Altered Oculomotor and Vestibulo-ocular Function in Children and Adolescents Postconcussion.

OBJECTIVE: To document (1) oculomotor (OM) and vestibulo-ocular (VO) function in children with concussion who were symptomatic at the time of assessment and to compare it with that in children with concussion who were clinically recovered (asymptomatic) and in children with no concussive injury, and (2) the extent to which OM and VO function relates to postconcussion symptom severity in injured children. SETTING: Participants were recruited from a concussion clinic or the community. PARTICIPANTS: A total of 108 youth with concussion (72 symptomatic; 36 recovered) and 79 healthy youth (aged 9-18 years). Youth with concussion were included if aged 9 to 18 years, had no previous concussion within the last 12 months, less than 90 days since injury, and no known existing visual disorders or learning disabilities. STUDY DESIGN: A prospective cross-sectional study. MAIN MEASURES: All participants were tested for OM and VO function with a commercial virtual reality (VR) eye-tracking system (Neuroflex®, Montreal,Québec, Canada). Participants in the concussion group who completed the postconcussion symptoms were scored with the Post-Concussion Symptom Inventory. RESULTS: There was a significant group effect for vergence during smooth pursuit (F2,176 = 10.90; P < .05), mean latency during saccades (F2,171 = 5.99; P = .003), and mean response delay during antisaccades (F2,177 = 9.07; P < .05), where children with symptomatic concussion showed poorer performance than clinically recovered and healthy children. Similar results were found in VO for average vestibular ocular reflex gain in the horizontal leftward (F2,168 = 7; P = .001) and rightward directions (F2,163 = 13.08; P < .05) and vertical upward (F2,147 = 7.60; P = .001) and downward directions (F2,144 = 13.70; P < .05). Mean saccade error was positively correlated to total Post-Concussion Symptom Inventory scores in younger clinically recovered children. CONCLUSION: VR eye tracking may be an effective tool for identifying OM and VO deficits in the subacute phase (<90 days) postconcussion.

Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents.

Objective: To (1) determine the level of agreement between symptom provocation and performance-based tests of vestibulo-ocular reflex (VOR) function after pediatric mild traumatic brain injury (mTBI) and (2) describe the level of symptom provocation induced by a VOR task in individuals with and without cervical findings. Design: Cross-sectional. Setting: This study was conducted at a tertiary care pediatric hospital. Participants: A total of 101 participants (N=101) aged 6-18 years within 3 weeks of mTBI diagnosis were included (54.5% female; mean age, 13.92±2.63 years; mean time since injury at assessment, 18.26±6.16 days). Interventions: None. Main Outcome Measures: Symptom provocation (Vestibular/Ocular Motor Screening tool), performance (clinician-observed VOR performance, head thrust test [HTT], computerized dynamic visual acuity test, video head impulse test), and cervical impairment (cervical flexion-rotation test, range of motion test, self-reported neck pain). Agreement was evaluated using Cohen's κ statistic. Results: No outcomes demonstrated agreement with symptom provocation (κ=-0.15 to 0.14). Fair agreement demonstrated between clinician-observed VOR performance and HTT (κ=0.32), with little to no agreement demonstrated between other measures. Proportions reporting test-induced dizziness and headache were greater among individuals with cervical findings (29.1%-41.8%) than without (2.3%-6.8%). Conclusions: Findings support that symptom provocation and performance-based tests measure different constructs and thus have distinct roles when assessing VOR function. Findings suggest results from measures of symptom provocation may be influenced by coexisting cervical impairments, underlining the value of assessing for cervical injury after pediatric mTBI.

Characterizing the evolution of oculomotor and vestibulo-ocular function over time in children and adolescents after a mild traumatic brain injury.

Background: Impairments to oculomotor (OM) and vestibulo-ocular reflex (VOR) function following pediatric mTBI have been demonstrated but are poorly understood. Such impairments can be associated with more negative prognosis, affecting physical and mental wellbeing, emphasizing the need to more fully understand how these evolve. Objectives: to determine i) the extent to which performance on clinical and computerized tests of OM and VOR function varies over time in children and adolescents at 21 days, 3-, and 6-months post-mTBI; ii) the proportion of children and adolescents with mTBI presenting with abnormal scores on these tests at each timepoint. Design: Prospective longitudinal design. Setting: Tertiary care pediatric hospital. Participants: 36 participants with mTBI aged 6 to18. Procedures: Participants were assessed on a battery of OM and VOR tests within 21 days, at 3- and 6-months post injury. Outcome measures: Clinical measures: Vestibular/ocular motor screening tool (VOMS) (symptom provocation and performance); Computerized measures: reflexive saccade test (response latency), video head impulse test (VOR gain), and dynamic visual acuity test (LogMAR change). Analysis: Generalized estimating equations (parameter estimates and odd ratios) estimated the effect of time. Proportions above and below normal cut-off values were determined. Results: Our sample consisted of 52.8% females [mean age 13.98 (2.4) years, assessed on average 19.07 (8-33) days post-injury]. Older children performed better on visual motion sensitivity (OR 1.43, p = 0.03) and female participants worse on near point of convergence (OR 0.19, p = 0.03). Change over time (toward recovery) was demonstrated by VOMS overall symptom provocation (OR 9.90, p = 0.012), vertical smooth pursuit (OR 4.04, p = 0.03), voluntary saccade performance (OR 6.06, p = 0.005) and right VOR gain (0.068, p = 0.013). Version performance and VOR symptom provocation showed high abnormal proportions at initial assessment. Discussion: Results indicate impairments to the VOR pathway may be present and driving symptom provocation. Vertical smooth pursuit and saccade findings underline the need to include these tasks in test batteries to comprehensively assess the integrity of OM and vestibular systems post-mTBI. Implications: Findings demonstrate 1) added value in including symptom and performance-based measures in when OM and VOR assessments; 2) the relative stability of constructs measured beyond 3 months post mTBI.

Attention-Deficit/Hyperactivity Disorder and Outcome from Concussion: Examining Duration of Active Rehabilitation and Clinical Recovery.

AIMS: The objective of this study was to compare recovery time and duration of active rehabilitation following concussion between adolescents with and without attention-deficit/hyperactivity disorder (ADHD). METHODS: A retrospective cohort study was conducted among adolescents presenting to a specialty concussion clinic. One-quarter of the eligible episodes of care were selected. The final sample included 540 adolescents (ages 13-17 years, median age 15 years; 49.8% girls), of which 65 (12.0%) had a pre-injury diagnosis of ADHD. Days to recovery and days of active rehabilitation were examined. RESULTS: ADHD was not associated with recovery time (ADHD: median = 49 days, IQR = 25-77; No ADHD: median = 47 days, IQR = 29-85) in univariate (Z = -0.45; p = 0.65) or multivariable analyses (Hazard Ratio: 1.17 (0.85-1.61); χ2(1) = 0.95; p = 0.33). The duration of active rehabilitation services received did not differ between youth with ADHD (median = 38.5 days, IQR = 27.5-54.5) and without ADHD (median = 37.5 days, IQR = 18.5-66) in univariate (Z = -0.19; p = 0.85) or multivariable analyses (Hazard Ratio: 1.04 (0.67-1.63); χ2(1) = 0.03; p = 0.85). CONCLUSIONS: Our findings support accumulating evidence that ADHD, in and of itself, is not a risk factor for longer recovery or worse outcomes following pediatric concussion.

Tracking postural stability of children and adolescents after a concussion: sport-related versus non-sport-related concussion.

BACKGROUND: Although postural impairments have long been reported following a concussion in the pediatric population, we still know very little about who is more at risk of presenting those balance problems and how the mechanism of injury (sport vs non-sport) could influence balance problems after concussions. The purpose of this study was to compare balance function in children having sustained a sport-related (SRC) or non-sport-related (NSRC) concussion, to that of children with an orthopedic injury (OI) and to non-injured (NI), over a one-year period. METHODS: One-hundred and twelve participants were included in this study. Among them, 38 were concussed, with 27 having sustained a SRC; and 11 an NSRC, as well as 38 NI, and 36 OI. Balance function was evaluated at 2 weeks, 3 months, 6 months, and 12 months after a concussion, and at the same time intervals for the control groups. The balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOT2) and Timed Foam Test was used to measure postural instability. Concussion related symptoms were measured by the Post Concussion Symptom Scale (PCSS). RESULTS: There was an improvement in tandem standing on the balance beam (P=.02) and in single-leg standing (SL) on foam surface (P=.02) for all groups over a year. At the 2nd week, NSRC had more postural instability than NI during SL on the balance beam when eyes were closed (P =.01), and performed significantly worse than SRC (P =.01) and NI (P =.01) during SL on the foam surface. NSRC also reported more symptoms than SRC on PCSS (P < 0.001). In the 3rd month, NSRC still had lower performance than SRC in SL on foam surface (P =.01). CONCLUSIONS: Children sustaining a concussion outside of a sport seem to have higher levels of postural instability up to 3 months post-injury when compared to those injured in sport.

Lifetime History of Concussion Among Youth With ADHD Presenting to a Specialty Concussion Clinic.

Child and adolescent student athletes with attention-deficit/hyperactivity disorder (ADHD) report a greater lifetime history of concussion than those without ADHD. This case-control study compared youth with and without ADHD presenting for care at a specialty concussion clinic on their lifetime history of concussion. We hypothesized that a greater proportion of youth with ADHD would report a history of prior concussion. Archival clinical data from patients presenting to a specialty concussion clinic in Montreal, Québec, Canada between September 2015 and August 2019 were analyzed. The sample included 2,418 children and adolescents (age: M = 13.6, SD = 2.7, range 5-18 years; 50.9% girls), including 294 (12.2%) with ADHD and 2,124 (87.8%) without ADHD. The proportion with prior concussion among youth with ADHD (43.9%) was significantly greater than youth without ADHD [37.5%, χ2 = 4.41, p = 0.04, OR = 1.30, 95% confidence interval (CI): 1.02-1.67]. A significantly higher proportion of boys with ADHD had a prior concussion history (48.1%) than boys without ADHD [38.4%, χ2 = 5.33, p = 0.02, OR = 1.48 (95% CI: 1.06-2.09)], but this difference was not observed for girls (χ2 = 0.31, p = 0.58). Youth with ADHD did not differ with regard to their estimated longest duration of symptoms from a prior concussion (Z = 1.52, p = 0.13) and the proportion who reported taking longer than 28 days to recover from a prior concussion did not differ between those with ADHD (15.3%) and without ADHD (12.2%), χ2 = 2.20, p = 0.14. Among youth presenting to a specialty clinic, ADHD was associated with greater lifetime history of concussion but not a greater duration of symptoms from a prior injury.

Feasibility of Early Active Rehabilitation for Concussion Recovery in Youth: A Randomized Trial.

OBJECTIVE: The primary objective is to evaluate the feasibility (safety and acceptability) of implementing early active rehabilitation (AR) for concussion management in youth with symptoms persisting 2 weeks after injury. A secondary and exploratory objective was to estimate the potential efficacy of early AR compared with standard AR. We hypothesize that AR at 2-weeks postconcussion will be safe and acceptable to patients. DESIGN: Randomized clinical trial. SETTING: The Montreal Children's Hospital of the McGill University Health Center (MCH-MUHC), a tertiary care pediatric teaching hospital affiliated with McGill University in Montreal, Canada. PARTICIPANTS: Twenty youth aged 9 to 17 years old with postconcussion symptoms for at least 2 weeks. INTERVENTION: Active rehabilitation (aerobic exercise, coordination drills, visualization, and education/reassurance) was administered by physiotherapists in-person, and then continued as a home program. METHODS: Twenty participants were randomized to either early AR (initiated 2 weeks after injury) or standard AR (initiated 4 weeks after injury). RESULTS: Two adverse events (one in each group) were identified through an online survey more than one-month postconcussion. Postconcussion symptoms decreased over time for both groups. CONCLUSIONS: The results from this pilot study indicate that a full clinical trial estimating the efficacy of early AR (starting 2 weeks after injury) is feasible. Further study is needed to determine the superiority of this strategy over current treatment approaches.

Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion.

OBJECTIVE: (1) To determine the impact of providing participants aged 8 to 17 years who are slow to recover after a concussion with a well-developed active rehabilitation intervention (ARI), compared with receiving standard care alone, on postconcussion symptoms (PCS) at 2 and 6 weeks after the initiation of ARI; and (2) to investigate functional recovery 6 weeks after initiation of ARI. DESIGN: A multicenter prospective quasi-experimental control group design. SETTING: Tertiary care pediatric trauma center and community health care providers. PARTICIPANTS: Forty-nine youth were enrolled (experimental n = 36; control n = 13). PROCEDURES: Participants were assessed on 3 different occasions: (1) initial visit (baseline); (2) 2 weeks; and (3) 6 weeks after enrollment. MAIN OUTCOME MEASURES: Child- and parent-reported PCS were obtained by the PCS Inventory Scale (primary outcome). Secondary outcomes included: (1) mood and anxiety; (2) quality of life; (3) energy level; (4) coordination and balance; (5) neurocognition; (6) parental anxiety; and (7) satisfaction with intervention. RESULTS: Both groups reported decrease of PCS over time (child: P = 0.01; parent: P = 0.03). Children in the experimental group presented higher quality of life (P = 0.04) and less anger (P = 0.02). A trend toward significance was observed for better tandem gait (P = 0.07) and for less general fatigue on self-reported PCS (P = 0.09) in the experimental group. CONCLUSIONS: Active rehabilitation intervention does not affect the PCS beyond the usual management, but it increases their quality of life, decreases anger, and potentially increases energy level and balance.

Effect of Sex on Recovery From Persistent Postconcussion Symptoms in Children and Adolescents Participating in an Active Rehabilitation Intervention.

OBJECTIVE: To estimate the extent to which biologic sex contributes to the severity of postconcussion symptoms (PCSs) in concussed youth, who are slow to recover and who receive an active rehabilitation intervention (ARI) as part of their standard care. SETTING: The concussion clinic of a pediatric trauma center in Canada. PARTICIPANTS: A total of 355 youth with persistent PCS (188 girls and 167 boys) as per the following criteria: (1) diagnosed with a concussion (or mild traumatic brain injury) as per the 2004 World Health Organization definition; (2) aged 8 to 17 years (mean = 14.34, standard deviation [SD] = 2.22 years); (3) presenting with at least 1 PCS interfering with daily activities (mean total PCS score at initial assessment = 24.50, SD = 18.88); and (4) on ARI 4 weeks postinjury (mean = 30.46, SD = 3.74 days). DESIGN: A retrospective analysis of a prospective cohort. MAIN MEASURES: PCS severity, measured by the PCS Scale (PCSS) included in the Sports Concussion Assessment Tool-3, was the dependent variable. PCSs were assessed 3 times over a 4-week period. RESULTS: Boys presented with significantly fewer symptoms than girls 4 weeks postinjury, at initiation of the ARI (PCSS total score mean: ♂ = 19.9, ♀ = 28.5, P < .001, confidence interval = -14.8 to -6.4), at 2 and 4 weeks of follow-up, but the rate of recovery was slightly faster for girls over the follow-up period. CONCLUSION: Despite differences between the PCSS score reduction after 4 weeks of intervention, our results favored to a slightly faster recovery for girls over the follow-up period. Although our findings are not strong enough to suggest distinct sex-specific intervention, both boys and girls benefit from participating in an ARI.

Is There an Optimal Time to Initiate an Active Rehabilitation Protocol for Concussion Management in Children? A Case Series.

OBJECTIVE: To estimate the time frame during which initiating an active rehabilitation intervention (aerobic exercise, balance, and sport specific skills) after concussion contributed to improvement in symptoms at follow-up in children and adolescents who are slow to recover (symptoms persisting beyond 2 weeks) from concussion. SETTING: Concussion clinic at a tertiary care pediatric teaching hospital. PARTICIPANTS: A total of 677 children and adolescents with concussion aged 7 to 18 years. DESIGN: Case series of participants starting active rehabilitation less than 2, 2, 3, 4, 5, or 6 or more weeks postconcussion. MAIN MEASURE: Symptom severity measured by the 22-item Post-Concussion Scale (PCS)-revised. RESULTS: All patients experienced significant improvement of symptoms while participating in active rehabilitation, irrespective of the start time postonset. Patients initiating active rehabilitation at 2 (P < .001) or 3 (P = .039) weeks postinjury demonstrated lower symptom severity at follow-up than those starting at 6 weeks or later. Patients starting at 2 weeks had lower symptom severity than patients starting less than 2 (P = .02), 4 (P = .20), or 5 weeks postinjury (P = .04). Lastly, patients starting less than 2 and 6 weeks or more postinjury yielded equivalent outcomes. CONCLUSIONS: The findings support the use of active rehabilitation in children and adolescents who are slow to recover from concussion. Participants starting active rehabilitation less than 2 weeks and up to 6 or more weeks postconcussion demonstrated significant symptom improvements, but improvement was observed in all groups, regardless of the time to start active rehabilitation.

Evaluation of an active rehabilitation program for concussion management in children and adolescents.

OBJECTIVE: To estimate the extent to which post-concussion symptoms were influenced by participation in an Active Rehabilitation (AR) program (aerobic exercise, coordination drills, visualization and education) for children and adolescents who are slow to recover from concussion. A secondary exploratory objective included examining the influence of sex on symptom evolution. METHODS: Analysis of prospectively collected data was performed on 277 youth who initiated an AR program, between three and four weeks post-injury at a Concussion Clinic in a tertiary care paediatric teaching hospital. MAIN OUTCOME MEASURE: Post-concussion symptom scale (PCSS) from Sport Concussion Assessment Tool-3 (SCAT 3). RESULTS: Children and adolescents participating in an active rehabilitation program displayed improved post-concussion symptom severity at follow-up (median = 9.5) compared to pre-intervention (median = 18) (p < .05). Patients demonstrated improved physical, cognitive, emotional and sleep-related post-concussion symptoms (p < .05). Female sex was associated with an increased post-concussion symptom severity at follow-up. CONCLUSIONS: Youth experiencing persisting symptoms three to four weeks post-concussion demonstrated improved post-concussion symptoms scores (physical, cognitive, emotional and sleep related) with participation in an active rehabilitation program.

Balance and mobility in clinically recovered children and adolescents after a mild traumatic brain injury.

PURPOSE: To compare the ability of clinical balance measures to detect differences between children recovered from a mild Traumatic Brain Injury (mTBI) and healthy controls. METHODS: A cross-sectional study, with twenty-six children with mTBI and twenty-two age-matched controls was conducted. Balance was evaluated on three scales: Bruininks- Osteresky Test-second edition; Balance Error Scoring System and Community Balance and Mobility Scale, along with gait analysis of three paradigms (self-selected paced walking, obstacle crossing and tandem walking), under single and dual-task conditions, using GAITRite\scriptsize® walkway. Independent sample t-tests (α = 0.05) were used to identify group differences. Dual-Task Cost (DTC) was analyzed using repeated measures ANOVA and t-tests. Discriminant analysis predicted which balance measure best identified the groups. RESULTS: Children with mTBI performed worse on all balance scales (p< 0.05). Gait parameters were significantly better for the controls. There were no group differences on the motor and cognitive DTC. The Community Balance and Mobility Scale and gait parameters including velocity at obstacle crossing and parameters for tandem walking, best discriminated the groups. CONCLUSION: Clinical balance assessments may need to include static and dynamic measures, to capture possible performance difficulties. The inclusion of these measures will enhance clinical decision making and prevent premature return to physical activities in children with mTBI.

Complementary and alternative health care use in young children with physical disabilities waiting for rehabilitation services in Canada.

PURPOSE: We wished to determine the frequency of complementary and alternative health care (CAHC) use in preschool aged children with physical disabilities (PD) waiting for public rehabilitation services in the province of Quebec (Canada), to evaluate its effectiveness from the parents' perspective and to explore factors associated with its utilisation. METHOD: Children with PD referred to rehabilitation centres from two Montreal hospitals were recruited. We evaluated the use of CAHC and its effectiveness from the parents' perspective in a cross-sectional manner, using descriptive statistics. We explored factors associated with utilisation, using logistic regression models. RESULTS: In this group of children with PD (n = 206, mean age: 2.6 years), 31 (15%) used CAHC and 15 (48.4%) of those tried more than one type. CAHC was considered at least moderately beneficial by parents in 53% of the cases. The use of CAHC was higher among children with low health-related quality of life (HRQOL) and children whose mothers were more educated and considered themselves as Canadian (p < 0.05). CONCLUSIONS: Although the use of CAHC by young children with PD was low, use of CAHC was higher among children with lower HRQOL and whose mothers were highly educated and Canadian. CAHC use should be evaluated by health providers to better educate parents of children with PD, which may help them to make the best decisions regarding their child's treatment while waiting for rehabilitation services.

Active rehabilitation for children who are slow to recover following sport-related concussion.

PRIMARY OBJECTIVE: To present an innovative approach to the management of children who are slow to recover after a sport-related concussion. RESEARCH DESIGN: The article describes the underlying principles and the development of specific interventions for a new rehabilitation programme as well as preliminary data on pre- and post-rehabilitation changes in outcome measures. METHODS AND PROCEDURES: Development of the intervention was done using multiple perspectives including that of the literature, of experts in the field of traumatic brain injury and of experienced clinicians involved with the paediatric and adolescent MTBI clientele. A logic model was developed providing sound theoretical background to the intervention. The intervention was implemented and evaluated with a sample of 16 children and adolescents. MAIN OUTCOMES AND RESULTS: The presented cases suggest that involvement in controlled and closely monitored rehabilitation in the post-acute period may promote recovery in children and adolescents who present with atypical recovery following a concussion. All 16 of the children and adolescents who participated in the programme experienced a relatively rapid recovery and returned to their normal lifestyles and sport participation. CONCLUSIONS: A gradual, closely-supervised active rehabilitation programme in the post-acute period (i.e. after 1 month post-injury) appears promising to improve the care provided to children who are slow to recover.

Is waiting for rehabilitation services associated with changes in function and quality of life in children with physical disabilities?

OBJECTIVES: To determine whether longer waiting times for rehabilitation were associated with deterioration in child functional status and/or quality of life. METHODS: Parents of 124 children (mean age 45 months) with physical disabilities (e.g., cerebral palsy, global developmental delay, spina bifida) who were referred to pediatric rehabilitation centers were interviewed every three months, from referral until admission into the rehabilitation program. Information from parental interviews included socio-demographics, parental empowerment (Family Empowerment Scale), function (WeeFIM: Functional Independence Measure for Children), and quality of life (PedsQL). Data on date of referral, age, gender, and diagnosis were obtained from hospital databases. RESULTS: Half of the sample waited more than 9.1 months (95% confidence interval: 6.5-16.1) for admission to a public rehabilitation program. A total of 42% paid for some private services while waiting. Over the waiting period, there was statistically significant improvement in WeeFIM cognition and total scores but not in mobility scores. PedsQL psychosocial summary score declined over the waiting period (p< .05). CONCLUSION: Longer wait times for rehabilitation were associated with declining psychosocial quality of life. Reducing waiting times for rehabilitation services may allow rehabilitation specialists to address psychosocial problems for these children.

Wait times for paediatric rehabilitation.

BACKGROUND: Early therapy intervention for children with disabilities may improve functional outcomes. Access to paediatric rehabilitation services can sometimes be difficult. OBJECTIVES: To describe waiting time to receive physical therapy (PT) and occupational therapy (OT) services at rehabilitation centres for young children with physical disabilities; to examine factors associated with these waiting times. DESIGN: Prospective cohort. SUBJECTS: Two hundred and six children with physical disabilities, aged 6 to 72 months, referred in 2002-2004 from the Montreal Children's Hospital and Sainte-Justine Hospital to paediatric rehabilitation centres. MEASURES: Data on date of referral, age, gender and diagnosis were obtained from the hospital databases. Data on date of first PT or OT appointments at the rehabilitation centre, family socio-demographics and disability severity (WeeFIM) were obtained during parental interviews. RESULTS: Half of the sample waited more than 7 and 11 months for PT and OT services, respectively. Shorter waiting time was significantly associated with younger child's age and referral to one particular rehabilitation centre. CONCLUSION: Children with physical disabilities experience long waiting times for PT and OT rehabilitation services. Strategies to improve timely service delivery are needed.

Associations between a functional independence measure (WeeFIM) and the pediatric quality of life inventory (PedsQL4.0) in young children with physical disabilities.

OBJECTIVES: To determine the association between functional status, measured by the WeeFIM and health-related quality of life (HRQL), measured by the PedsQL4.0 for children with physical disabilities. To explore child, parent and service-related factors associated with each of these measures. PATIENTS: Parents of 115 children (2-5 years) with physical disabilities who were referred to occupational (OT) or physical therapy (PT). Mean age of the children was 3 years 7 months (+/-10 months), 79 were boys and 67 were diagnosed with global developmental delay. RESULTS: Children had more difficulties with self-care tasks and cognitive abilities, as compared to mobility activities on the WeeFIM. The correlation between total WeeFIM and total PedsQL4.0 was r=0.39. WeeFIM mobility and self-care quotients were each fairly correlated with PedsQL-Physical Health Summary Score (rs=0.29 and rs=0.28 respectively). There was no significant association between WeeFIM cognition quotient and each of PedsQL scores (rs=0.03-0.05). The receipt of PT services was highly associated (p<0.001) with lower scores on the PedsQL-Physical Health Summary score, PedsQL-Total score, and WeeFIM mobility quotient. CONCLUSION: The WeeFIM and the PedsQL4.0 appear to assess related but different constructs, supporting the need to incorporate complementary measures when measuring general health of children with disabilities.

When and by whom is concern first expressed for children with neuromotor problems?

OBJECTIVE: To describe when and by whom concern is first expressed for children referred to rehabilitation because of neuromotor problems. STUDY DESIGN AND SETTING: We conducted a survey of parents of 92 children (aged 0-6 years) who were on the waiting list for physical or occupational therapy services at rehabilitation centers in Montréal, Québec. We compared age of child at initial concern with who first expressed concern for children who were considered at risk due to their perinatal history of prematurity and those who were not born prematurely but were later diagnosed as having neuromotor problems. INTERVENTION: Parents were interviewed regarding their child's medical history and utilization of health care services. RESULTS: Parents were concerned later than physicians were regarding their child's development (mean difference, 8.2 months; 95% confidence interval [CI], 3.7-12.6 months). There was no significant difference in time of recognition of problems between the premature (10.2 months) and full-term (11.9 months) groups. Even after controlling for risk group, parental concern occurred later than physician concern (beta coefficient, 7.3; 95% CI, 2.5-12.2). The child's age at the time of initial concern was associated with the child's age at referral to rehabilitation (beta coefficient, 0.04; 95% CI, 0.01-0.06). CONCLUSIONS: Early recognition is important if a child is to benefit from early rehabilitation. It may be important to improve primary care screening of children for neuromotor problems and to increase parental awareness regarding normal motor development of their children. Prompt, simultaneous referral to medical evaluation and rehabilitation resources may decrease delays in rehabilitation.