Measurement practices in pediatric rehabilitation: a survey of physical therapists, occupational therapists, and speech-language pathologists in Ontario

We investigated measurement practices in pediatric rehabilitation. We conducted a survey of 63 physical, 72 occupational, and 74 speech-language therapists working in one of 16 children's rehabilitation programs in Ontario, Canada. Therapists were surveyed about their measurement practices, and their confidence, beliefs, and attitudes about measurement. Results showed that standardized clinical measures were used frequently, but were often modified. Clinicians rated themselves as least comfortable with statistical concepts related to the uncertainty in test scores, and rated factors related to finding appropriate measures as the most important influences on their measurement practices. Some variance in measurement attitudes and practices was associated with treatment centre of practice, suggesting that there may be organizational or peer influences on measurement behaviour. The results have implications for continuing education, measurement development, and interventions designed to facilitate sound measurement practices.     

Aging adult children with developmental disabilities and their families: challenges for occupational therapists and physical therapists

The purpose of this article was to review the literature about families of adult children with developmental disabilities, the impact of culture on access to health care services, and community-based health care services for adults with developmental disabilities to answer the following questions: (1) How do parents of adult children with mental retardation and other developmental disabilities describe their caregiving experiences?, (2) What are frequently identified unmet service needs by the parents/families?, (3) Does the family's culture or ethnic background influence how they view their caregiving experiences?, and (4) What are the unique challenges facing families when attempting to access health care services? Currently little information exists about the needs of parents and other family members who live with adults with developmental disabilities. Longitudinal studies and studies to assess the influence of culture on care giving are especially needed. Therapists need to use approaches that will empower children and their families so they can better meet their current challenges and provide a foundation for the skills they will need to meet future challenges as adults.     

Epilepsy: knowledge and attitudes of physiotherapists,occupational therapists,and speech therapists

Physiotherapists, occupational therapists, and speech therapists play a key role in the treatment of children with epilepsy. We performed a survey of therapists’ knowledge of and attitudes towards epilepsy in two regions of Germany, the city of Leipzig and the rural district of Zwickau. Therapists of 29/68 (43%) outpatient practices and 4/9 (44%) hospitals took part. In total, 195 therapists participated: 63 (32%) physiotherapists, 74 (38%) occupational therapists, and 58 (30%) speech therapist. In 65%, epilepsy was subject of vocational training. Of all therapists, 8% claimed they had not treated epilepsy patients so far. During professional life, 43% had witnessed a seizure. Of all therapists, 44% correctly assumed a seizure could result in death. During a seizure, 42% would perform the obsolete measure of placing something solid in the patient’s mouth, and 41% would administer a prescribed rescue medication. More information on epilepsy was requested by 92%.

Conclusion: Most therapists treat patients with epilepsy, and almost half have already witnessed a seizure. Often, however, epilepsy is not subject of vocational training. The risk of a fatal outcome of a seizure is underestimated, and many therapists would perform obsolete measures. Knowledge of seizure management should be transmitted to therapists especially during vocational training.

     

Contemporary trends and practice strategies in pediatric occupational and physical therapy

This paper identifies and reflects on recent trends in pediatric occupational therapy and physical therapy practice. These trends were initially identified by the student authors for a Maternal and Child Health (MCH) leadership seminar, which was conducted as part of the postprofessional graduate program in physical therapy at the University of Washington. Trends were then reviewed and discussed among the student and faculty authors. Consensus was reached on the most important trends, which were subsequently summarized in this paper. The first part of the paper reviews the impact of these trends on current and future clinical practices in health, educational, and community-based settings. The second part of the paper offers proposed directions to meet the challenges presented by the trends in four key areas; (1) research, (2) professional education, (3) enhancing family-centered care, and (4) advocacy.     

Updated competencies for physical therapists working in schools.

PURPOSE: The purpose of this project was to update the 1987 competencies for physical therapists who work in schools and their content to reflect present practice, legislation, and terminology. METHODS: A review of the literature and competencies for professionals working in schools was completed. Four focus groups of school physical therapists were formed to ascertain their perspectives of the roles and responsibilities of school therapists and what knowledge and skills enabled them to be effective. This information was integrated into a listing of competencies. The competencies were reviewed regionally and nationally by experts in the field. RESULTS: Nine content areas with specific competencies were identified for physical therapists working in schools. These competencies reflect an expanded role of school-based therapists compared with previous competencies. CONCLUSION: Physical therapists who work in schools require specific skills and knowledge to effectively serve children with disabilities. Competencies help guide professional development.     

儿童扩张型心肌病临床特征分析

目的了解儿童扩张型心肌病(DCM)临床特点和死亡相关因素。方法对2006—2011年115例DCM患儿临床资料进行整理分析。结果 115例患儿中,男70例(61%),女45例(39%);起病年龄1～180个月,平均(37.61±4.84)个月,起病≤1岁者占54%(62/115);初诊心功能Ⅲ～Ⅳ级者62.5%(72/115)。左室射血分数、左室缩短分数在心功能Ⅰ～Ⅱ级组[(33.0±7.9)%、(16.1±4.4)%]明显高于Ⅲ～Ⅳ级组[(29.2±7.5)%、(13.6±3.8)%](P<0.05);起病年龄≤1岁、～10岁、>10岁三组患儿经体表面积标准化的左房内径、左心室舒张末期内径、左心室收缩末期内径逐渐减小;Ⅲ～Ⅳ级组的cTnI、CK、CK-MB值均明显高于心功能Ⅰ～Ⅱ级组(P<0.05)。确诊时心功能级数(P<0.01)、左室射血分数(P<0.05)、左室缩短分数(P<0.05)是扩张型心肌病死亡相关因素。结论儿童扩张型心肌病确诊时≤1岁患儿最多,多为心功能Ⅲ～Ⅳ级,初诊年龄及心功能级别对患儿预后有明显影响;DCM患儿初诊心功能评估、超声心动图心功能参数可作为预测病情的指标。     

儿童髓母细胞瘤的临床特点及预后相关因素分析

目的通过分析儿童髓母细胞瘤的临床特点、治疗方法和患者预后的关系,探索影响儿童髓母细胞瘤预后相关因素。方法收集2004年至2014年复旦大学附属儿科医院收治且术后病理证实为髓母细胞瘤患儿的病例资料,对所收集数据进行分组,采用单因素Kaplan-Meier法进行生存分析,统计各组病人的总体生存时间及累计生存率,采用Log-Rank检验分析各组病人累计生存率差异,采用Cox回归进行多因素分析,探讨儿童髓母细胞瘤临床因素与生存时间、生存结局的关联性。结果单因素分析结果认为,临床症状阳性数(P=0.039)、M分期(P=0.009)、术后放疗(P=0.001)、术后化疗(P=0.018)、肿瘤复发(P=0.04)是髓母细胞瘤患儿预后的影响因素;Cox多因素分析结果认为术后放疗(OR=0.291,95%置信区间:0.120~0.706,P=0.006)和化疗(OR=0.095,95%置信区间:0.024~0.384,P=0.001)是影响髓母细胞瘤患儿预后的保护因素;性别、年龄、肿瘤位置、T分期、肿瘤切除程度、病理分型等因素未发现与预后有关(P>0.05)。结论术后是否接受放疗、化疗对患儿预后影响较大,而临床症状的个数、M分期、肿瘤复发对患儿预后的判断价值有限,性别、年龄、肿瘤位置、T分期、肿瘤切除程度、病理分型等因素则与预后无关。     

儿童再生障碍性贫血临床特点及临床分型探讨

目的探讨儿童再生障碍性贫血(再障)临床特点及临床分型。方法2003-01—2005-12在中山大学附属第二医院儿科确诊儿童再障50例,年龄2～15岁,其中37例接受免疫抑制治疗(IST),观察再障发病诱因、临床表现、血象、骨髓象变化特点、临床分型及治疗转归。结果86%的儿童再障为特发性,70%患儿病程≤6个月,按疾病严重程度分型,临床诊断重型再障(SAA)38例,轻型再障(MAA)12例,骨髓有核细胞增生程度除与病情严重程度相关外,还与取材部位、病程及是否接受IST等因素有关。特发性再障患儿强化IST(IIST)及单用环孢菌素A(CsA)治疗6个月有效率分别为78.3%(18/23)和40.0%(4/10,χ2=4.59,P<0.05),多数患儿于IIST后2～3个月起效,仅1例病程2年余的SAA于IIST后7个月达部分缓解。结论儿童再障多数为特发性,起病急,病情重,临床表现及血象改变严重程度与骨髓增生减低程度相关,特发性再障患儿IIST疗效显著优于单用CsA治疗者,宜按国际标准根据病情严重程度分为重型和轻型。     

儿童炎症性肠病临床及结肠镜下特点分析

目的 探讨儿童炎症性肠病的临床特点,分析结肠镜及活组织学检查对疾病诊断的重要性.方法 研究在我院住院的34例炎症性肠病患儿的临床表现、实验室检查、结肠镜下特点及活检组织学特点,分析其诊断价值.其中克罗恩病(CD)10例,溃疡性结肠炎(UC)24例.结果 CD组中,轻-中度活动型4例,重度活动型6例.临床表现以腹痛多见(80%,8/10);并发症:肠穿孔1例,肠梗阻2例,肛瘘2例.UC组中,轻度5例,中度14例,重度5例.临床表现以腹泻为主(23/24,96%);肛周疾病3例,并发慢性肠套叠1例.CD组血沉、C反应蛋白水平较UC组高(X2=15.938、11.184,P均<0.01).10例CD中,小肠结肠型6例(60%),结肠型1例(10%),小肠捌3例(30%).结肠镜下表现有节段性分布、溃疡多样性、修复性改变、部分肠管狭窄僵硬等特点.24例UC中,全结肠累及者6例(25%),乙状结肠、直肠累及者14例(58%),左半结肠累及者7例(29%),结肠镜下表现为连续性黏膜充血水肿、糜烂,多发浅溃疡多见,溃疡多不规则,7例(29%)可见假息肉形成,黏膜桥未见.CD活检组织学均有淋巴细胞浸润,1例见裂隙状溃疡,2例见上皮性肉芽肿.UC活检标本均有多量中性粒细胞、淋巴细胞、浆细胞等炎性细胞浸润表现,其中4例(17%)见隐窝脓肿.结论 儿童炎症性肠病的临床特点具有非特异性,结肠镜结合组织活检对UC的诊断有可靠的价值.对于结肠型或小肠结肠型CD,结肠镜检查有重要意义,组织活检特异性不高,可多部位、深凿活检以提高阳性率,协助诊断.     

Clinical and epidemiological characteristics of retinoblastoma: correlation with prognosis in a Turkish pediatric oncology center

Advanced intraocular tumors and metastatic disease in retinoblastoma patients still occur frequently in developing countries. The aim of this retrospective study was to describe the clinical and epidemiological characteristics of patients with retinoblastoma and the effects of these features on disease prognosis in the authors' pediatric oncology unit as a developing country profile to define the problem. A retrospective chart review of 91 patients who presented to the unit between May 1996 and December 2003 was conducted in this study. Patients with unilateral disease presented at a median age of 24 months and those with bilateral disease at a median age of 9.5 months (p < .01). Most of the eyes with retinoblastoma (68.6%) had Reese-Ellsworth stage V disease. Metastatic disease was diagnosed in 19 (20.9%) patients. Cases with metastatic disease presented at a median age of 24 months and those without metastatic disease at a median age of 12.5 months (p < .05). In 31 patients (34.1%) there was a delay in diagnosis. The enucleation ratio in eyes with advanced intraocular stage was significantly higher than in eyes with early intraocular stage (57.9 vs. 3.8%) (p < .001). In patients with metastatic disease, tumor recurrence was more frequent than in the nonmetastatic patients (36.8 vs. 4.2%) (p < .01). Seven children (7.7%) died due to central nervous system (CNS) metastasis (p < .01). Advanced intraocular disease and distant metastases occur more frequently in Turkish children with retinoblastoma than in children in developed countries, causing a higher rate of enucleation and mortality. Late referral might account for the delayed diagnosis.