致培养的人才不精不专,甚至无法与国际专业组织及人员进行对话。这就要求我们要逐步改革目前康复治疗专业教育模式,构建与国际接轨、符合精准医学理念的人才培养模式。文章立足于国内康复治疗人才培养现状,从专业设置分化、课程体系和教学内容设立、教学师资队伍建设、教育教学模式和教学手段改革、临床实习带教队伍建设等5个方面,阐述了如何开展分方向培养康复治疗人才,培养符合精准医学理念的、满足国际国内需求的高、精、专高水平合格人才,以迎接精准医学教育时代的到来。     

Remediation of learning difficulties in children after treatment for a cerebellar medulloblastoma: A single-case study

In the process of establishing a methodology for individualized remediation programmes in children treated for cerebellar tumour, this study followed prospectively over 11 years a young child treated for a medulloblastoma at 18 months of age throughout the rehabilitation process. Repeated neuropsychological and academic evaluations evidenced temporary disruptive behaviour, deficient manual and visual abilities, attention and working memory difficulties, but preserved language abilities, in relation with vermian and left cerebellar damage. However, the described remediation programmes and interventions allowed the child to have fluent progression in school. Limits and benefits of rehabilitation are discussed.

Con el propósito de establecer una metodología para los programas de remedio individualizados en niños tratados por tumores cerebelares, se estudiaron en forma prospectiva durante 11 años a niños de 18 meses de edad tratados por un meduloblastoma, a lo largo del proceso de rehabiitación. En relación al daño cerebelar y vermiano se pusieron en evidencia, a través de evaluaciones académicas y neuropsicológicas aplicadas en forma repetida, una conducta alterada en forma temporal, una deficiencia en las habilidades visuales y manuales, y la presencia de dificultades en la atención y en la memoria de trabajo, pero sin alteraciones en el lenguaje. Sin embargo, los programas de remedio y las intervenciones descritos le permitieron al niño tener una progreso correcto en la escuela. Se discuten los beneficios y los límites de la rehabilitación. Palabras clave: Cerebelo, meduloblastoma, remedio, resultado, rehabilitación en equipo     

快速康复护理模式在骨科患者围手术期中的应用

目的研究骨科患者围手术期应用快速康复护理模式的效果。方法选取2017年5月—2019年12月本院收治的100例骨科手术患者,分为两组,各50例。对照组行常规护理,观察组行快速康复护理模式,对比两组护理满意度、运动功能评分、生活质量评分、并发症的发生情况。结果观察组的护理总满意率为98.0%,高于对照组的82.0%,P<0.05;护理后,观察组的运动功能、生活质量评分分别为(81.48±1.87)分、(90.15±1.85)分,均高于对照组,P<0.05;观察组的并发症发生率为4.0%,低于对照组的20.0%,P<0.05。结论快速康复护理模式应用于骨科患者围手术期,可有效减少并发症情况,提高患者生活质量,进而提高护理满意度。     

Multidisciplinary intestinal rehabilitation in acute type II intestinal failure: Results from an intestinal rehabilitation team

BackgroundType II (acute) intestinal failure (IF) is usually caused by complications of abdominal surgery resulting in enteric fistulas or proximal stomas and requires parenteral nutrition (PN) for several months. This study aimed to evaluate clinical management and outcome of type II IF patients in a single center.MethodsMedical records of patients referred to the Intestinal Rehabilitation Team (IRT) at Samsung Medical Center (Seoul, Korea) were retrospectively analyzed.ResultsFrom 2014 to 2019, 34 patients with IF were referred. 28 patients were type II IF and were included in the analysis. There were 17 males and 11 females. Mean age of patients was 56.7 years. Pathophysiology of IF were high-output stoma in 16 cases, extensive bowel resection (with bowel in continuity) in 7 cases, and enterocutaneous fistula in 5 cases. The catastrophic events necessitating abdominal surgery in the patients were adhesive ileus in 9 cases, superior mesenteric artery thrombosis in 8 cases, internal herniation of bowel in 5 cases, traumatic bowel injury in 3 cases, and ischemic enteritis in 3 cases. Following medical and surgical rehabilitation, 10 patients (35.7%) were weaned off PN and overall mortality was 28.5%. Deaths were related to progression of underlying malignancies in 4 cases, liver failure in 3 cases, and sepsis in 1 case. Thirteen patients underwent surgery to restore bowel continuity. Six postoperative complications occurred in 4 patients (30.7%) and there were no postoperative mortalities.ConclusionStandardized care including restorative surgery resulted in successful outcomes in type II IF patients in this cohort.     

Validation of the relation between the type and amount of seating support provided and Level of Sitting Scale (LSS) scores for children with neuromotor disorders

Objectives: To assess the construct validity of the Level of Sitting Scale (LSS) by examining the relationship between LSS scores and the type and amount of seating supports.

Methods: Secondary analysis of the data for 114 children ≤18 years, with neuromotor disorders who participated in a responsiveness study of the Seated Postural Control Measure.

Results: A significant inverse relationship (Spearman rho?=??0.42, p?<?0.05) was found between LSS scores and amount of seating support provided. Statistically significant differences were also revealed between LSS levels of sitting ability (p?<?0.004) and pelvic, thigh, trunk and head seating components and type of seating system, using Kruskal-Wallis test.

Conclusion: This study provides evidence of construct validity for the LSS in use as a discriminative measure of sitting ability in children with neuromotor disorders. Further validation is justified. Clinically intuitive associations between sitting ability and seating interventions were confirmed.