Home Videos for Remote Assessment in Children with Disabilities: A Scoping Review.

Background: Analysis of parent-provided home videos is a mode of technology that can facilitate a telehealth assessment, allowing observation of function in the child's natural home environment. This scoping review investigated areas of use of home videos for functional assessment by health professionals with a pediatric population with disabilities. Methods: Four databases were searched for articles in which parent-provided home videos were employed by health professionals for functional assessment in children with disabilities. Articles published from 2013 to 2023 were included in the review if they met the inclusion criteria, and the data were extracted into an Excel file. Results: After screening 3,019 articles, 30 articles were included in the data extraction. The majority of studies utilized home videos for diagnosis of autism, followed by assessment of motor development in infants. Studies found that using home videos for assessment is feasible and empowers parents. The validity and reliability of various home video platforms were demonstrated. Conclusions: Analysis of home videos can aid in making a timely diagnosis for prompt intervention, and can be used to assess various body functions, interchangeable with a live clinic assessment. It is important to provide parents with clear instructions when using this method. Future studies are necessary to determine whether parent-provided home videos can be utilized by a multidisciplinary team to assess diverse factors, including activity, participation, and the environment, in a variety of populations of children with disabilities, thus extending services beyond the physical borders of the clinic.

Proximal and distal movement patterns during a graphomotor task in typically developing children and children with handwriting problems.

BACKGROUND: Therapists specializing in handwriting difficulties in children often address motor problems including both proximal and distal movements in the upper extremity. Kinematic measures can be used to investigate various aspects of handwriting. This study examined differences in movement patterns in proximal and distal joints of the upper extremity during graphomotor tasks between typically developing children with and without handwriting problems. Additionally, it explored relationships between movement patterns, speed, and legibility of writing. METHODS: Forty-one children, aged 7-11 years, were assessed with the Aleph Aleph Ktav Yad Hebrew Handwriting assessment and the Beery Test of Visual Motor Integration and, based on their scores, were divided into a research group (with handwriting difficulties) and a control group (without handwriting difficulties). Upper extremity joint movement patterns were analyzed with a motion capture system. Differences in the quality of shapes traced and copied on a graphics tablet positioned horizontally and vertically were compared. Between-group differences and relationships with speed and legibility were analyzed. RESULTS: In both groups, there was greater movement in the distal compared to the proximal joints, greater movement when performing the task in a horizontal compared to a vertical plane, and greater movement when tracing than copying. Joint movements in the arm executed scaled-down versions of the shapes being drawn. While the amount of joint displacement was similar between groups, children in the research group showed greater dissimilarity between the drawn shape and the shape produced by the proximal joints. Finally, the drawing measure on the tablet was a significant predictor of legibility, speed of writing, visual motor integration and motor coordination, whereas the dissimilarity measure of joint movement was a significant predictor of speed of writing and motor coordination. CONCLUSIONS: This study provides support for the role of the distal upper extremity joints in the writing process and some guidance to assist clinicians in devising treatment strategies for movement-related handwriting problems. While we observed differences in proximal joint movements between the children with and without handwriting difficulties, the extent to which they are responsible for the differences in drawing quality remains to be determined. Further studies should use a similar methodology to examine additional tasks such as drawing shapes of varying sizes.

Occupation Based Telerehabilitation Intervention for Adolescents with Myelomeningocele: A Pilot Study.

AIMS: This pilot study examined the impact of an occupation based intervention using a telerehabilitation format with adolescents with myelomeningocele (MMC). METHODS: We conducted a nonrandomized pilot study including four adolescents ages 14-18 with MMC. The intervention program included 10-12 sessions of the Cognitive Orientation to daily Occupational Performance remotely delivered via videoconferencing. Outcome measures included the Canadian Occupational Performance Measure (COPM), Wee-Functional Independence Measure;(Wee-FIM), and the Pediatric Quality of Life Inventory (PedsQL). Assessments were administered at baseline, post intervention and at three-month follow-up. RESULTS: Following intervention, participants rated their performance as having improved 2 points on the COPM for 8 out of 12 trained goals and on 2 out of 8 untrained goals. At 3-month follow-up improvement was reported on 9 out of 12 trained goals and 3 out of 8 untrained goals All participants made clinically significant improvements on the Wee-FIM total score following intervention and improvements were maintained at 3-month follow-up. The intervention effect on the PedsQL was inconclusive. Feedback interviews suggested that participants experience high satisfaction from the results and implementation of the intervention. CONCLUSIONS: Our results demonstrate potential efficacy of occupation based teleintervention for adolescents with MMC.

Lessons Learned during a Naturalistic Study of Online Treatment for Pediatric Rehabilitation.

The COVID-19 pandemic forced many health care providers to modify their service model by adopting telehealth and tele-rehabilitation with minimal time to plan for its execution. ALYN-Pediatric Rehabilitation Hospital in Jerusalem, Israel, responded with alacrity by providing a broad range of rehabilitation services to young people via online therapy during the first 5 months of the pandemic. The objectives of this naturalistic study were: (1) to monitor usage and user experience of online rehabilitation provided to young people receiving out-patient sessions of physical therapy, occupational therapy, speech and language therapy and psychology and (2) to consider the advantages and disadvantages of retaining this model of online treatment in full or in part post-COVID-19. The online rehabilitation treatment program was provided to 147 young people, aged 3 months to 20 years (mean 8.5 y; SD 5.3), and monitored and evaluated via data from the medical records as well as interviews, questionnaires and focus groups. The results use descriptive and inferential statistics to analyze data on the types and frequencies of therapy provided to 147 young people. Over a five month-period, 2392 therapy sessions were provided, 61 therapists from four disciplines were involved and 56.4% of the young people received two or more types of therapies via online rehabilitation. A repeated measures ANOVA showed significant differences over time per therapy. Feedback and recommendations about the process from therapists, parents and young people were collected during two focus groups of the professional staff (n = 12), parents and young people (parents n = 5, young people n = 3). Tele-rehabilitation services were perceived to be beneficial and effective by the great majority of young people, their parents and the healthcare professionals. The results are discussed within the context of conventional therapy as well as in comparison to reports of other online services for similar populations. We conclude that a hybrid approach in which in-person therapy sessions are coordinated with synchronous, online sessions, will provide a best-case fit for young people with chronic disabilities.

Exploring hand dexterity in children with myelomeningocele.

PURPOSE: To assess hand dexterity in children with myelomeningocele (MMC) and to explore factors related to hand dexterity in these children. METHODS: Ninety-four children with myelomeningocele, aged 4 to 18 years, were assessed. Demographic characteristics, disease factors, visual perception (Beery test of Visual Motor Integration), cognition (WeeFunctional Independence Measure), and self-care (Pediatric Evaluation of Disability Inventory) were assessed in relation to the Nine-Hole Peg Test (9HPT) for hand dexterity using Spearmen correlations and linear regressions. RESULTS: The children's performance on the 9HPT in both hands was significantly slower than the norms for their age groups. Children without a shunt showed significantly better function in both hands (p = .005) than those with a shunt. Factors most related to hand dexterity were neurological spinal level of MMC, presence of shunt, age, cognitive ability, and years of mother's education. CONCLUSION: Children with MMC appear to have poorer hand skills than typically developed children, which was related to pathology as well as functional and environmental factors. When addressing hand dexterity in children with MMC, it is important that rehabilitation professionals continue to work with these children as they get older, and put greater emphasis on parent education using materials that are adapted to varying educational levels.

Independence in self-care activities in children with myelomeningocele: exploring factors based on the International Classification of Function model.

PURPOSE: To investigate the relationship between disease factors, body functions and structures, activities, personal and environmental factors with independence in self-care activities in children with myelomeningocele (MMC), utilizing the International Classification of Function model. METHOD: 113 children with MMC, aged 3-18 years were assessed during an annual MMC-clinic visit. Data on the personal and environmental factors, disease factors, hand function, mobility, visual perception, cognition, and communication were assessed in relation to the Pediatric Evaluation of Disability Inventory (PEDI) self-care domain. RESULTS: The mean PEDI caregiver assistance score was 22.1 (ranged between <10 and 62) well below the norms. The most significant determinant of dependence in self-care activities was the presence of hydrocephalus, a child with hydrocephalus scored a mean of 9.2 points less on the PEDI caregiver scale (p = 0.02). By using a linear regression, the most significant factors associated with the PEDI scores among children with hydrocephalus were the age of the child, function of the non-dominant hand, ambulation, and cognitive function. CONCLUSION: In children with MMC the presence of hydrocephalus appears to be more significantly associated with functional independence than the neurological level. The International Classification of Function model provides an in-depth multidisciplinary model that facilitates in investigating independence in self-care activities in children with MMC. It is important to take personal factors and various functional impairments into account when working with these children to promote independence. Implications for Rehabilitation When working with children with myelomeningocele on independence in daily living activities, it is necessary that health professionals demonstrate a holistic view of the child and his/her disability. Health professionals should take into account information on all factors of the International Classification of Function, in order to help the children, achieve maximal independence. It is important for health professionals to consider presence or lack of hydrocephalus when working with children with myelomeningocele to achieve functional gains. Improving upper extremity function and cognitive ability in children with myelomeningocele may help promote independence in activities of daily living. It is necessary for health professionals to continue to work with children with myelomeningocele on maximizing independence as they get older, for it is possible for them to achieve independence at a later age. While this study did not explore participation, this is an essential part of the International Classification of Function and is generally related to function. Participation allows a child to be involved in life situations, contributes to life satisfaction and prepares children for critical adult roles. It is therefore important to assess and monitor this measure. Further studies should examine associations between independence in self-care activities and participation.

Analysis of proximal and distal muscle activity during handwriting tasks.

OBJECTIVE: In this study we sought to describe upper-extremity proximal and distal muscle activity in typically developing children during a handwriting task and to explore the relationship between muscle activity and speed and quality of writing. METHOD: We evaluated 35 third- and fourth-grade Israeli children using the Alef-Alef Ktav Yad Hebrew Handwriting Test. Simultaneously, we recorded the participants' upper trapezius and thumb muscle activity by surface electromyography. Using the coefficient of variation (standard deviation divided by mean amplitude) as a measure of variability within each muscle, we analyzed differences in muscle activity variability within and between muscles. RESULTS: The proximal muscle displayed significantly less variability than the distal muscles. Decreased variability in proximal muscle activity was associated with decreased variability in distal muscle activity, and decreased variability in the distal muscles was significantly associated with faster speed of writing. CONCLUSION: The lower amount of variability exhibited in the proximal muscle compared with the distal muscles seems to indicate that the proximal muscle functions as a stabilizer during a handwriting task. In addition, decreased variability in both proximal and distal muscle activity appears to be more economical and is related to faster writing speed. Knowledge of the type of proximal and distal muscle activity used during handwriting can help occupational therapists plan treatment for children with handwriting disabilities.