Técnicas sensoriales específicas y modificaciones sensoriales ambientales para niños y jóvenes con dificultades de integración sensorial: una revisión sistemática / Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: a systematic review

Este trabajo realiza una revisión sistemática de intervenciones sensoriales distintas de la Integración Sensorial de Ayres, realizando un análisis de investigaciones que utilizan técnicas sensoriales específicas y modificaciones ambientales, publicadas entre 2007 y 2015. De los trabajos analizados, 8 cumplen con los criterios de inclusión-exclusión. Excepto el masaje Qigong, con una evidencia de moderada a fuerte y la modificación ambiental de una clínica dental, con evidencia moderada, el resto de técnicas obtienen una evidencia limitada. De esta forma, los terapeutas ocupacionales deben realizar estudios con calidad metodológica suficiente que nos ayuden a delimitar la eficacia de las técnicas e intervención que se utilizan a nivel sensorial, elegir las técnicas de tratamiento que mejor evidencia tengan para ayudar a los clientes con dificultades sensoriales a mejorar su desempeño ocupacional y continuar formándose en Integración Sensorial

This paper carries out a systematic review of sensory interventions, different than Sensory Integration of Ayres, making an analysis of research using specific sensory techniques and sensory environmental modifications, between 2007 and 2015. At the end, 8 works meet the inclusion-exclusion criteria. Except Qigong massage, with moderate to strong evidence, and the environmental modification of a dental clinic, with moderate evidence, the rest of techniques show limited evidence. So occupational therapists must perform studies with methodological quality enough to help us to define the effectiveness of the techniques and interventions used for sensory disfunctions, to choose the best evidence treatment techniques to help clients with sensory difficulties to improve their occupational performance and as professionals, we must be trained in Sensorial Integration and other sensory techniques

Caracterización de pacientes ingresados en consulta de atención temprana. Policlínico Jimmy Hirzel, 2018 / Characterization of patients admitted to early care consultation. Jimmy Hirzel Polyclinic, 2018

La Atención Tempana (AT) reduce los efectos de las discapacidades o de los factores de riesgo y optimiza, en la medida de lo posible, el curso del desarrollo del niño. Se realizó un estudio observacional descriptivo de corte transversal para caracterizar a los niños que recibieron tratamiento rehabilitador en la consulta de AT del policlínico Jimmy Hirzel, durante el año 2018. El universo estuvo constituido por 1560 casos atendidos en la consulta durante ese periodo y la muestra la conformaron los 199 casos ingresados para tratamiento en el Servicio de Rehabilitación Integral. Los datos fueron tomados de la base de datos de los registros estadísticos del centro y de las historias clínicas individuales. Se emplearon como medidas de resumen, de la estadística descriptiva, las frecuencias absolutas y relativas. Como resultados principales, el 44,2 por ciento de los casos fue remitido por retardo del desarrollo psicomotor, siendo más frecuentes los niños menores de seis meses de edad (38,7 por ciento), del sexo femenino (53,8 por ciento), con antecedentes perinatales positivos (83,9 por ciento) y del área urbana Jesús Menéndez (46,7 por ciento). La evoluciónn fue favorable en la mayoría de los casos(AU)

Early Attention (TA) reduces the effects of disabilities or risk factors and optimizes, as far as possible, the course of the child's development. A descriptive cross-sectional observational study was conducted to characterize children who they received rehabilitative treatment in the AT clinic of the Jimmy Hirzel polyclinic during 2018. The universe consisted of 1,560 cases attended in the clinic during that period and the sample was made up of 199 cases admitted for treatment at the Comprehensive Rehabilitation Service. The data was taken from the database of the statistical records of the center and from the individual medical records. Absolute and relative frequencies were used as summary measures of descriptive statistics. As main results, 44.2 percent of the cases were referred for retardation of psychomotor development, being more frequent the children younger than six months of age (38.7 percent), of the female sex (53.8 percent), with a history positive perinatals (83.9 percent) and Jesús Menéndez urban area (46.7 percent). The evolution was favorable in most cases(EU)

Tools for the assessment of neuropsychomotor profile in the rehabilitation of children with central nervous system tumor: a systematic review.

OBJECTIVE: This study reviews the scientific literature to identify and describe which assessment tools (ATs) are used in pediatric oncology and neuro-oncology rehabilitation and which development neuropsychomotor (DNPM) ATs were built for children with central nervous system (CNS) tumors. METHODS: A systematic review was performed searching PubMed, CINAHL, PEDro, Science Direct, and Catalog of National Institute of Tumors databases and specialized journals. The search covered 7 years (2010-2017) and used relevant keywords in different combinations. A further search was carried out on DNPM rehabilitation manuals and academic thesis. RESULTS: The review retrieved 35 eligible articles containing 63 ATs. The most common ATs were the Behavioral Rating Inventory of Executive Function (BRIEF) and the Wechsler Intelligence Scale for Children (WISC). Most of the ATs covered a single area of child development among behavioral/psychological, cognitive, and motor areas. A total of 159 ATs were found in manuals and thesis, and only 17 of them were already identified in the journal search. None of the ATs identified in both searches had been specifically developed for children with CNS tumor. CONCLUSION: The results highlight the need to develop and validate a global multidimensional AT for children with CNS tumor, overcoming the fragmentation of the assessment procedures and promoting standardized rehabilitation protocols.

Feasibility of six-point Goal Attainment Scale among subacute and chronic stroke patients.

Feasibility of six-point Goal Attainment Scale among stroke patients were examined. Thirty-five subacute and chronic stroke patients with upper limb function problems were included (December 2015-March 2017). Sixty-minute conventional therapy and 30-minute occupational therapy was provided on every consecutive weekday, for 4 weeks. Beside Functional Independence Measure, Action Reach Arm test, Fugl-Meyer upper extremity assessment motor function subtest and six-point Goal Attainment Scale were collected. The content of the previous tests was linked with International Classification of Functioning, Disability and Health domains. Feasibility characteristics were checked according to previous feasibility studies and the following aspects: acceptability, demand, implementation, practicality, integration, and expansion. Data analysis was done in 2018. Participants' global functions were described with the Functional Independence Measure median points were 116.5. All of the outcome measures showed significant improvement at group level (P < 0.001). Most of the goals matched to one or more International Classification of Functioning, Disability and Health domains but were not covered with the Action Reach Arm test or the Fugl-Meyer tests. Association between clinically relevant change of the first Goal Attainment Scale and the other tests was not significant. Six-point Goal Attainment Scale proved to be a feasible outcome measure among subacute and chronic stroke participants. It completed the functional picture of a patient, beside standardized measures. Further studies needed to complete the psychometric properties of six-point Goal Attainment Scale among stroke patients and in other patient groups.

The effect of motor imagery and mirror therapy on upper extremity function according to the level of cognition in stroke patients.

This study was conducted to investigate the effects of motor imagery (MI) and mirror therapy (MT) on upper extremity function according to the level of cognition in stroke patients. Twenty-four participants who were diagnosed with stroke were divided into a mild cognitive group (n = 12) and a severe cognitive group (n = 12). Then, the two groups were again divided into MI group (n = 6) and MT group (n = 6). The participants were evaluated for function of upper extremity using the Box and Block Test (BBT), the Jebsen-Taylor Hand Function Test (JTHFT), and Manual Function Test (MFT). There were significant differences between the two groups of cognitive function of mild level in the post-test of JTHFT (p < 0.05). In the MI group, significant differences were found in the pre- and post-test scores for all variance (p < 0.05). In the MT group, significant differences were found in the pre- and post-test scores for JTHFT and MFT (p < 0.05). There were significant differences between the two groups of cognitive function of severe level in the post-test of all variances (p < 0.05). Furthermore, in the MT group, significant differences were found in the pre- and post-test scores for all variances (P < 0.05). The results of this study suggest that applying MI to the mild cognitive group is effective and that applying MT to the severe cognitive group is effective.

Influence of Attentional Focus Instructions on Motor Performance Among Adolescents With Severe Visual Impairment.

Substantial research has demonstrated that an external (vs. internal) attentional focus enhances motor performance among various populations. Interest has recently grown in examining the effects of attentional focus among individuals with visual impairments (VI), and, to date, research results have been conflicting with some studies supporting a potential benefit to an external focus among adults with VI, while a study of children with severe VI was inconclusive regarding this benefit. The present investigation compared the effects of an internal versus an external attentional focus on a discrete throwing task among adolescents with severe VI. We recruited 13 participants with a visual acuity score of less than 6/60 and had them throw a Goalball (25 cm ball with bells often used in competitive sports designed for people with VI) as fast as possible for three familiarization trials, three internal focus trials, and three external focus trials. These participants threw the ball with significantly higher velocity when using an external focus than in other conditions, indicating a benefit from an external focus for this population when performing this discrete task.

Optimized and Predictive Phonemic Interfaces for Augmentative and Alternative Communication.

Purpose We empirically assessed the results of computational optimization and prediction in communication interfaces that were designed to allow individuals with severe motor speech disorders to select phonemes and generate speech output. Method Interface layouts were either random or optimized, in which phoneme targets that were likely to be selected together were located in proximity. Target sizes were either static or predictive, such that likely targets were dynamically enlarged following each selection. Communication interfaces were evaluated by 36 users without motor impairments using an alternate access method. Each user was assigned to 1 of 4 interfaces varying in layout and whether prediction was implemented (random/static, random/predictive, optimized/static, optimized/predictive) and participated in 12 sessions over a 3-week period. Six participants with severe motor impairments used both the optimized/static and optimized/predictive interfaces in 1-2 sessions. Results In individuals without motor impairments, prediction provided significantly faster communication rates during training (Sessions 1-9), as users were learning the interface target locations and the novel access method. After training, optimization acted to significantly increase communication rates. The optimization likely became relevant only after training when participants knew the target locations and moved directly to the targets. Participants with motor impairments could use the interfaces with alternate access methods and generally rated the interface with prediction as preferred. Conclusions Optimization and prediction led to increases in communication rates in users without motor impairments. Predictive interfaces were preferred by users with motor impairments. Future research is needed to translate these results into clinical practice. Supplemental Material https://doi.org/10.23641/asha.8636948.

Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury.

Background: In synergy with the mounting scientific evidence for the capacity of recovery after spinal cord injury (SCI) and training, new evidence-based therapies advancing neuromuscular recovery are emerging. There is a parallel need for outcome instruments that specifically address recovery. The Pediatric Neuromuscular Recovery Scale (Pediatric NRS) is one example with established content validity to assess neuromuscular capacity within task performance. Objective: The objective of this study was to determine interrater reliability of the Pediatric NRS to classify motor capacity in children after SCI. Methods: Pediatric physicians (3), occupational therapists (5), and physical therapists (6) received standardized training in scoring the scale, then rated video assessments of 32 children post SCI, 2-12 years of age, 78% non-ambulatory. Interrater reliability was analyzed using Kendall coefficient of concordance for individual Pediatric NRS items and overall score. Results: The interrater reliability coefficient was determined to be near 1 for the overall Pediatric NRS score (ICC = 0.966; 95% CI, 0.89-0.98). Twelve of 16 individual items exhibited high concordance coefficients (Kendall's W ≥ 0.8) and four items demonstrated concordance coefficients, < 0.8 and > 0.69. Interrater reliability was equivalent among groups defined by age and neurological level, but lower among non-ambulatory individuals. Conclusion: Strong interrater reliability was demonstrated by pediatric clinicians who scored children with SCI using the Pediatric NRS.

Surgical and Nonsurgical Treatment of Penetrating Spinal Cord Injury: Analysis of Long-term Neurological and Functional Outcomes.

Objective: To describe long-term neurological and functional outcomes for patients with penetrating spinal cord injury (PSCI) following surgical (SX) and nonsurgical (NSX) treatment. Methods: We identified all patients with PSCI in the Spinal Cord Injury Model Systems database from 1994-2015. Patients with PSCI were divided into surgical (SX) and nonsurgical (NSX) groups. Outcomes were measured using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Functional Independence Measure (FIM) motor scores. Outcomes were then analyzed separately for patients with complete and incomplete PSCI during acute hospitalization, SCI rehabilitation, and 1-year follow-up. Results: For patients with complete PSCI, acute hospital length of stay (LOS) was increased in the SX group (19 days vs 14 days; p < .0001) while median FIM motor scores were similar at 1-year follow-up (74 vs 75; p = .4). The percentage of patients with complete PSCI remained similar between groups at discharge from SCI rehabilitation (88% vs 88%; p = 0.5). For patients with incomplete PSCIs, acute hospital LOS was similar between groups (13 vs 11; p = .3) and no difference was observed in ASIA Impairment Scale improvement at discharge from rehabilitation (38% vs 37%; p = .9) or in FIM scores at 1 year (84 vs 85; p = .6). Conclusion: Surgery for patients with complete PSCI is associated with increased acute hospital LOS for complete PSCI and is not associated with improvement in neurological or functional outcomes in patients with either complete or incomplete PSCI.

Use of a robotic walking aid in rehabilitation to reduce fear of falling is feasible and acceptable from the end user's perspective: A randomised comparative study.

Objectives To determine the acceptability and feasibility of the use of a robotic walking aid to support the work of physiotherapists in reducing fear of falling in the rehabilitation of elderly patients with 'psychomotor disadaptation' (the most severe form of post-fall syndrome). Study design 20 participants with psychomotor disadaptation admitted to an academic rehabilitation ward were randomised to receive physiotherapist care supported by the SafeWalker® robotic walking aid or standard care only, for ten days. SafeWalker® supports the body weight whilst securing postural stability without relying on upper body strength or high cognitive demand. Main outcome measures The primary outcome was the feasibility and acceptability of rehabilitation sessions at five and ten days based on (i) questionnaires completed by patient and physiotherapist, (ii) the number of steps performed during sessions, (iii) replacement of a robotic session by a conventional one. Results The mean age of the participants was 85.2 years. They had lost their ability to perform some basic living activities. Patients in the intervention group found that the rehabilitation sessions were easier (p = 0.048). No robotic rehabilitation session had to be replaced by conventional rehabilitation. There were no statistical differences between the two groups on the other outcome measures. Conclusion We demonstrated the feasibility and acceptability of the use of a robotic walking aid from the perspective of both older individuals and physiotherapists. This could fill the gap between devices that fully compensate for walking and those which allow patients to maintain residual mobility.

Reliability and validity of the shortened Singapore versions of the Chedoke Arm and Hand Activity Inventory.

Upper limb deficits are common sequelae after a stroke and negatively affect daily living and quality of life. The use of outcome measures to evaluate upper limb function is essential to assess sensorimotor recovery and to determine the effectiveness of rehabilitation. The aim of this study was to estimate the construct validity and inter-rater reliability of three shortened versions of the Singapore version of the Chedoke Arm and Hand Activity Inventory (CAHAI-SG) comprising seven, eight, and nine test items. The sample consisted of 55 inpatients with acute/subacute stroke to whom the CAHAI-SG, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT) were administered. To estimate convergent and discriminative construct validity, Spearman's rank correlation coefficient and 95% confidence intervals were computed for CAHAI-SG scores with FMA-UE and ARAT scores. Reliability was estimated using intraclass correlation coefficient (relative reliability) and the standard error of measurement (absolute reliability). Convergent validity with the FMA-UE was 0.79, 0.80, and 0.81 for seven-item, eight-item, and nine-item versions of the CAHAI-SG, respectively, and 0.81 with the ARAT for all shortened versions. Discriminative validity with the FMA-UE pain subscale was between 0.37 and 0.38. The absolute reliability was 3.09, 3.65, and 3.98, and relative reliability was 0.96, 0.95, and 0.96 for the seven-item, eight-item, and nine-item versions, respectively. All shortened versions of the CAHAI-SG demonstrated similar psychometric properties to the full (13 item) version, meaning clinicians may use these shorter versions that require less time to administer and score.

Concussion history is negatively associated with visual-motor force complexity: evidence for persistent effects on visual-motor integration.

OBJECTIVES: Long-term monitoring of concussion recovery requires time- and cost-effective methods. Physiologic complexity may be useful in evaluating visual-motor integration following concussion. The purpose of this study was to quantify the extent to which prior number of concussions influenced visual-motor tracking force complexity. METHODS: Thirty-five individuals with a self-reported concussion history (age: 20.92 ± 1.98) and 15 without (age: 20.92 ± 2.21) performed an isometric visual-motor tracking task, using index finger force to trace a straight line across a computer screen. Finger force root mean square error (RMSE), multi-scale complexity, and average power from 0 to 12 Hertz (Hz) were calculated. Individual multiple regressions were fit to these outcomes. RESULTS: Force complexity decreased linearly with an increasing number of concussions (R2 = 0.101). Males had more complex force overall (R2 = 0.219) and greater 4-8 Hz average power (R2 = 0.193). The 8-12 Hz average power decreased significantly for individuals with prior loss of consciousness (LOC) and increasing numbers of concussions (R2 = 0.143). CONCLUSION: Individuals exhibited linear decreases in visual-motor tracking force complexity with increasing numbers of concussions, influenced by both gender and a history of LOC. These findings indicate cumulative changes in the ways in which previously concussed individuals process and integrate visual information to guide behaviour.

Home based training for dexterity in Parkinson's disease: A randomized controlled trial.

BACKGROUND: Patients with Parkinson's disease exhibit disturbed manual dexterity. This impairment leads to difficulties in activities of daily living, such as buttoning a shirt or hand-writing. The aim of the present study was to investigate the effectiveness of a home-based dexterity program on fine motor skills in a single-blinded, randomized controlled trial, in patients with Parkinson's disease. METHODS: One hundred and three patients with Parkinson's disease (aged between 48 and 80 years, Hoehn & Yahr stage I-IV) were randomized to either a home-based dexterity program (HOMEDEXT) or Thera-band program. All patients trained over a period of 4 weeks, 5 times/week, 30 min for each session. A baseline, post-intervention, and follow-up assessment (12 weeks later, time period without intervention) were done. The primary outcome measure was dexterity as measured with the Nine Hole peg test (9-HPT). Secondary outcome measures included strength, motor parkinsonian symptoms, dexterity-related activities of daily living (ADL) and Health-related Quality of Life (HrQoL). RESULTS: There was a significant difference in favor of the HOMEDEXT group as compared to the Thera-band group on the primary outcome 9-HPT (p = 0.006) and dexterity-related ADL (p = 0.02) at post intervention. No significant differences were found for the other outcomes, nor at follow-up. CONCLUSION: This is the first randomized controlled trial showing that an intensive, task specific home-based dexterity program significantly improved fine motor skills in Parkinson's disease. The effect generalized to dexterity-related ADL functions. As these improvements did not sustain, the finding suggest that continuous training is required to maintain the benefit.

Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity.

BACKGROUND: People with chronic arm impairment should exercise intensely to regain their abilities, but frequently lack motivation, leading to poor rehabilitation outcome. One promising way to increase motivation is through interpersonal rehabilitation games, which allow patients to compete or cooperate together with other people. However, such games have mainly been evaluated with unimpaired subjects, and little is known about how they affect motivation and exercise intensity in people with chronic arm impairment. METHODS: We designed four different arm rehabilitation games that are played by a person with arm impairment and their unimpaired friend, relative or occupational therapist. One is a competitive game (both people compete against each other), two are cooperative games (both people work together against the computer) and one is a single-player game (played only by the impaired person against the computer). The games were played by 29 participants with chronic arm impairment, of which 19 were accompanied by their friend or relative and 10 were accompanied by their occupational therapist. Each participant played all four games within a single session. Participants' subjective experience was quantified using the Intrinsic Motivation Inventory questionnaire after each game, as well as a final questionnaire about game preferences. Their exercise intensity was quantified using wearable inertial sensors that measured hand velocity in each game. RESULTS: Of the 29 impaired participants, 12 chose the competitive game as their favorite, 12 chose a cooperative game, and 5 preferred to exercise alone. Participants who chose the competitive game as their favorite showed increased motivation and exercise intensity in that game compared to other games. Participants who chose a cooperative game as their favorite also showed increased motivation in cooperative games, but not increased exercise intensity. CONCLUSIONS: Since both motivation and intensity are positively correlated with rehabilitation outcome, competitive games have high potential to lead to functional improvement and increased quality of life for patients compared to conventional rehabilitation exercises. Cooperative games do not increase exercise intensity, but could still increase motivation of patients who do not enjoy competition. However, such games need to be tested in longer, multisession studies to determine whether the observed increases in motivation and exercise intensity persist over a longer period of time and whether they positively affect rehabilitation outcome. TRIAL REGISTRATION: The study is not a clinical trial. While human subjects are involved, they participate in a single-session evaluation of a rehabilitation game rather than a full rehabilitation intervention, and no health outcomes are examined.

Tratamiento rehabilitador a un paciente con síndrome de Cornelia de Lange / Rehabilitation Treatment to a Patient with Cornelia de Lange Syndrome

Se presentó un paciente de un año de edad con síndrome Cornelia de Lange, único recibido en el Servicio de Rehabilitación del Policlínico Docente René Vallejo Ortiz del municipio Manzanillo, provincia Granma, con signos evidentes de retraso del desarrollo psicomotor, remitido al servicio por su médico de familia cuando tenía seis meses de nacido. Para su tratamiento se emplearon técnicas específicas de la estimulación temprana, se lograron pequeños avances en su desarrollo motor y cognitivo, aunque no solo depende de la rehabilitación, sino también del entorno familiar en el cual se va desarrollando el niño. Se lograron pequeños avances motores en el paciente como: sostén cefálico, abertura de las manos y seguimiento de los objetos con la mirada, el paciente continúa rehabilitándose en el servicio de fisiatría.(AU)

A one –year-old patient with Cornelia de Lange syndrome (SCdL) was presented in this article, who was the only one attended in the service of rehabilitation of the René Vallejo Ortiz teaching polyclinic of Manzanillo municipality, Granma province. The patient had evident signs of late psychomotor development, so he was referred to this service by the family doctor when he was six months of age. For the treatment, specific techniques of early stimulation were used; small advances have been achieved regarding motor and cognitive development, although it not only depends on the rehabilitation, but also depends on the family environment, in which the infant is developing. Not many motors progresses were achieved in the patient such as: cephalic support, opening of the hands and objects pursuit followed by the eyes. The patient continues rehabilitating in the physiotherapy service.(AU)

The use of commercial video games in rehabilitation: a systematic review.

The aim of this paper was to investigate the effect of commercial video games (VGs) in physical rehabilitation of motor functions. Several databases were screened (Medline, SAGE Journals Online, and ScienceDirect) using combinations of the following free-text terms: commercial games, video games, exergames, serious gaming, rehabilitation games, PlayStation, Nintendo, Wii, Wii Fit, Xbox, and Kinect. The search was limited to peer-reviewed English journals. The beginning of the search time frame was not restricted and the end of the search time frame was 31 December 2015. Only randomized controlled trial, cohort, and observational studies evaluating the effect of VGs on physical rehabilitation were included in the review. A total of 4728 abstracts were screened, 275 were fully reviewed, and 126 papers were eventually included. The following information was extracted from the selected studies: device type, number and type of patients, intervention, and main outcomes. The integration of VGs into physical rehabilitation has been tested for various pathological conditions, including stroke, cerebral palsy, Parkinson's disease, balance training, weight loss, and aging. There was large variability in the protocols used (e.g. number of sessions, intervention duration, outcome measures, and sample size). The results of this review show that in most cases, the introduction of VG training in physical rehabilitation offered similar results as conventional therapy. Therefore, VGs could be added as an adjunct treatment in rehabilitation for various pathologies to stimulate patient motivation. VGs could also be used at home to maintain rehabilitation benefits.

Recovery of motor imagery ability in the first year after stroke.

The aim of this study was to examine the level and recovery of motor imagery ability (MIA) in the first year after stroke and whether the recovery of MIA is related to that of arm/hand function. Twenty-three patients with diminished arm/hand function were included. The accuracy score on the hand laterality judgment task was used to assess MIA and the Fugl-Meyer Assessment was used to evaluate the recovery of arm/hand function. The patients were assessed 3, 6, 16, 26, and 52 weeks after stroke. In the first year after stroke, the percentage of patients with moderate to good MIA improved from 78% after 3 weeks to 94% after 1 year. The recovery of MIA took place in the first 6 weeks after stroke. No correlation was found between the recovery of MIA and arm/hand function, despite the fact that the greatest improvement in both occurred in the first 6 weeks.

[Utilization of Occupational Therapy in Children - Results from the KiGGS Basis Survey]. / Inanspruchnahme von Ergotherapie im Kindesalter - Ergebnisse aus der KiGGS-Basiserhebung.

BACKGROUND: A population-based analysis on use of occupational therapy by child's parentally reported health restrictions and socio-demographic determinants is missing. PATIENTS AND METHODS: The basis KiGGS survey (2003 to 2006) reports on health in 17 641 children aged 0 to 17 years. The use of occupational therapy in the last 12 months could be ticked as other therapies with a free text field to name occupational therapy or others. Health restrictions potentially relevant for the use of occupational therapy and sociodemographic factors were assessed. The proportion of use of occupational therapy explained by the health restrictions was estimated by the population attributable risk fraction. RESULTS: The average use of occupational therapy for 3 to 13-year-olds was 2.4%. There was no association with the socioeconomic status; Children with immigration background used occupational therapy less often (e. g. age group 3 to 6 years: ORadjusted 0.2 [95-% KI: 0.1-1.0]). The proportion of occupational therapy explainable by the health restrictions considered ranged from 45% (3 to 6 years) to 65% (11 to 13 years). DISCUSSION: The lower use of occupational therapy in the KiGGS survey compared to health insurance reports may be explained by the ascertainment method. A lower use of occupational therapy related to immigration background matches lower use for physician visits. CONCLUSION: The causes for the low proportion of explained occupational therapy in young children and the lower use in children with immigration background warrant further research.

Persons with multiple disabilities engage in stimulus choice and postural control with the support of a technology-aided program.

Technology-aided programs have been reported to help persons with disabilities develop adaptive responding and control problem behavior/posture. This study assessed one such program in which choice of stimulus events was used as adaptive responding for three adults with multiple disabilities. A computer system presented the participants stimulus samples. For each sample, they could perform a choice response (gaining access to the related stimulus whose length they could extend) or abstain from responding (making the system proceed to the next sample). Once choice responding had strengthened, the program also targeted the participants' problem posture (i.e., head and trunk forward bending). The stimulus exposure gained with a choice response was interrupted if the problem posture occurred. All three participants successfully (a) managed choice responses and access to preferred stimuli and (b) gained postural control (i.e., reducing the problem posture to very low levels). The practical implications of those results are discussed.

[Long-term outcome of childhood hypoxic-ischemic encephalopathy].

OBJECTIVE: To propose an adequate rehabilitation program for children suffering from hypoxic-ischemic encephalopathy (HIE) based on estimated outcomes. METHODS: Participants were 42 children, 28 boys and 14 girls, who suffered from HIE after neonatal period. We divided them into three groups; favorable (GMFCS level 1 or 2), moderate (level 3 or 4), and unfavorable (level 5), and compared the extent of brain lesions on MRI, age of onset, and complications among the groups. RESULTS: The number of children in favorable, moderate, and unfavorable groups was 10, 10 and 22, respectively. All children in favorable and moderate groups showed focal cerebral lesions on MRI. In contrast, most children in unfavorable group (19/22) had diffuse brain damage and the rest were infantile onset with focal cerebral lesions. The etiology and situation of HIE did not differ among three groups. Three children in moderate group whose onsets were earlier than 5 months showed lesions similar to those in neonatal HIE; in bilateral basal ganglia, thalamus, and perirolandic cortex. In favorable group, 7 children were able to walk independently within 5 months after the insult, but 9 had moderate or severe mental retardation and 3 showed severe visual impairment. A majority of unfavorable group developed scoliosis or hip dislocation, and underwent tracheostomy or gastrostomy. Five children who had stayed acute hospitals for longer than 6 months developed irreversible complications such as joint contractures before discharge. CONCLUSIONS: Children with focal cerebral lesions need continual rehabilitation and education for mental retardation and visual impairment, even if they can walk within several months after HIE. Those with diffuse brain damage need sufficient rehabilitation as early as possible to avoid developing secondary complications. MR image, age of onset, and clinical course were of great prognostic value to make appropriate long-term rehabilitation and education programs.