ABSTRACT
The immature central nervous system is recognized as having substantial neuroplastic capacity. In this study, we explored the hypothesis that rehabilitation can exploit that potential and elicit reciprocal walking in nonambulatory children with chronic, severe (i.e., lower extremity motor score < 10/50) spinal cord injuries (SCIs). Seven male subjects (3-12 years of age) who were at least 1-year post-SCI and incapable of discrete leg movements believed to be required for walking, enrolled in activity-based locomotor training (ABLT; clinicaltrials.gov NCT00488280). Six children completed the study. Following a minimum of 49 sessions of ABLT, three of the six children achieved walking with reverse rolling walkers. Stepping development, however, was not accompanied by improvement in discrete leg movements as underscored by the persistence of synergistic movements and little change in lower extremity motor scores. Interestingly, acoustic startle responses exhibited by the three responding children suggested preserved reticulospinal inputs to circuitry below the level of injury capable of mediating leg movements. On the other hand, no indication of corticospinal integrity was obtained with transcranial magnetic stimulation evoked responses in the same individuals. These findings suggest some children who are not predicted to improve motor and locomotor function may have a reserve of adaptive plasticity that can emerge in response to rehabilitative strategies such as ABLT. Further studies are warranted to determine whether a critical need exists to re-examine rehabilitation approaches for pediatric SCI with poor prognosis for any ambulatory recovery.
Subject(s)
Movement Disorders , Spinal Cord Injuries , Humans , Male , Child , Reflex, Startle , Walking/physiology , Gait , Lower Extremity , Recovery of Function , Spinal CordABSTRACT
PURPOSE: A multi-institutional and multidisciplinary pediatric physical medicine rehabilitation healthcare system was developed to meet regional patient needs. METHODS: A ten-year experience meeting regional patient care needs in northeast Florida and southern Georgia is described. RESULTS: A collaborative effort of multiple institutions resulted in the recruitment of a pediatric physical medicine and rehabilitation physician in June 2009, followed by planning stages that included initiation, development, and structuring of the program. PHASE I: selection of clinic spaces, training of existing staff, creating specialized programs. PHASE II: recruitment of an additional physician and dedicated advanced practice registered nurse, hospital nursing and radiology personnel training, development of protocols for specific disease entities, formulating a team approach for patient care, development of dedicated clinics for disease processes. Phase III: incorporating care into existing multidisciplinary clinics, education of existing physical, occupational, and speech therapists in dedicated remote clinics on early detection and management of specialty issues. Phase IV: ongoing education provided by rehabilitation faculty. Quality improvement aspects included outcome studies, coordinating with the Cerebral Palsy Research Network databank, and others. All phases overlapped in time and are ongoing, adapting to new needs. CONCLUSION: A collaborative program can be created to provide comprehensive pediatric physical medicine and rehabilitation in regions lacking such a system.
Subject(s)
Delivery of Health Care , Physical and Rehabilitation Medicine , Child , Humans , Quality ImprovementABSTRACT
We describe the initiation and development of a comprehensive multidisciplinary and multi-institutional program for the evaluation and management of youth with spasticity. A descriptive step-by-step process of the administrative and organizational sequence of the development of the program is delineated. The Spasticity Clinic now meets regularly, and multiple diagnostic and treatment modalities are performed. This experience may assist those that wish to initiate a similar venue for youth with spasticity.
Subject(s)
Muscle Spasticity/rehabilitation , Muscle Spasticity/therapy , Neurosurgery/organization & administration , Patient Care Team/organization & administration , Pediatrics/organization & administration , Ambulatory Care Facilities/organization & administration , Child , Humans , Occupational Therapy/organization & administration , Orthopedics/organization & administration , Physical Therapy Specialty/organization & administration , Pilot Projects , Program Development , Quality Improvement/organization & administrationABSTRACT
BACKGROUND: Expeditious care within minutes of severe injury improves outcome and is the driving force for development of trauma care systems. Transition from hospital care to rehabilitation is an important step in recovery after trauma-related injury. We hypothesize that delay in the transition from acute care to rehabilitation adversely affects outcome and diminishes recovery after traumatic brain injury (TBI). METHODS: After institutional review board approval, the trauma registry of our regional level I pediatric trauma center was queried for all children with severe blunt TBI (initial Glasgow Coma Scale score
Subject(s)
Brain Injuries/rehabilitation , Wounds, Nonpenetrating/rehabilitation , Child , Female , Humans , Injury Severity Score , Male , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To measure the effect of behavior management training on restraint use and prn medication delivery on an acute inpatient brain injury unit. SETTING/PARTICIPANTS: Interdisciplinary staff and hospitalized brain injury patients on a 20-bed unit within a freestanding rehabilitation hospital. INTERVENTION: Staff participated in the Nonviolent Crisis Intervention (NCI) program from the Crisis Prevention Institute. MAIN OUTCOME MEASURES: Applied physical restraints and delivered prn medications. RESULTS: Despite comparable patient levels of agitation severity across the duration of the study, the use of physical restraints initially declined and then increased after training. Data collected on prn medication delivery also indicated a trend for an increase in the delivery of select medication categories across time. CONCLUSION: NCI training resulted in a temporary, short-lived reduction in physical restraint use, but had an inverse effect on prn medication delivery for select categories of medication. Medication delivery significantly increased over time and restraint use eventually exceeded baseline level. Ramifications of these results are discussed.
