Nonpharmacological rehabilitation interventions for motor and cognitive outcomes following pediatric stroke: a systematic review.

The aim of this review was to evaluate the evidence for nonpharmacological rehabilitation interventions for motor and cognitive impairment following pediatric stroke. A literature search was conducted using multiple scientific databases. Studies were included if (1) the study population was > 50% pediatric (< 18 years) stroke, (2) a diagnosis of stroke was explicitly stated, (3) there were ≥ 3 pediatric stroke participants included in the study sample, and (4) motor or cognitive outcome measures were used to assess effect of treatment. Levels of evidence were assigned to each study to determine the strength of the evidence for each intervention. A total of 18 articles met inclusion criteria. Most studies (N = 14) examined rehabilitation of the upper limb, with constraint-induced movement therapy (CIMT) as the most common intervention. Overall, the evidence supports the use of CIMT, forced use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation, and robotics, but suggests no beneficial effect of transcranial direct current stimulation. Very few studies assessed interventions for the lower limb (N = 1) or cognitive impairment (N = 3).Conclusion: Effective rehabilitation approaches are important for optimizing outcomes in children who have had a stroke. Although the number of published clinical trials has increased in recent years, little evidence-based guidance exists for this clinical population. What is Known: • Pediatric stroke is a significant cause of disability in children that is often associated with long-term motor and cognitive sequelae. • There is a need to establish a knowledge base regarding available evidence-based rehabilitation therapies for this clinical population. What is New: • Most studies examining interventions for motor function focus on upper limb rehabilitation, whereas few studies have investigated interventions for improving lower limb or cognitive impairment. • An important gap exists regarding evidence-based rehabilitative treatment approaches for pediatric stroke.

Development of a Formalized, Multifaceted Mentorship Program in Physical Medicine and Rehabilitation Residency Education.

ABSTRACT: Mentorship in medicine has long been a vital component to the training, development, and career advancement of physicians. Although optimal strategies for facilitating mentorship relationships are unknown, it is recognized that establishing a formalized mentorship program within residency training may augment mentor-mentee pairing, improve overall trainee experience, and enhance resident perception of strong mentoring relationships. A formalized mentorship program was successfully developed in a Canadian physical medicine and rehabilitation residency program, including innovations such as near-peer self-matching, a needs assessment survey, a speed dating event, formation of "link groups," and "fireside chats" with faculty members. This approach may serve as a guide for other medical education and residency programs seeking to implement a similar concept.

Common wearable devices demonstrate variable accuracy in measuring heart rate during supraventricular tachycardia.

BACKGROUND: Wearable devices are used as a noninvasive method of monitoring health. The accuracy of wearables for heart rate (HR) monitoring has been extensively studied in sinus rhythm, but evidence for tachyarrhythmias, particularly supraventricular tachycardia (SVT), is sparse. OBJECTIVE: The purpose of this study was to examine the accuracy of 4 common wearable devices-Apple Watch, Fitbit Charge HR, Garmin VivoSmart HR, and Polar A360-in measuring HR during paroxysmal SVT. METHODS: Data were gathered from 52 patients by placing 1 device on each wrist during an electrophysiological study at which SVT was induced. The device-measured HR was obtained by using the highest HR measured by the device during each SVT episode. This HR was compared with measurements from a 12-lead electrocardiogram (ECG), for which the rate during the last 5 seconds of SVT was averaged. RESULTS: For SVT episodes <15 seconds, the Apple, Fitbit, Garmin, and Polar devices registered an increase from baseline HR in 18.7%, 19.5%, 1.5%, and 37.7% of episodes, respectively. For episodes 15-60 seconds, the Apple, Fitbit, Garmin, and Polar devices registered an increase in 67.6%, 42.4%, 24.3%, and 65.5% of episodes, respectively. For episodes ≥60 seconds, the Apple and Polar devices had 23 of 23 and 19 of 21 episodes with at least 90% agreement between device-measured and ECG-measured HR, whereas the Fitbit and Garmin devices had 7 of 20 and 8 of 22 episodes with at least 90% agreement. CONCLUSION: All wearable devices are inaccurate for short-duration SVT. Some devices are accurate for longer duration SVT.