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Mixed-methods, including expert consensus for initial development and a multi-center repeated measures design for field testing.To develop an International Spinal Cord Injury Basic Data Set for caregivers of individuals with spinal cord injury/disorder (SCI/D) for use in research and clinical care settings.International, multi-disciplinary working group with field testing in five North American pediatric rehabilitation hospitals.The data set was developed iteratively through meetings and online surveys with a working group of experts in pediatric and adult SCI/D rehabilitation and caregivers of individuals with SCI/D. Initial reliability was examined through repeat administration of a beta form with a sample of caregivers recruited by convenience. The sample was characterized with descriptive statistics. Intra-rater reliability of variables was assessed using Intra-Class Correlations.The beta test form included 27 items, covering 3 domains: (1) demographic information for persons providing care; (2) caregiver's allocation of time and satisfaction; and (3) perceived burden of caregiving. Thirty-nine caregivers completed both administrations. Mean time for completion was 10 min. There was moderate to excellent reliability for the majority of variables, but results indicated necessary revisions to improve reliability and decrease respondent burden. The final version of the data form contains 7 items and is intended for self-administration among informal caregivers of individuals with SCI/D across the lifespan.The International SCI Basic Data Set for Informal Caregivers can be used to standardize data collection and reporting about informal caregivers for individuals with SCI/D to advance our understanding of this population and the data form has additional utility to screen for caregiver needs in clinical settings.

Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974–2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4–5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.

Importance: Unplanned hospital readmissions can profoundly affect older adults’ quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy’s involvement remains unclear. Objective: To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy’s scope of practice. Data Sources: We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. Findings: Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients’ needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. Conclusions and Relevance: Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy’s value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy’s domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.

This investigation was a cohort study that included: 36 typically developing (TD) children and 19 children with spinal cord lesions who underwent spinal cord MRI.To investigate diffusion tensor imaging (DTI) cervical and thoracic spinal cord changes in pediatric patients that have clinically traumatic and non-traumatic spinal cord injury (SCI) without MR (SCIWOMR) abnormalities.Thomas Jefferson University, Temple University, Shriners Hospitals for Children all in Philadelphia, USA.36 TD children and 19 children with spinal cord lesions that represent either a chronic traumatic acquired SCI or chronic non-traumatic SCI (≥6 months post injury), age range, 6-16 years who underwent cervical and thoracic spinal cord MRI in 2014-2017. Additionally DTI was correlated to clinical American Spinal Injury Association Impairment Scale (AIS).Both SCIWOMR and MRI positive (+) groups showed abnormal FA and RD DTI values in the adjacent MRI-normal appearing segments of cephalad and caudal spinal cord compared to TD. The FA values demonstrated perilesional abnormal DTI findings in the middle and proximal segments of the cephalad and caudal cord in the SCIWOMR AIS A/B group compared to SCIWOMR AIS C/D group.We found DTI changes in children with SCIWOMR with different causes of spinal lesions. We also investigated the relationship between DTI and clinical AIS scores. This study further examined the potential diagnostic value of DTI and should be translatable to adults with spinal cord lesions.

Mixed methods cohort study.To develop and assess psychometric properties of the pediatric measure of participation (PMoP) short forms (SF) version 2.0.Secondary analyses of data collected from 381 children with spinal cord injury (SCI) of at least 3-month duration living in the community, and 322 parents of children with SCI at three pediatric orthopedic hospitals in the United States.Mixed methods iterative process to customize SF based on, highly relevant items, age and school analysis of item distributions; ceiling and floor effects; internal consistency and group-level reliability; correlation of SF scores with scores derived from the total item bank; and assessment of the degree to which item difficulty matched the abilities of children in the sample.PMoP SF V2.0 mean T scores ranged from 47.59 to 51.23. Overall, mean scores were somewhat higher for older children and parent respondents. Group-level reliability values ranged from 0.66 to 0.79; Cronbach's alpha values ranged from 0.79 to 0.90; ICC values ranged from 0.89 to 0.95. Pearson Correlations ranged from 0.80 to 0.95, showing good to strong correlation between scores from the SFs and total item bank for each domain. Test information function demonstrated that score estimates will be less precise at higher ends of the scale.PMoP SFs V2.0 contain items relevant to participation among children with SCI, and are tailored for four age groups and school status. They are recommended for use when computer adaptive testing (CAT) is not possible.

Prospective repeated measures.Evaluate intra-rater agreement of repeated motor and sensory scores at individual spinal levels.Non-profit pediatric rehabilitation center.Fifty-eight youth with complete spinal cord injury undergoing two neurological exams. Agreement between exams for each myotome and dermatome was evaluated for four neurological groups: C1-C4 (N=9); C5-C8 (N=8); T1-T6 (N=22); T7-T12 (N=19). Kappa (k) and weighted k (k(w)) coefficients were calculated.Agreement between strength scores was 99 and 100% in subjects with tetraplegia and paraplegia, respectively. C1-C4: pin prick (PP)=absolute agreement (AA) in 57% dermatomes (D) (k range=0.10-0.83; k(w) range=0.36-0.93). Light touch (LT)=AA in 59% D (k range=0.35-0.77; k(w) range=0.34-0.84). C5-C8: PP=AA in 86% D (k range=0.28-0.78; k(w) range=0.43-0.93). LT=AA in 80% D (k range=0.10-0.80; k(w) range=0.12-0.91). T1-T6: PP=AA in 82% D (k range=0.36-0.83; k(w)=0.20-0.96). LT=AA in 77% D (k range=0.23-0.89; k(w) range=0.23-0.89). T7-T12: PP=AA in 82% D (k range=0.46-0.90; k(w) range=0.54-0.90). LT=AA in 84% D (k range=0.41-0.87; k(w) range=0.52-0.94).Overall, agreement was excellent for myotome comparisons. For the C5-C8, T1-T6 and T7-T12 groups, there are variations in sensory scores within three levels of the neurological level (NL). For the C1-C4 group, variation in sensation extended well caudal to the NL. The International Standards for Neurological Classification of Spinal Cord Injury is a good outcome measure for a single-site, one-rater study but differences in repeated sensory scores at individual D were found, which should be considered in the interpretation of results of outcome studies.

Date Presented 3/31/2017 This qualitative study was conducted to understand the needs and priorities of mothers raising a child with autism in the Chassidic community. Five major themes emerged that reflect unique challenges. This research highlights the importance of routines and rituals that define insular communities. Primary Author and Speaker: Faye Levy Contributing Authors: M. J. Mulcahey

This chapter provides an overview of spinal cord injuries (SCI) in children and adolescents, including epidemiology, medical and musculoskeletal complications, rehabilitation and psychosocial aspects. Males are more commonly affected than females during adolescence; however, as the age at injury decreases, the preponderance of males becomes less marked, and by 3 years of age the number of females with SCIs equals that of males. The neurologic level and degree of completeness varies with age; among children injured prior to 12 years of age approximately two-thirds are paraplegic and approximately two-thirds have complete lesions. Among adolescents, approximately 50% have paraplegia and 55% have complete lesions. Management of pediatric-onset SCI should be family centered and developmentally based, responsive to the dynamic changes that occur during growth and development. Distinctive anatomical and physiological features of children and adolescents, along with growth and development, are responsible for unique manifestations and complications of pediatric SCI. SCI without radiological abnormalities (SCIWORA), birth injuries, lap-belt injuries, upper cervical injuries, and the delayed onset of neurological deficits are relatively unique to pediatric SCI. Children who sustain their SCI before puberty experience a higher incidence of musculoskeletal complications, such as scoliosis and hip dislocation.

Generation of spinal cord tracts from diffusion tensor imaging (DTI) of the pediatric spinal cord can be extremely beneficial to visualize the connectivity of nerve fibers, to reveal patterns of overall diffusivity and anisotrophy of the fibers, overall architectural features, and integrity of the spinal cord. Twenty pediatric subjects were scanned: ten controls without evidence of spinal cord pathology and ten patients with cervical spinal cord injury (SCI) were scanned using a newly developed reduced field of view (FoV) DTI method on a 3T scanner. After motion correction, tractography images were generated based on Fiber Assignment by Continuous Tracking (FACT) algorithm. Various DTI indices as well as tract specific information were calculated using regions of interest manually drawn at every axial slice location along the cervical spinal cord. Results showed average values of FA=0.60±0.13, MD=0.74±0.18×10−3 mm2/s in normal subjects and FA=0.45±0.14, MD=0.77±0.24×10−3 mm2/s in SCI patients. In conclusion, this study showed that tractography images can be successfully generated from pediatric spinal cord DTI data and various DTI parameters can be reliably estimated.

The purpose of the study was to further develop the psychometric rigor of the Grasp and Release Test (GRT), a hand function assessment designed to measure tendon transfer and functional electrical stimulation (FES) outcomes on functional limitation of individuals with tetraplegia.Nineteen participants (21 hands) between 7 and 20 years of age with cervical-level spinal cord injuries (SCIs) participated in this study. Three participants (5 hands) had strong C6 or C7 function and underwent bilateral surgical tendon transfers to restore volitional thumb and finger flexion. The remaining 16 participants (16 hands) had C5- or weak C6-level SCI and underwent unilateral surgical implantation of the Freehand System for stimulated grasp and release. Preliminary evaluation of test-retest reliability, predictive validity, and sensitivity to change of the GRT was conducted. Reproducibility of test scores was evaluated by intraclass correlation coefficients (ICCs).Three objects-which included a fork, paperweight, and videotape-had perfect correlation. For the 3 remaining GRT objects, ICC values were significant (block = 0.87, peg = 0.93, can = 0.99; P0.01). For predictive validity, the relationships between 12-month Functional Independence Measure (FIM) scores and the peg, block, paperweight, and total number of GRT objects were nonsignificant. Correlation was significant between 12-month FIM scores and the fork (rho = 0.624, P0.01), can (rho = 0.700, P0.01), and videotape (rho = 0.503, P0.05). Sensitivity to change was evident by a significant difference between baseline and postrehabilitation GRT scores for the fork (z = 3.05, P0.01), paperweight (z = 2.83, P0.01), and can (z = 2.66, P0.01), and between the total number of GRT objects that were manipulated following surgery as compared with the number prior to surgery (z = 3.40, P0.05).Based on this study, the GRT has good test-retest reliability as evidenced by coefficients between 0.87 and 1.00, and is able to detect changes in hand function following tendon transfers and FES.

This study evaluated the effects of functional electrical stimulation (FES) applied to the muscles acting on the pelvis, hip, and knee on muscle strength, energy cost of walking, maximum walking distance and speed, step length and cadence, and joint kinematics during gait in 3 ambulatory adolescents with incomplete spinal cord injury (SCI).Percutaneous FES was used to strengthen weakened muscles and to augment walking. After training, participants walked as desired at home with FES for 1 year. Data were collected at baseline (preintervention), and with FES on and FES off immediately following the training period and with FES on and FES off at 3, 6, and 12 months posttraining.Voluntary strength improved in 12 out of 13 stimulated muscles. Decreased energy cost, increased maximum walking distance and speed, increased step length, and improved joint kinematics during gait were demonstrated with FES on and FES off.FES was able to achieve selective stimulation of key weakened muscles for augmented walking. The data suggest that FES had both direct and carryover effects.

AIM: To assess inter- and intra-rater reliability (agreement) between two region of interest (ROI) methods in pediatric spinal cord diffusion tensor imaging (DTI). METHODS: Inner-Field-of-View DTI data previously acquired from ten pediatric healthy subjects (mean age = 12.10 years) was used to assess for reliability. ROIs were drawn by two neuroradiologists on each subject data twice within a 3-mo interval. ROIs were placed on axial B0 maps along the cervical spine using free-hand and fixed-size ROIs. Agreement analyses for fractional anisotropy (FA), axial diffusivity, radial diffusivity and mean diffusivity were performed using intra-class-correlation (ICC) and Cronbach’s alpha statistical methods. RESULTS: Inter- and intra-rater agreement between the two ROI methods showed moderate (ICC = 0.5) to strong (ICC = 0.84). There were significant differences between raters in the number of pixels selected using free-hand ROIs (P < 0.05). However, no significant differences were observed in DTI parameter values. FA showed highest variability in ICC values (0.10-0.87). Cronbach’s alpha showed moderate-high values for raters and ROI methods. CONCLUSION: The study showed that high reproducibility in spinal cord DTI can be achieved, and demonstrated the importance of setting detailed methodology for post-processing DTI data, specifically the placement of ROIs.

Chronically indwelling percutaneous intramuscular electrodes were implanted in the upper extremity muscles of five adolescents with C5 or C5-6 tetraplegia in an effort to provide lateral and palmar prehension using the neuroprosthetic system designed by Case Western Reserve University. The responses from 177 electrodes were evaluated at 3-month intervals and included measurements of electrical impedance and an assessment of recruitment properties. Electrode failures were categorized as breakage, an altered stimulated response or adverse sensation during stimulation. Survival probabilities were generated for all electrodes, each muscle group, the volar and dorsal exit sites, intrinsic and extrinsic muscles, and according to the subjects' time postinjury. The overall probability of an electrode surviving to 6 months was 0.75 and the 1 year survival probability was 0.56. Among muscle groups, the finger extensor and thumb adductor electrodes had the highest proportion of failures and the poorest survival likelihoods within the first year after implant. According to the Breslow test, significantly smaller survival chances were predicted for electrodes exiting dorsally and for the newly-injured adolescents (1 year postinjury). The cumulative survival likelihoods of this study are smaller than those reported in adult applications using the same electrode design. Factors that may account for the disparate results are discussed.

A phenomenological approach was used to explore the experience of returning to school following a spinal cord injury. Four adolescents who sustained spinal cord injuries and returned to premorbid school environments were interviewed concerning their perceptions, feelings, and experiences of returning to school. The responses were coded into six themes: people, role change, self-image, coping strategies, accessibility, and feelings. The themes were discussed as to their relevance on returning to school following a spinal cord injury. The research participants’ suggestions on ways to ease the transition from the rehabilitation environment to the school environment and implications of the study are included.

The incidence of paralytic scoliosis subsequent to acquired spinal cord injury (SCI) has been reported to range from 46% to 97% in patients injured before the adolescent growth spurt.The purpose of this report is to review early bracing of children with SCI as a means of preventing or delaying surgical fusion.Patient records from January 1996 to December 2001 from the Shriners Hospitals for Children-Philadelphia were retrospectively reviewed; 123 patients met the inclusion criteria of cervical or thoracic SCI prior to skeletal maturity. Patients were divided into 5 groups based on their radiographic curve severity at presentation, and then they were subdivided into a group that was managed with prophylactic bracing and a group that was not braced. End-points included completion of bracing regimen, surgery, or cessation of growth.Forty-two patients presented with a curve10 degrees, 29 of whom were braced, and 13 who were not. Of the braced group, 13 (45%) went on to surgery, whereas 10 (77%) of the nonbraced group had surgical correction (P = 0.03). Of the patients who were initially braced, the average time to surgery was 8.5 years, whereas that for the nonbraced group was 4.2 years (P = 0.002). A similar trend was seen in the patients who presented with an initial curve between 11 degrees and 20 degrees (P0.001). There was no significant difference between time to surgery for the braced and nonbraced patient groups at higher (20 degrees) initial curve presentations.Bracing of children with SCI before significant curve formation (20 degrees) delays the time to surgical correction of the deformity as it progresses. At smaller curves (10 degrees), bracing may even prevent the need for surgery. As curve size increases (or = 20 degrees), bracing seems to play a limited role, because it does not seem to prevent surgery or delay time to surgical correction.