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OBJECTIVE Severe traumatic brain injury (TBI) is a leading cause of disability and death in the pediatric population. While intracranial pressure (ICP) monitoring is the gold standard in acute neurocritical care following pediatric severe TBI, brain tissue oxygen tension (PbtO2) monitoring may also help limit secondary brain injury and improve outcomes. The authors hypothesized that pediatric patients with severe TBI and ICP + PbtO2 monitoring and treatment would have better outcomes than those who underwent ICP-only monitoring and treatment. METHODS Patients ≤ 18 years of age with severe TBI who received ICP ± PbtO2 monitoring at a quaternary children’s hospital between 1998 and 2021 were retrospectively reviewed. The relationships between conventional measurements of TBI were evaluated, i.e., ICP, cerebral perfusion pressure (CPP), and PbtO2. Differences were analyzed between patients with ICP + PbtO2 versus ICP-only monitoring on hospital and pediatric intensive care unit (PICU) length of stay (LOS), length of intubation, Pediatric Intensity Level of Therapy scale score, and functional outcome using the Glasgow Outcome Score–Extended (GOS-E) scale at 6 months postinjury. RESULTS Forty-nine patients, including 19 with ICP + PbtO2 and 30 with ICP only, were analyzed. There was a weak negative association between ICP and PbtO2 (β = −0.04). Conversely, there was a strong positive correlation between CPP ≥ 40 mm Hg and PbtO2 ≥ 15 and ≥ 20 mm Hg (β = 0.30 and β = 0.29, p < 0.001, respectively). An increased number of events of cerebral PbtO2 < 15 mm Hg or < 20 mm Hg were associated with longer hospital (p = 0.01 and p = 0.022, respectively) and PICU (p = 0.015 and p = 0.007, respectively) LOS, increased duration of mechanical ventilation (p = 0.015 when PbtO2 < 15 mm Hg), and an unfavorable 6-month GOS-E score (p = 0.045 and p = 0.022, respectively). An increased number of intracranial hypertension episodes (ICP ≥ 20 mm Hg) were associated with longer hospital (p = 0.007) and PICU (p < 0.001) LOS and longer duration of mechanical ventilation (p < 0.001). Lower minimum hourly and average daily ICP values predicted favorable GOS-E scores (p < 0.001 for both). Patients with ICP + PbtO2 monitoring experienced longer PICU LOS (p = 0.018) compared to patients with ICP-only monitoring, with no significant GOS-E score difference between groups (p = 0.733). CONCLUSIONS An increased number of cerebral hypoxic episodes and an increased number of intracranial hypertension episodes resulted in longer hospital LOS and longer duration of mechanical ventilator support. An increased number of cerebral hypoxic episodes also correlated with less favorable functional outcomes. In contrast, lower minimum hourly and average daily ICP values, but not the number of intracranial hypertension episodes, were associated with more favorable functional outcomes. There was a weak correlation between ICP and PbtO2, supporting the importance of multimodal invasive neuromonitoring in pediatric severe TBI.

This study has an objective of suggesting the ways to improve infant’s sense of self-respect and peer competence, by examining what effect infant temperament has on infant’s sense of self-respect and peer competence. The notable study results through analysis are as follows; First, it was shown that, in regard with adaptability and activity of infant temperament, cognitive ability of the sense of self-respect and peer acceptance, the average score of day care centers was higher, while it was shown that, in regard with response of infant temperament, the sense of self-respect’s mother acceptance, peer relationship, sociability of peer competence, the average score of kindergartens was higher, and the boy infants’ physiological regularity was shown to be higher than that of girl infants. Second, as a result of looking into the difference of infant temperament, sense of self-respect, and peer competence according to infant’s age, we found that, in case of ‘response’ of infant temperament, age 5 group was classified into ‘group a’, and age 3 and 4 group was classified into ‘group b’, and two groups showed the difference, and in case of ‘physiological regularity’, age 3 group had the biggest regularity while age 5 group had the relatively low regularity, thus two groups showed the difference. In regard with sense of self-respect and peer competence, it was shown that age 4 and 5 group had higher one than that of age 3 group.

The objective of this study is to empirically examine the effect that social welfare officials’ awareness of welfare, who play the core role in delivering public welfare service, has on their sense of duty value and duty efficiency. The implications this study suggests are as follows; First, this study has a meaning in that it empirically proved the social welfare officials’ awareness level of welfare. Second, this study provided the specific theoretical basis for the approaches and alternatives for the need to improve social welfare officials’ awareness of welfare and operate the desirable welfare policy and system, by examining the effect that social welfare officials’ awareness of welfare has on their sense of duty value and duty efficiency. Third, we can find the political implication from this study that welfare policy should be established and operated toward the direction of enhancing equalization effect of welfare system, and minimizing free ride or hampering the will to work, if we intend to improve social welfare officials’ awareness of welfare. Fourth, this study presented the need to improve the work system of social welfare officials, through the fact that the shorter their work period is, the lower sense of welfare, duty value and duty efficiency they have. Based on the study results above, we suggest the activation of studies on social welfare officials’ awareness of welfare, the need to regularly educate social welfare officials about welfare policy, system and value, the need to improve social welfare officials’ positive awareness of welfare and their duty performance through deciding welfare policy toward the direction of enhancing social equality and equalization, and the need to improve social welfare officials’ work system.

Objective This self-directed learning module focuses on the physiatric management of the common morbidities associated with pediatric traumatic brain injury and cerebral palsy. It is part of the study guide on pediatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and pediatric medicine. The goal of this article is to enhance the learner's knowledge regarding current physiatric management of complications related with pediatric traumatic brain injury and cerebral palsy.

Kim C-T, Han J, Kim H. Pediatric stroke recovery: a descriptive analysis. Objective To investigate recovery patterns and potential prognostic factors of pediatric stroke. Design Retrospective study. Setting Acute rehabilitation at a university-based children's hospital. Participants Children (N=44; 25 boys, 19 girls; age range, 8mo–17y) with diagnosis of first-ever stroke. Interventions Not applicable. Main Outcome Measures Functional outcomes at discharge and 1-year follow-up. Modified Brunnstrom stages, Gross Motor Function Classification System, activities of daily living (ADLs), swallowing, speech, and sphincter function were measured. Results Recovery of swallowing function occurred earlier than other functions in the first 2 to 3 months poststroke. Less than half of the patients were able to use the affected arms and legs without assistive devices. Eleven of 32 patients who initially had poor body control became ambulatory without assistive devices. A total of 18 of 44 patients were able to walk without assistive devices. Bilateral hemisphere lesions and flaccid muscle tone of the affected extremity at stroke onset had a less favorable prognosis in terms of ambulation and ADLs. Hemorrhagic strokes without surgical complications had a better prognosis than nonhemorrhagic strokes. Conclusions Similar to the adult stroke population, most of the functional recovery in pediatric stroke occurs within the first 2 to 3 months after stroke, but the quality of functional recovery was better in the pediatric population. The lesion size of the stroke was found to be related to prognosis. Additional large cohort studies are suggested to understand the complex similarities and differences in recovery between pediatric and adult stroke.

The purpose of the study contained herein was to determine the usefulness of electrical impedance for measurement of bladder volume in spinal cord-injured patients, with an assessment of the relationship between electrical impedance and bladder volume exclusively. The study was performed during urodynamic studies to match the exact bladder volume. Thirteen patients with complete spinal cord injuries were recruited. We used silver-silver chloride compound electrodes composed of one pair of current and amplitude electrodes to minimize the influence of superficial skin impedance. Each compound electrode was attached on the lower abdomen bilaterally after skin cleansing. Constant current (60 kHz-1.0 mA), converted from 9 V of direct current, was applied, and corresponding electrical impedance (omega) was measured at "pre" (before urodynamic empty bladder), "full" (with a urodynamic filled bladder), and "post" (after urodynamic empty bladder) status. Electrical impedance at the full status was definitely lower than that at the pre and post statuses in all subjects, with a statistically significant difference (P < 0. 001). The correlation between electrical impedance and bladder volume was negative (r = -0.7988), and the fact of how much the variation in electrical impedance could be explained by variation in bladder volume was estimated (r2 = 0.6381). From these findings, we have determined that the electrical impedance analysis technique can be an alternative measure of bladder volume indirectly.

Primary objective: To report a case of pneumatosis intestinalis complicated with sorbitol containing medicines.Research design: Case report.Methods and procedures: Clinical course and literature review.Experimental interventions: Chart review.Main outcomes and results: Large amount of sorbital may cause a reversible gastrointestinal complication, pneumatosis intestinalis.Conclusions: In the assessment of enteral abnormalities, all components of medications, active and ‘inactive’, must be evaluated as possible aetiological factors of pneumatosis intestinalis.

Length of stay (LOS) is one of the most important pieces of data used to measure clinical rehabilitation outcomes, but there is a paucity of LOS data regarding pediatric acute rehabilitation. The purpose of this study was to predict LOS based on admission diagnosis to an acute pediatric inpatient rehabilitation unit. The hypothesis was that LOS will vary according to admission diagnosis. One thousand one hundred forty-five patients were admitted to our acute inpatient rehabilitation unit from January 1, 2000 to December 31, 2007. Common admission impairment groups were orthopedic conditions (29.3%), brain injury (17.9%), brain tumor (7.9%), pain syndrome (7.5%), complex medical conditions (7.4%), stroke (7.2%), meningoencephalitis (7.2%), and spinal cord injury (4.4%). The distribution of LOS data was significantly skewed to the right (for example, mean 40.6 days and median 26 days, respectively, in brain injury group). The median LOS of patients admitted with orthopedic conditions was the shortest (13 days), compared to patients admitted with spinal cord lesions, which was the longest (32 days). Logarithm-transformed mean LOS was different among the admission impairment groups (F = 28.7, p< 0.01). However Tukey's Honestly Significance Difference test further showed that: 1) LOS data was not always statistically different across admission impairment groups, and 2) LOS of patients with orthopedic conditions and spinal cord lesions was the shortest and longest, respectively, compared to other admission impairment groups. No proportional decrease in median LOS was observed across the impairment groups from 2000 to 2007. LOS for pediatric acute inpatient rehabilitation varied according to admission diagnosis. When considering future comprehen- sive pediatric rehabilitation outcome studies, focusing on a uniform impairment group is suggested. In addition, attention to other factors such as functional status changes, severity of illness, payment types, and psychosocioeconomic status should be considered.

Kim C-T, Bryant P. Complex regional pain syndrome (type I) after electrical injury: a case report of treatment with continuous epidural block. Arch Phys Med Rehabil 2001;82:993-5. A 26-year-old man presented with severe complex regional pain syndrome type I of the affected limb after a work-related electrical injury. He suffered causalgia-like pain with no electrodiagnostic evidence of nerve injury. Early steroid and analgesic regimens did not adequately relieve these symptoms. His symptoms were temporarily relieved several times with stellate ganglion blocks. The patient underwent a cervical epidural block with a local anesthetic as well as a narcotic agonist over a 4-day period, which resulted in prompt, remarkable pain relief. Vocational rehabilitation was instituted as the pain subsided. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Objective This self-directed learning module highlights the environmental factors that influence the participation of children and youth with disabilities in life situations, including activities of self-care, mobility, socialization, education, recreation, and community life. It is part of the study guide on pediatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and pediatric medicine. This module emphasizes the participation of children with disabilities in adapted sports and reviews mobility devices to promote function, in the context of the International Classification of Functioning and in reference to the Americans with Disabilities Act. It provides the physiatrist with strategies to promote community participation, functional independence and healthcare transitions for children with disabilities as they approach adulthood. The goal of this article is to improve the learner's treatment strategies to maximize the participation of children and youth with disabilities in all settings, particularly schools and communities.

Objective This self-directed learning module focuses on the role of accurate diagnosis, psychological support, and family integration of children who have chronic impairments such as pain, spasticity, or cognitive disability. It is part of the study guide on pediatric rehabiliation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and pediatric medicine. The role of therapeutic, medical (traditional and nontraditional) and psychological interventions that improve family and individual function are emphasized. The goal of this article is to refine a learner's knowledge of the impact family-centered care can have on the medical, psychological, financial, and functional capabilities of families to improve treatment decisions in the context of children with disability.

Williams FH, Johns JS, Weiss JM, Weiss LD, Kim C-T, Strommen JA, Rashbaum IG. Neuromuscular rehabilitation and electrodiagnosis. 1. Mononeuropathy. This self-directed learning module highlights mononeuropathies. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on diagnostic criteria and classifications of mononeuropathies, including carpal tunnel, brachial neuritis, and lumbosacral plexopathy. The timeline status post nerve injury is discussed in relation to findings on electrodiagnostic studies. The differential diagnosis and electrodiagnostic design and interpretation is detailed in the chapter. Treatment options are reviewed. Overall article objective To summarize the diagnosis, classification, and treatment of mononeuropathies, from an electrodiagnostic perspective.

Weiss LD, Weiss JM, Johns JS, Strommen JA, Kim C-T, Williams FH, Rashbaum IG. Neuromuscular rehabilitation and electrodiagnosis. 2. Peripheral neuropathy. This self-directed learning module highlights peripheral neuropathies. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on diagnostic criteria and classifications of peripheral neuropathy, including diabetic, alcoholic, carcinomatous, human immunodeficiency virus-associated, and critical illness polyneuropathies. Treatment options are reviewed. The causes for difficult to obtain nerve conduction studies are highlighted. Overall article objective To summarize the diagnosis, classification, and treatment of peripheral neuropathies.

Kim C-T, Strommen JA, Johns JS, Weiss JM, Weiss LD, Williams FH, Rashbaum IG. Neuromuscular rehabilitation and electrodiagnosis. 4. Pediatric issues. This self-directed learning module highlights the physician's role in the diagnosis and treatment of neuromuscular disorders in pediatric populations. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses both clinical and electrodiagnostic features of common neuromuscular disorders in pediatric populations. The diagnostic value of somatosensory evoked potential is reviewed in a case of traumatic spinal cord injury without radiographic abnormality. Therapeutic interventions of progressive muscular dystrophy are discussed, as well as the differential diagnosis of floppy infant syndrome, the most common pediatric electrodiagnostic referral. Overall article objectives (a) To become familiar with electrodiagnosis and rehabilitation for common neuromuscular disorders in the pediatric population, (b) to undrstand electrodiagnostic findings of Guillain-Barre syndrome corresponding to pathophysiology, (c) to become familiar with somatosensory evoked potentials, and (d) to be able to make differential diagnosis of floppy infant syndrome based on clinical findings as well as electrodiagnosis.

Strommen JA, Johns JS, Kim C-T, Williams FH, Weiss LD, Weiss JM, Rashbaum IG. Neuromuscular rehabilitation and electrodiagnosis. 3. Diseases of muscles and neuromuscular junction. This self-directed learning module highlights formation of a differential diagnosis as well as electrodiagnostic evaluation for those patients who present with the common complaint of weakness. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the common symptoms and typical clinical findings that allow the clinician to narrow the differential diagnosis. This is followed by the diagnostic evaluation, with emphasis on the technical aspects and interpretation of electrodiagnostic studies. Overall article objective To summarize the clinical presentation and electrodiagnostic findings in persons with disorders of muscle or disorders of the neuromuscular junction.

CRPS-type I or causalgia is a challenging pain syndrome and its pathogenesis remains controversial. Although its incidence is relatively low, the pain and suffering it causes can be severe and functionally debilitating. Early, accurate diagnosis permits initiation of appropriate therapeutic interventions and enhances the potential for successful treatment.