Secondary traumatic stress among pediatric nurses: Relationship to peer-organizational support and emotional labor strategies.

BACKGROUND: Even though the cost of caring is acknowledged in multiple helping professions, research into secondary traumatic stress in pediatric nursing remains limited. This study aimed to determine the prevalence of secondary traumatic stress among pediatric nurses and examine its correlation with demographics, perceived organizational support, peer support, and emotional labor strategies. DESIGN AND METHODS: A total of 186 nurses working in a pediatric hospital completed questionnaires addressing secondary traumatic stress, perceived organizational support, peer support, and emotional labor strategies. Through correlational and mediation analyses, we explored the relationships between the study variables. RESULTS: Approximately 77.8% of the pediatric nurses surveyed exhibited moderate to severe secondary traumatic stress. Notably, the level of secondary traumatic stress did not correlate with demographic variables. Increased peer support was significantly associated with a heightened use of all emotional labor strategies (surface acting, deep acting, and natural expression) and with elevated levels of secondary traumatic stress. However, surface acting was the sole mediator of this relationship. Conversely, greater perceived organizational support correlated with decreased levels of surface acting and secondary traumatic stress, with surface acting serving as the mediator. CONCLUSIONS: Pediatric nurses are greatly impacted by secondary traumatic stress. Enhancing organizational support and carefully assessing peer support can reduce this, by decreasing nurses' need to suppress or feign genuine emotions. PRACTICE IMPLICATIONS: To enhance nurses' psychological well-being, healthcare institutions should raise awareness of secondary traumatization and foster a supportive organizational environment that prioritizes effective team emotional support and evaluates collegial emotional labor.

Prolonged duration of post-traumatic amnesia: A sensitive classification for predicting cognitive outcomes in children recovering from traumatic brain injury.

OBJECTIVE: A paucity of data exists regarding the duration of post-traumatic amnesia (PTA) as a predictor of cognitive functioning among children after traumatic brain injury (TBI). The study aimed to assess the relationship between PTA duration and areas of neurocognitive function among the pediatric population in the sub-acute phase of recovery and rehabilitation. METHODS: Data were collected from medical files on 103 children aged 5.5-16.5 hospitalized at a pediatric rehabilitation department with a diagnosis of moderate-severe TBI (msTBI) between the years 2004-2019. The Children Orientation and Amnesia Test was used to evaluate PTA duration. Measures of high-order cognitive abilities of attention and executive function were collected using the Test of Everyday Attention-Child version (TEA-Ch). RESULTS: Three PTA duration groups were assembled out of a cluster analysis: "Long PTA" (M = 21 days), "Very Long PTA" (M = 47 days), and "Extremely Long PTA" (M = 94 days). Analyses revealed that the "Long PTA" group preformed significantly better than the "Very Long PTA" and "Extremely Long PTA" groups on all TEA-Ch measures, that is, Selective Attention, Attentional Control Switching, and Sustained Attention. CONCLUSIONS: This study is the first to demonstrate that PTA duration is a useful predictor of high-order cognitive functions among children with msTBI in the sub-acute phase of recovery and rehabilitation. The findings emphasize the importance of using a more sensitive classification of prolonged PTA durations to improve outcome prediction and allocation of resources to those who can benefit most after severe brain injuries.

Perfectionism, Big Five and biopsychosocial functioning among parents of children with and without acquired brain injury (ABI).

BACKGROUND AND OBJECTIVE: Personality factors are often investigated in the context of parenting but are rarely studied in relation to coping with child disabilities like pediatric acquired brain injury (pABI). This study (1) compares Biopsychosocial functioning (BPSF), Big Five personality traits, and dimensions of perfectionism of parents of children with and without pABI, and (2) examines the role personality factors play in parental BPSF in each group. METHOD: 57 parents of children who sustained a significant pABI and 50 parents of typically developing children participated in this cross-sectional study. Parents completed scales measuring Multidimensional Perfectionism, Big Five inventory, and BPSF. RESULTS: Among the pABI group, multivariate analysis indicated significantly poorer BPSF, higher levels of neuroticism, socially prescribed perfectionism, and lower levels of openness, than controls. Regression analysis showed that personality explained 60.5% of the variance in parental BPSF post pABI. In both samples, neuroticism and socially prescribed perfectionism appeared as two prominent personality factors with a significant negative effect on parental BPSF, while self-perfectionism appeared prominent only in the pABI group, indicating a significant positive effect. IMPLICATIONS: pABI may result in changes to parents` personality. Personality characteristics significantly contribute to parental BPSF post-injury and should be addressed in clinical practice.

"Mind the gap": Exploring pediatric nurses` perceptions of the theory and practice of caring for children and families.

PURPOSE: To investigate how pediatric nurses interpret and conceptualize theoretical underpinnings and daily practice scenarios pertaining to their role in pediatric care. DESIGN AND METHODS: 139 pediatric nurses completed a survey in which they were asked to endorse to what extent practices related to pediatric concepts are expected from their role ("Expected") or are actually implemented in their clinical work ("Actual"). Survey items were derived from a nursing textbook that outlines the theoretical tenets of the "art of pediatric nursing", along with scenarios and conflicts encountered in everyday practice, covering family-child centered care, child growth and development, and emotional boundaries. RESULTS: In both Expected and Actual practices, the highest level of endorsement was for items focused on core elements of family-centered care (80-96%), and moderate-low endorsement levels were observed for items related to therapeutic relationship management and emotional boundaries. A factor analysis yielded 12 factors representing themes related to pediatric nursing. However, the division of items per factor indicated diffusion between key concepts and a discrepancy between theory and practice, especially in regard to maintaining emotional separateness and objectivity, advocacy, managing conflicts within the nurse-child-family triad, and navigating oneself boundaries. CONCLUSIONS: Nurses' ability to manage and contain various types of unclear boundaries is crucial for optimal care provision when working with children and families. PRACTICE IMPLICATION: Variability in nurses' theoretical role-perception and practical care provision is largely attributed to the way they navigate various ambiguous boundaries in practice and this could be a focal point in educational programs and on-the-job training.

Online Awareness among Adolescents with Acquired Brain Injury: Preliminary Findings following Performance of Motor, Cognitive and Functional Tasks.

Aims: Online awareness is an ongoing ability to monitor performance within the stream of action. It involves the ability to detect errors emerging during actual performance, as well as to anticipate potential problems. This preliminary within-subject study aimed to evaluate emergent and anticipatory online awareness among adolescents with Acquired Brain Injury (ABI) during performance of motor, cognitive and functional tasks.Methods: 14 adolescents (11-18 years) following ABI were recruited. Before and after completion of the tasks, participants fulfilled task-related awareness questionnaires.Results: In the motor task, no significant correlations were found between heart rate and the subjective perceived exertion scale (emergent awareness). In the cognitive task, no significant correlations were found between the estimated difficulty before the task (anticipatory awareness) and actual performance, however a significant correlation was found between performance and the self-evaluation of performance (emergent awareness), in the easiest item of the task. In the functional task, two main patterns of online awareness were recognized: accurate and overestimation of performance.Conclusions: Online awareness deficits in adolescents after ABI, vary as a function of task characteristics. Clinicians who aim to improve online awareness should direct interventions to mainly include functional tasks, as compared to cognitive and motor tasks.

Factors associated with Multidisciplinary Healthcare Resource Utilization Following Discharge from Pediatric Rehabilitation: A One-year Follow-up Study.

AIMS: To characterize multidisciplinary healthcare resource utilization (mHRU), including physical, occupational, speech and psychosocial therapy one-year following discharge from prolonged inpatient and outpatient pediatric rehabilitation in Israel and to identify factors associated with long-term mHRU. METHODS: According to Andersen's model of health service use, predisposing (child's age and sex), enabling (district of origin, income level, parental education, insurance) and need factors (injury type, functional status, family psychosocial risk) were collected from parents of children hospitalized for >1 month in a large rehabilitation hospital in Israel, and phone interviews were held 3-months (T1), 6-months (T2) and 12-months (T3) post-discharge. The effect of time and the role of various factors on mHRU, operationalized as number of therapy sessions in the previous 2 weeks, were evaluated. RESULTS: Sixty-one families participated at T1 and T2, and 46 participated at T3. HRU was similar over time. Predisposing factors (age) and need factors (functional status and psychosocial risk) were associated with specific disciplines of mHRU, but enabling factors were not. CONCLUSIONS: mHRU is high and stable 12-months post-discharge. The lack of impact of enabling factors on mHRU, and the discipline-specific impact of predisposing and need factors, support equity of care provision for children following prolonged rehabilitation.

Using a biopsychosocial approach to examine differences in post-traumatic stress symptoms between Arab and Jewish Israeli mothers following a child's traumatic medical event.

BACKGROUND: Parents of children following traumatic medical events (TMEs) are known to be at high risk for developing severe post-traumatic stress symptoms (PTSS). Findings on the negative impact of TMEs on parents' PTSS have been described in different cultures and societies. Parents from ethnic minority groups may be at particularly increased risk for PTSS following their child's TME due to a host of sociocultural characteristics. Yet, differences in PTSS manifestation between ethnic groups following a child's TME has rarely been studied. OBJECTIVES: We aimed to examine: (1) differences in PTSS between Israeli-Arab and Israeli-Jewish mothers, following a child's TME, and (2) risk and protective factors affecting mother's PTSS from a biopsychosocial approach. METHODS: Data were collected from medical files of children following TMEs, hospitalized in a Department of Pediatric Rehabilitation, between 2008 and 2018. The sample included 47 Israeli-Arab mothers and 47 matched Israeli-Jewish mothers. Mothers completed the psychosocial assessment tool (PAT) and the post-traumatic diagnostic scale (PDS). RESULTS: Arab mothers perceived having more social support than their Jewish counterparts yet reported higher levels of PTSS compared to the Jewish mothers. Our prediction model indicated that Arab ethnicity and pre-trauma family problems predicted higher levels of PTSS among mothers of children following TMEs. CONCLUSIONS: Despite reporting higher social support, Arab mothers reported higher levels of PTSS, as compared to the Jewish mothers. Focusing on ethnic and cultural differences in the effects of a child's TME may help improve our understanding of the mental-health needs of mothers from different minority groups and aid in developing appropriate health services and targeted interventions for this population.

Factors associated with parental grief reaction following pediatric acquired brain injury.

The present study investigated factors associated with parental grief reaction (PGR) following pediatric acquired brain injury (ABI), and compared PGR to the one exhibited following child death. Fifty-seven parents of 51 children (aged 3-18) whose ABI occurred 1-14 years before participation, completed the multi-scale Two-Track Bereavement Questionnaire; a socio-demographic questionnaire; and a scale assessing perceived behavioural changes in the child. Results from regression analysis indicated that time since injury had no impact on parents' grief other than having an adverse impact on their overall coping and functioning; A higher amount of weekly caring hours predicted only a greater traumatic perception of the loss; Older children's ages but mostly greater parental-perceived behavioural changes, predicted greater PGR on most scales. PGR was compared with the pre-existing data of bereaved parents who completed the same grief questionnaire. Although grief response patterns and intensity were similar in both groups, significant differences were found on scales assessing the continuing bond with the child: relational active grief, close and positive relationship, and conflictual relationship. Our findings indicate that parental grief is multi-dimensional following pediatric ABI and illuminate the interplay between elements characterizing parents' nonfinite vs. finite loss experience.

"Concurrent Ropes and Ladders": Mapping and Conceptualizing the Emotional Loss Experience of Parents Following Pediatric Acquired Brain Injury.

This grounded theory study aims to map, conceptualize, and theorize the emotional loss experienced by parents following their child's pediatric acquired brain injury (pABI). Data were obtained from 47 semi-structured interviews conducted with parents (72% mothers) at least 1 year following pABI. The study's theory of "concurrent ropes and ladders" emerged from a process of initial in vivo coding followed by focused and thematic coding. Codes were consolidated into five thematic categories capturing parents' emotional continuous loss experience: (a) comparing life before and after, (b) struggling to construct new realities, (c) recognizing instability and permanency, (d) adjusting and readjusting, and (e) grieving as an emotional shadow. These categories are at work simultaneously in parents' accounts, thus supporting a model of dynamic concurrency within and across their lived experiences. Recommendations for practitioners were derived from the theory to support parents' emotional coping with living loss throughout the chronic stage.

Child and Family Factors Associated With Posttraumatic Stress Responses Following a Traumatic Medical Event: The Role of Medical Team Support.

OBJECTIVES: This study examined the contribution of pretrauma psychosocial factors (child emotional functioning, family resources, family functioning, and social support) and environmental factors (mother's posttraumatic stress symptoms [PTSSs], medical team support [MTS]) to PTSSs of injured or seriously ill children within a pediatric rehabilitation setting. It was hypothesized that psychosocial variables would be strongly associated with child's PTSS; that mother's PTSS and MTS would mediate the association between psychosocial factors and child's PTSS; that mother's report on child's PTSS would mediate the association between mother's PTSS and child's PTSS. METHODS: Participants were 196 children hospitalized following an injury/illness and assessed M = 47.7 days postevent. Children completed measures of PTSS, mothers completed measures of their own PTSS, child's PTSS, and pretrauma psychosocial factors. Family's therapist completed a MTS measure. Structural equation modeling was employed to evaluate the study hypotheses. RESULTS: Pretrauma family structure and resources were associated with child's self-reported PTSS; each pretrauma variable and mother's report of child's PTSS was significantly associated. Although mother's PTSS was not directly associated with child's PTSS, this relationship was mediated by mother's report of child's PTSS. MTS mediated the relationship between pretrauma social support and mother's PTSS. CONCLUSION: This study further explicates the utility of a biopsychosocial framework in predicting childhood PTSS. Findings confirm the role of pretrauma factors and environmental factors at the peritrauma period in the development of PTSS following a pediatric injury/illness. Mother's PTSS and MTS may be appropriate targets for prevention and early intervention.

Despite dystonia: natural history of delayed-onset pediatric secondary dystonia.

Background: Dystonia is a movement disorder involving involuntary movements and/or postures of the limbs, trunk, neck or face. Secondary dystonia following brain injury is uncommon, with unfavorable long-term consequences. Given the limited evidence regarding pediatric secondary dystonia, this study's aim was to document the natural history of the condition and the effect of interventions on its symptomatology. Methods: We describe three cases of girls (age 8 to 11 y) who developed dystonia secondary to an acquired brain injury, received intensive rehabilitation treatments and were followed for 8-33 months post-injury. In all three cases, secondary dystonia appeared 1-3 months post-insult. Results: In none of the cases was there alleviation of dystonic symptoms over time despite physical and pharmacological interventions; in two cases the dystonic hand is now used as an assisting hand only, whereas in the third it is completely non-functional. However, despite their impairment, two girls achieved basic functional independence and one is partly independent in activities of daily living. Conclusions: Rehabilitation professionals who work with pediatric patients susceptible to developing secondary dystonia should be aware of its possible consequences and inform families and staff. Intensive task-specific training during rehabilitation may be key to regaining overall functional capabilities despite residual impairment.

Parents and teachers reporting on a child's emotional and behavioural problems following severe traumatic brain injury (TBI): the moderating effect of time.

BACKGROUND: Gathering information from parents and teachers following paediatric traumatic brain injury (TBI) has substantial clinical value for diagnostic decisions. Yet, a multi-informant approach has rarely been addressed when evaluating children at the chronic stage post-injury. In the current study, the goals were to examine (1) differences between parents' and teachers' reports on a child's emotional and behavioural problems and (2) the effect of time elapsed since injury on each rater's report. METHODS: A sample of 42 parents and 42 teachers of children following severe TBI completed two standard rating scales. Receiver Operating Characteristic (ROC) curves were used to determine whether time elapsed since injury reliably distinguished children falling above and below clinical levels. RESULTS: Emotional-behavioural scores of children following severe TBI fell within normal range, according to both teachers and parents. Significant differences were found between parents' reports relatively close to the time of injury and 2 years post-injury. However, no such differences were observed in teachers' ratings. CONCLUSIONS: Parents and teachers of children following severe TBI differ in their reports on a child's emotional and behavioural problems. The present study not only underscores the importance of multiple informants, but also highlights, for the first time, the possibility that informants' perceptions may vary across time.

Gross motor proficiency deficits among children and adolescents post posterior fossa brain tumor removal vs. traumatic brain injury in the chronic phase of recovery: a cross-sectional study.

Introduction: Acquired brain injury (ABI) is a prevalent diagnosis in pediatric rehabilitation. Gross motor skills are often affected by ABI and limit the ability to participate in various physical activities. However, as ABI injury location is diverse, children and adolescents (youth) with localized ABI, such as ABI in the posterior fossa (ABI-PF) may present unique and different motor disabilities than youth with ABI on account of traumatic brain injury (TBI). Aims: The aims of the study were: (1) to compare gross motor deficits in youth with TBI vs. ABI-PF; and (2) to compare two methods on scoring BOT2 to determine which is better for identifying motor deficits. Methods: Participated in this study youth with TBI (N = 50) and ABI-PF (N = 30). Participants were tested on Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition (BOT2) Upper-Limb Coordination, Balance, Strength, Running Speed and Agility, and Bilateral-Coordination subtests. Motor performance deficits were established using two-standard deviations (2SD) and age-equivalent methods. Between-group differences were assessed via independent t-tests and receiver operating characteristic curves (ROC). Results: According to the 2SD method, motor deficits in the ABI-PF group ranged from 20% to 66.66%, whereas in the TBI group 8%-16%. According to the age-equivalent method, in the TBI and ABI-PF groups 40%-66.0% and 46.66%-76.66% of the youth presented motor deficits, respectively. Moreover, ROC analysis showed that motor performance deficits of both groups in all sub-scales except for Bilateral Coordination differed enough to result in medium area under the curve. Conclusions: Motor deficits post-pediatric ABI are prevalent. In comparison to the TBI group, deficits are greater in the ABI-PF group. Moreover, compared to the 2SD method, the extent of motor deficiency is greater in the age-equivalent method. Therefore, using the later might provide a more valid classification of deficits in gross motor proficiency for youth post-ABI.

Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis.

Background: Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families' psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. Objectives: Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. Methods: Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. Results: The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. Conclusion: Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.

Antecedentes: Síntomas de estrés postraumático (SEPT) a menudo son experimentados por los niños y miembros de la familia después de eventos médicos pediátricos traumáticos (PTME, por sus siglas en inglés). La evaluación de los factores de riesgo psicosocial de las familias es una parte crucial de la práctica informada sobre el trauma, ya que ayuda a identificar el riesgo de SEPT después de PTME.Objetivos: Usando la Herramienta de Evaluación Psicosocial 2.0 (PAT2.0), este estudio describe el riesgo psicosocial de las familias luego de un PTME de dos maneras: 1. Describiendo el riesgo psicosocial definido por la PAT2.0 basado en niveles de riesgo en tres niveles; 2. Usando un análisis de perfiles latentes (LPA, por sus siglas en inglés); identificar perfiles de riesgo psicosocial y examinar cómo los factores relacionados con los niños y las lesiones pueden afectar la pertenencia al perfil.Métodos: Los cuidadores de 374 niños después de un PTME admitidos en un departamento de rehabilitación pediátrica en Israel completaron el PAT2.0. En el primer análisis se incluyeron la puntuación total de PAT2.0 y las siete subescalas de PAT2.0 (estructura/recursos familiares, apoyo social, problemas de los niños, problemas de hermanos, problemas familiares, reacciones de estrés del cuidador y creencias familiares). Se calcularon las puntuaciones medias de PAT2.0 de tres categorías de riesgo (universal, específico, clínico); se usaron LPA, que permite crear modelos transversales de una mezcla de las variables latentes para identificar la heterogeneidad dentro de una población, y regresiones logísticas multinomiales usando seis de las siete subescalas PAT2.0, para determinar distintas diferencias de perfil y predictores de membresía al perfil.Resultados: Los tres niveles de riesgo revelados fueron relativamente altos, en comparación con los niveles en familias de niños con otros diagnósticos clínicos. LPA arrojó una solución de tres perfiles: bajo riesgo familiar (63,53%); alto estrés del cuidador, niveles de riesgo familiar superiores a la media (22,5%); y problemas entre hermanos, niveles de riesgo familiar superiores a la media (13,94%). La pertenencia étnica y el tipo de lesión pronosticaron la pertenencia al grupo.Conclusión: Las familias de niños que presentan PTME tienen un mayor riesgo psicosocial. Un enfoque clínicamente útil para identificar y prevenir el TEPT puede ser evaluar patrones de dominio específicos en lugar de solo el nivel de riesgo total de PAT2.0, basado en las subescalas de PAT2.0.

Visual assessment in children with cerebral palsy: implementation of a functional questionnaire.

AIM: The aim of this study was to evaluate an interdisciplinary visual assessment for multiply challenged children diagnosed with cerebral palsy (CP). METHOD: A comprehensive ophthalmological assessment together with a visual classification scale (VCS) and a questionnaire evaluating daily visual function were completed regarding 77 children (41 females, 36 males; age range 3-20y; mean age 8 y 3 mo [SD 4 y 3 mo]; Gross Motor Function Classification System [GMFCS] level V; Manual Ability Classification System level V) who were diagnosed with CP (79.2% spastic quadriplegia, 6.5% athetoid quadriplegia, 10.4% mixed type, 3.9% hemiplegia). All participants had severe to profound motor and intellectual disability and an inability to communicate consistently through either verbal or assisted communication. The interrater and test-retest reliability of the questionnaire and its validity in comparison with the VCS were examined. In addition, the contribution of ophthalmological testing in predicting daily visual function was assessed. RESULTS: The ophthalmological examination revealed three diagnostic subgroups: a group with cerebral visual impairment (CVI), a group with optic atrophy, and a group without visual impairment. The questionnaire was found to have high values of interrater reliability (interclass correlation coefficient [ICC]=0.873; 95% confidence interval [CI] 0.762-0.935) and test-retest reliability (ICC=0.988; 95% CI 0.964-0.996). Validity was established for the questionnaire factors: task-orientated visual function (r=0.802; 95% CI 0.669-0.885) and basic visual skills (r=0.691; 95% CI 0.504-0.816). The questionnaire provided information about daily visual performance not available from one-time ophthalmological testing, particularly for participants diagnosed with CVI. The visual performance scale significantly predicted daily visual function for all groups. INTERPRETATION: This study highlights the benefits of implementing a diagnostic performance scale as well as a reliable functional questionnaire to achieve a precise visual assessment of children with severe neurological impairment.

The Development and Evaluation of the Powered Mobility Function Scale (PMFS) for Children and Adolescents with Cerebral Palsy.

Aims: To describe the development and evaluation of a novel task-based measure of powered mobility function: the Powered Mobility Function Scale (PMFS).Methods: PMFS was developed in Hebrew in four phases, with feedback from clinicians and clients. Psychometric properties (inter-rater, test-retest reliability, concurrent, convergent and known-groups validity) were evaluated for N = 49 children and adolescents with Cerebral Palsy (11.1 ± 4.8y) using Powered Mobility Program (PMP), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)Results: PMFS development involved 3 versions over three years. Inter-rater reliability was κ=0.75-0.95 (video/observation). Test-retest reliability was κ=0.93-0.96. Concurrent validity (PMP) was ρ=-0.84-to-0.96. Convergent validity (PEDI-CAT) was ρ=-0.47-to-0.70. Known-groups validity (GMFCS/MACS) demonstrated medium effect sizes (r = 0.33-0.46)Conclusions: PMFS is valid and reliable for measuring powered mobility function in children and adolescents with CP. Future validation of the English version of PMFS is warranted.

Serum biochemical markers for brain damage in children with emphasis on mild head injury.

Despite the high incidence of mild pediatric head injuries, only within the past few years has there been increased interest and research in this area. This interest began when the findings from research done in adult patients showed that the effects of mild closed head injuries could interfere significantly with higher cognitive functioning, which impacted daily activities and employment. Traumatic brain injury (TBI) often involves a combination of mechanical trauma and local hypoxemia, on which serum biomarker concentrations may provide critical therapeutic data to time the brain injury. Biochemical serum markers after TBI may be used as a source for the identification of the injury, the extent of the injury and the time of its occurrence, and even for identifying its most likely outcome. This article discusses current research and theories regarding biochemical serum markers in brain injury with an emphasis on their impact on and utility in mild head injury in children.

Factors Associated With Gains in Performance During Rehabilitation After Pediatric Brain Injury: Growth Curve Analysis.

OBJECTIVE: Predicting recovery of functional performance within pediatric rehabilitation after brain injury is important for health professionals and families, but information regarding factors associated with change in functional skills ("what the child can do") and functional independence ("what the child does") is limited. The aim of the study was to examine change in functional skills and independence over time in children with moderate-severe brain injury during prolonged inpatient rehabilitation. DESIGN: This study used a retrospective cohort design. Longitudinal data from 139 children (age 1.6-20.6 yrs), hospitalized for 115.4 ± 72 days, were examined. Growth curve analysis was used to examine factors associated with change in the Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance, ie, functional independence) in mobility and self-care. Typical estimates for change per hospitalization day were obtained. RESULTS: Traumatic brain injury and older age at injury, but not sex, were associated with faster recovery. Length of stay was associated with rate of change in functional skills but not in functional independence, suggesting that improvement in functional independence during rehabilitation may be associated with other factors. CONCLUSIONS: Identifying the factors associated with individual profiles of functional improvement can provide valuable information for clinicians and decision-makers to optimize performance after prolonged inpatient rehabilitation.

Exploring the role of perceived vs. observed behavioral outcomes in parental grief reaction following pediatric acquired brain injury.

BACKGROUND: Pediatric acquired brain injury may result in a significant gap between the "pre" and "post-injury" child. OBJECTIVE: We aimed to quantitatively explore the mechanism underlying parents' loss experience by examining the mediating role of behavioral outcomes (observed-problems and perceived-change) in the relationship between injury severity and grief. METHOD: The study employed a cross-sectional retrospective design and comprised 40 parents of children (aged 3-18 years) with moderate-severe brain injury. Data for each parent included an adapted version of the Two-Track Bereavement Questionnaire and Socio-demographics; Data for each child included the child's Information Processing Speed Index; the Child Behavioral Checklist and Parental Perception of Behavioral Changes scale. RESULTS: Slowed information processing speed was significantly associated with elevated ratings on both measures of behavioral outcomes and with intensified grief. Mediation analyses revealed that parental perceived behavioral change, significantly mediate the relationship between information processing speed and grief; the Child Behavioral Checklist total score also mediated the same relationship but only in 90% confidence interval. CONCLUSIONS: Findings reveal the adverse impact of behavioral outcomes on grief and suggest parents' loss experience to be stemming primarily from their subjective perception over their "changed-child", rather than the observed problems. Implications for clinical practice are discussed.

Sense of autonomy and daily and scholastic functioning among children with cerebral palsy.

BACKGROUND: There is growing evidence that children's sense of autonomy is an important psychological need closely linked with the development of self-esteem and motivation. Among children with physical disabilities, motor or cognitive limitations may negatively affect child's sense of autonomy (CSA) and competency. PURPOSE: To examine how sense of autonomy among children with cerebral palsy (CP) directly and indirectly relates to their activity of daily living (ADL) and scholastic performance. METHODS: Seventy-three children with CP and their mothers participated in this study. Child's ADL skills and scholastic performance were assessed using the Pediatric Evaluation Disability Inventory (PEDI) and the Scholastic Skills Rating Scale (SSRS), respectively. Level of impairment was assessed using the Gross Motor Function Measure-66 (GMFM-66). CSA was established via videotaped mother-child interactions. Regression analyses were conducted to examine factors predicting child's functional level (ADL and scholastic). The overall model was tested for goodness-of-fit and test of mediation. RESULTS: GMFM and CSA significantly predicted child's ADL and scholastic functioning. GMFM explained 15% of the variance for CSA, 84% for PEDI, and 24% for scholastic functioning. CSA positively mediated the association between GMFM and child's ADL skills. GMFM was positively associated with CSA. CONCLUSION: Motor impairment has a substantial impact on child's level of functioning. However, child's functioning is a complex construct that is also affected by her or his sense of autonomy. Therefore, sense of autonomy can serve as a potential point of intervention to improve functioning among children with CP.