Faculty Bibliography

IMPORTANCE/OBJECTIVE:Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. OBJECTIVE:To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. DESIGN/METHODS:Pilot study. Assessments were performed pretreatment and immediately posttreatment. SETTING/METHODS:Hospital-based outpatient occupational therapy department. PARTICIPANTS/METHODS:Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. INTERVENTION/METHODS:Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. OUTCOMES AND MEASURES/METHODS:Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). RESULTS:All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. CONCLUSIONS AND RELEVANCE/CONCLUSIONS:This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.

In this commentary, a medical student reflects on the promise of artificial intelligence (AI) in mitigation of physician burnout and moral injury. The rapid introduction of AI technologies may present a challenge to medical professionals, especially those engaged in the transdisciplinary care of children with disabilities.

This case report details the complex case of an adolescent patient with chondroblastic osteosarcoma in the setting of Li-Fraumeni syndrome, leading to hemipelvectomy and post-operative complications. International Classification of Functioning principles were used as a roadmap for optimization of functional restoration and transition of care coordination.

This article describes the experience of a resident physician on the burnout-prone demands of postgraduate training during rapidly evolving integration of technology including artificial intelligence.

STUDY DESIGN/METHODS:International multicentre cross-sectional study. OBJECTIVES/OBJECTIVE:To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. SETTING/METHODS:Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. METHODS:An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. RESULTS:The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. CONCLUSIONS:As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.

PURPOSE/OBJECTIVE:Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI. METHODS:A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with ≥20 adolescents aged 13-17 years at least 6 months' post rehabilitation. RESULTS:Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents' plans for the future. CONCLUSION/CONCLUSIONS:Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.

This case report details the complex rehabilitation of an adolescent patient with congenital heart disease with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) who presented with a sudden cardiac arrest. The International Classification of Functioning, Disability and Health for Children and Youth, World Health Organization (ICF-CY WHO) principles were used to guide the course of the patient's acute inpatient rehabilitation.

An aneurysmal bone cyst (ABC) is a benign lesion often found in long bones. Almost one third of ABCs are secondary to primary tumors. When found in the spine, ABCs can cause insidious back pain and, in rare cases, neurological deficits. This case will discuss an adolescent female who acquired a non-traumatic spinal cord injury (NTSCI) as a result of complications from an aneurysmal bone cyst. Treatment consisted of surgical removal of the cyst, laminectomy, corpectomy, and fusion of the thoracic spine. Following surgical intervention, the child spent several weeks in an acute inpatient pediatric rehabilitation facility. Goal oriented outpatient services facilitated further recovery and led to near complete resolution of symptoms associated with non-traumatic spinal cord injury. Contemporary and clinically oriented child and family interventions are essential in successful rehabilitation of children with NTSCI as a result of ABCs.