A Systematic Review of Telehealth-Based Pediatric Cancer Rehabilitation Interventions on Disability.

Background: Telehealth is an emerging method which may overcome barriers to rehabilitation access for pediatric cancer survivors (aged ≤19 years). This systematic review aimed to examine telehealth-based rehabilitation interventions aimed at preventing, maintaining, or improving disability in pediatric cancer survivors. Methods: We performed systematic searches in Ovid MEDLINE, Ovid EMBASE, Cochrane Library, SCOPUS, Web of Science, and CINAHL Plus between 1994 and 2022. Eligible studies included telehealth-based interventions assessing disability outcomes in pediatric cancers. Results: Database searches identified 4,040 records. Nine unique interventions met the eligibility criteria. Telehealth delivery methods included telephone (n = 6), email (n = 3), mobile health applications (n = 3), social media (n = 3), videoconferencing (n = 2), text messaging (n = 2), active video gaming (n = 2), and websites (n = 2). Interventions focused on physical activity (n = 8) or self-management (n = 1). Outcomes assessing disability varied (n = 6). Three studies reported statistically and clinically significant results. Narrative synthesis of findings was constructed based on the Picker's principles for patient-centered care: (1) values, preferences, and needs; (2) involve family and friends; (3) coordination of care; (4) provide social support; (5) holistic well-being; and (6) information and communication. Conclusions: Telehealth-based rehabilitation interventions for pediatric cancer survivors is an emerging research area with potential to improve disability outcomes. Adequately powered trials with consistency in disability outcome measures are warranted. Additional research is needed to determine the effectiveness and best practices for telehealth-based pediatric cancer rehabilitation.

Muscle Properties, Gross Motor Performance, and Quality of Life in Children With Sickle Cell Disease.

PURPOSE: To explore muscle properties, gross motor performance, and quality of life (QoL) in children with sickle cell disease (SCD) compared with controls and to assess relationships among these outcomes. METHODS: A cross-sectional study of 24 children assessed muscle properties including: knee extension strength by dynamometry; vastus lateralis (VL) and rectus femoris (RF) muscle thickness by ultrasonography; and VL and RF neuromuscular activation (rate of muscle activation [RoA]) by electromyography (EMG). Gross motor performance and QoL were assessed by standardized tests and questionnaires. RESULTS: Children with SCD had impaired knee extension strength, VL EMG RoA, gross motor performance, and QoL compared with children without SCD. Relationships among muscle properties, gross motor performance, and QoL were identified. CONCLUSIONS: These findings indicate that comprehensive muscle properties, gross motor performance, and QoL assessments should be considered to support and develop individualized physical therapy plans for children with SCD.

Diaphragm excursion correlates with performance and ventilation on the 6-min walk test in children with sickle cell disease.

INTRODUCTION: Diaphragm function may be impaired in children with sickle cell disease (SCD). We hypothesized that diaphragm function is related to performance and ventilation on the 6-min walk test (6MWT). METHODS: Respiratory muscle testing, diaphragm ultrasonography, and the 6MWT with portable gas analysis were performed on children with SCD and age- and sex-matched controls. RESULTS: Fourteen children with SCD were enrolled. Comparisons were made between nine children with SCD (9.89 ± $\pm $ 2.93 years) and nine controls (10.33 ± $\pm $ 2.35 years). Diaphragm thickness at total lung capacity, thickening fraction, and excursion time during quiet breaths and deep breaths (DB), all normalized by forced vital capacity, were greater in children with SCD ( p < $p\lt $ 0.05 for all). 6MWT distance was shorter in children with SCD (450.87 ± $\pm $ 74.2 m vs. 579.22 ± $\pm $ 72.46 m, p = $p=$ 0.01). Tidal volume ( V T ${V}_{T}$ ), minute ventilation ( V ˙ E ${\dot{V}}_{E}$ ), and oxygen consumption ( V ˙ O 2 ${\dot{V}}_{{O}_{2}}$ ) were also lower ( p < $p\lt $ 0.05 for all). DB excursion correlated positively with 6MWT distance ( r = $r=$ 0.648, p = $p=$ 0.023) and negatively with rate of perceived exertion (RPE) ( r = $r=$ -0.759, p = $p=$ 0.003). RPE correlated negatively with distance ( r = $r=$ -0.680, p = $p=$ 0.015). DB excursion time correlated positively with distance ( r = $r=$ 0.611, p = $p=$ 0.035), V T ${V}_{T}$ ( r = $r=$ 0.770, p = $p=$ 0.009), V ˙ E ${\dot{V}}_{E}$ ( r = $r=$ 0.736, p = $p=$ 0.015), and V ˙ O 2 ${\dot{V}}_{{O}_{2}}$ ( r = $r=$ 0.751, p = $p=$ 0.012). CONCLUSIONS: Increased diaphragm excursion may be a strategy used to relieve air hunger while longer excursion time may reflect compensations to increase lung recruitment. Further studies are needed to better understand how these mechanisms affect exercise tolerance in children with SCD.

Skeletal Muscle Measurements in Pediatric Hematology and Oncology: Essential Components to a Comprehensive Assessment.

Children with hematologic and oncologic health conditions are at risk of impaired skeletal muscle strength, size, and neuromuscular activation that may limit gross motor performance. A comprehensive assessment of neuromuscular function of these children is essential to identify the trajectory of changes in skeletal muscle and to prescribe therapeutic exercise and monitor its impact. Therefore, this review aims to (a) define fundamental properties of skeletal muscle; (b) highlight methods to quantify muscle strength, size, and neuromuscular activation; (c) describe mechanisms that contribute to muscle strength and gross motor performance in children; (d) recommend clinical assessment measures; and (e) illustrate comprehensive muscle assessment in children using examples of sickle cell disease and musculoskeletal sarcoma.

Quantifying muscle strength, size, and neuromuscular activation in adolescent and young adult survivors of musculoskeletal sarcoma: Identifying correlates and responses to functional strengthening.

BACKGROUND: Medical and surgical treatment for musculoskeletal sarcoma (MSS) place survivors at risk for impairments in muscle properties including muscle strength, muscle size, and neuromuscular activation. The purpose of this study was to explore muscle properties, gross motor performance, and quality of life (QoL) and the changes in response to a 6-week functional strengthening intervention (PT-STRONG) in MSS survivors of childhood cancer (CCS). METHODS: Eight lower extremity MSS CCS (13-23 years old) performed baseline testing and three completed PT-STRONG. Participants completed measurements of knee extension strength using handheld dynamometry, vastus lateralis (VL) and rectus femoris (RF) muscle thickness using ultrasonography at rest, and neuromuscular activation using electromyography during strength testing and a step-up task. Participants also completed gross motor and QoL assessments. RESULTS: Compared with the non-surgical limb, MSS CCS had lower surgical limb knee extension strength, VL muscle thickness, and RF step-up muscle rate of activation (RoA). Compared with normative values, MSS CCS had decreased bilateral knee extension strength, gross motor performance, and physical QoL. Positive correlations among muscle strength, muscle thickness, and gross motor performance were identified. After PT-STRONG, MSS CCS had improvements in VL muscle thickness, VL and RF RoA duing step-up, gross motor performance, and physical QoL. CONCLUSIONS: Positive association between larger muscle thickness with greater knee extension strength, and higher knee extension strength with better gross motor performance indicate that comprehensive physical therapy assessment and interventions that identify and target impairments in muscle properties to guide clinical decision making should be considered for MSS CCS into survivorship.

Relationships between diaphragm ultrasound, spirometry, and respiratory mouth pressures in children.

Diaphragm ultrasound (DUS) is a noninvasive method of evaluating the diaphragm's structure and function. This study explored the relationships between DUS, spirometry, and respiratory mouth pressures in 10 healthy children (median age: 11 [range: 7-14 years]; 5 females, 5 males). Thickening fraction correlated with maximal inspiratory pressure (MIP) (Spearman's rho [rs] = 0.64, p = 0.05). During quiet breaths, excursion time correlated with MIP (rs = 0.78, p = 0.01) while velocity correlated with maximal expiratory pressure (rs = -0.82, p = 0.01). During deep breaths, MIP correlated with excursion (rs = 0.64, p = 0.05) and time (rs = 0.87, p = 0.01). Excursion time during deep breaths also correlated with forced vital capacity (rs = 0.65, p = 0.04). Our findings suggest that DUS parameters are closely related to spirometry and respiratory mouth pressures in healthy children and further support the use of DUS as a noninvasive method of respiratory assessment.

Ultrasound measures of muscle thickness and subcutaneous tissue from the hip abductors: Inter- and intra-rater reliability.

BACKGROUND: Ultrasound imaging is important in many fields such as medicine, sports, and health sciences to assess parts of muscle structure (e.g., muscle thickness [MT]) or composition (subcutaneous tissue [SubT]). OBJECTIVE: The aim of the present study was to investigate the intra- and inter-rater reliability of MT and SubT measurements of the hip abductor muscles gluteus medius (GM) and tensor fascia latae (TFL). DESIGN: Cross-sectional study. METHOD: Twenty young adults participated in the study. Intra-rater reliability was established by measuring the same two images twice by the same rater, while inter-rater reliability was assessed between two raters by measuring the same two images for each muscle. For both intra- and inter-rater reliability, the reliability of the TFL and GM outcomes (MT- SubT) were determined by the intraclass correlation coefficient (ICC), coefficient of variation (CV), standard error of the measurement (SEM), and Bland-Altman plots. RESULTS: For intra-rater reliability, variables of both muscles showed an excellent ICC (≥0.90), lower CV and SEM, and bias near zero. Inter-rater reliability also showed an excellent ICC for both variables and muscles (≥0.81) with lower CV, SEM, and bias. CONCLUSION: Therefore, these results provide strong evidence of a reliable measure of MT and SubT from GM and TFL. The present study provides health care professionals and researchers increased confidence in using 2D ultrasound to assess the hip abductors muscles reliably.

The Efficacy of Targeted Exercise on Gross Motor and Neuromuscular Performance in Survivors of Childhood Leukemia: A Pilot Study.

Objectives: This quasi-experimental study examined the efficacy of targeted exercise training on gross motor performance and neuromuscular impairments in survivors of childhood acute lymphoblastic leukemia (ALL CCS). Materials and Methods: Ten ALL CCS (median age: 10 years; range: 6-14 years) performed a 6-week training program three times per week (five in-person sessions), including a warm-up, total body stretching, progressive jump rope training, and a cool down. Gross motor performance (test of gross motor proficiency) and lower extremity rate of muscle activation (electromyography), joint torques (motion capture and force plate), and jump height (motion capture) were measured during a countermovement jump at baseline and post-training. Results: Post-training, ALL CCS demonstrated improvements in body coordination, strength and agilty, bilateral coordination, running speed and agility, and strength gross motor performance (mean change: 1.6-8.1; p < 0.05), the rate of muscle activation of the tibialis anterior and vastus lateralis muscles (mean change: 0.58-0.75; p < 0.05), hip and ankle joint torques (mean change: 0.07; p < 0.05), and jump height (mean change: 0.05; p < 0.05). Conclusion: This study demonstrated that targeted exercise training can improve gross motor performance and neuromuscular impairments in ALL CCS post-medical treatment.

Energy efficient vortex-enhanced water evaporation technology for concentrated brine management: Theory and process simulation evaluation.

Desalination drinking water systems and industrial processes generating high salinity streams require practical brine management options for disposal and/or treatment. Treatment most often involves large capacity brine concentrating processes, on the order of 2000 m3/day, that rely on water evaporation, vapor compression, and condensation. A new technology adds an aerosol-generating device to the evaporation step with the goal of energy efficient operation even at smaller scales. The principles behind the tornadic flowfield that breaks up and aerosolizes water as air and water flow over the machined surface in the device are introduced. Design of a 6.8 m3/day demonstration system, based on this new technology, producing a NaCl slurry (55 wt% solids) from a 22 wt% NaCl influent is described. Simulations of the system with three influent brine concentrations and three forms of final NaCl concentrate are presented and predicted energy usage is compared to estimates for conventional systems. By varying simulation process parameters, the heat transfer performance of the evaporator/condenser is identified as having a large impact on overall efficiency. The new system is anticipated to be most competitive, on an energy usage basis, with conventional concentrator/crystallizer systems when processing higher salinity brines and producing final concentrates containing precipitated NaCl.

Physical Impairment and Function in Children and Adolescents With Sickle Cell Disease: A Systematic Review.

OBJECTIVE: To examine physical impairments and physical function in children and adolescents with sickle cell disease (SCD). DATA SOURCES: PubMed, Embase (embase.com), Cumulative Index to Nursing and Allied Health (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), and Dissertations and Theses (ProQuest) were searched from January 1, 1990, to September 25, 2020. References retrieved were required to include a term for SCD and a term for physical impairments or physical function. Results were limited to articles with children and adolescents and in the English language. STUDY SELECTION: A total of 3054 nonduplicate articles were independently screened by 2 reviewers, resulting in 240 articles for full-text review. The full-text review, performed by 2 independent reviewers, resulted in 67 articles. DATA EXTRACTION: Data were extracted from each full text to a custom Excel document by a single reviewer and were verified by a secondary reviewer. DATA SYNTHESIS: The studies identified in this systematic review offer evidence that children and adolescents with SCD demonstrate physical impairments and physical function limitations compared with control participants as noted by varying percentages in deficits up to 19%-58% in muscle and bone composition and/or symptoms, muscle strength, cardiopulmonary function, motor performance, physical activity, and physical function domains of quality of life questionnaires. CONCLUSIONS: Children and adolescents with SCD present with physical impairments and physical function limitations. Scientists and clinicians should consider developing collaborative standards to define and objectively measure physical impairment and function in this population to comprehensively examine the underlying factors that contribute to physical impairments and function.

Hip Abductor and Adductor Rate of Torque Development and Muscle Activation, but Not Muscle Size, Are Associated With Functional Performance.

Understanding the physiological variables that contribute to a functional task provides important information for trainers and clinicians to improve functional performance. The hip abductors and adductors muscles appear to be important in determining the performance of some functional tasks; however, little is known about the relationship of the hip abductor/adductors muscle strength, activation, and size with functional performance. This study aimed to investigate the relationship of maximum torque, rate of torque development (RTD), rate of activation (RoA), and muscle thickness of the hip abductors [tensor fascia latae (TFL) and gluteus medius (GM)] and adductor magnus muscle with the Four Square Step Test (FSST) and the two-leg hop test in healthy young adults. Twenty participants (five males) attended one testing session that involved ultrasound image acquisition, maximal isometric voluntary contractions (hip abduction and hip adduction) while surface electromyography (EMG) was recorded, and two functional tests (FSST and two-leg side hop test). Bivariate correlations were performed between maximum voluntary torque (MVT), RTD at 50, 100, 200, and 300ms, RoA at 0-50, 0-100, 0-200, and 0-300, and muscle thickness with the dynamic stability tests. For the hip abduction, MVT (r=-0.455, p=0.044) and RTD300 (r=-0.494, p=0.027) was correlated with the FSST. GM RoA50 (r=-0.481, p=0.032) and RoA100 (r=-0.459, p=0.042) were significantly correlated with the two-leg side hop test. For the hip adduction, there was a significant correlation between the FSST and RTD300 (r=-0.500, p=0.025), while the two-leg side hop test was correlated with RTD200 (r=0.446, p=0.049) and RTD300 (r=0.594, p=0.006). Overall, the ability of the hip abductor and adductor muscles to produce torque quickly, GM rapid activation, and hip abductor MVT is important for better performance on the FSST and two-leg hop tests. However, muscle size appears not to influence the same tests.

Neuromuscular mechanisms that contribute to gross motor performance in survivors of childhood acute lymphoblastic leukemia.

PURPOSE: This study explored neuromuscular mechanisms and clinical measures that contribute to countermovement jump performance in survivors of childhood acute lymphoblastic leukemia (ALL CCS) compared to age- and sex-matched peers. METHODS: This exploratory cross-sectional observational study examined 12 participants, six ALL CCS and six age- and sex-matched peers (7-16 years). During a countermovement jump, rates of muscle activation of lower leg muscles were measured with electromyography, and joint torques and peak jump height with force plates and a motion capture system. Clinical measures included muscle extensibility, balance, and mobility measured by active ankle dorsiflexion, Bruininks-Oseretsky Motor Proficiency (BOT-2), and Timed Up and Go (TUG) tests. RESULTS: Compared to peers, ALL CCS demonstrated reduced gastrocnemius muscle extensibility and tibialis anterior rate of muscle activation, decreased jump height, and poorer performance on the BOT-2 and TUG. Jump height was significantly correlated with clinical measures of the BOT-2 and TUG. CONCLUSION: These ALL CCS demonstrated neuromuscular impairments that may impact jump performance, an essential childhood physical activity. Further research is needed to explore intervention strategies to improve the neuromuscular mechanisms that contribute to high-level gross motor skills in ALL CCS.

Assessing the Reliability of Handheld Dynamometry and Ultrasonography to Measure Quadriceps Strength and Muscle Thickness in Children, Adolescents, and Young Adults.

Aims: Muscle strength testing is a core aspect in the pediatric physical and occupational therapy clinical examination and evaluation, and quadriceps muscle strength is associated with the ability to perform gross motor skills. The aim of this study was to assess the reliability of handheld dyamometry (HHD) and ultrasonography to measure quadriceps muscle strength and thickness in children, adolescents, and young adults. Methods: In 30 participants (6-26 years), without motor impairment, quadriceps strength was measured with HHD in seated and supine with the knee flexed to 90° and 35°. Rectus femoris (RF) and vastus lateralis (VL) muscle thickness was measured using ultrasonography. Typical error of measurement (TEM), coefficient of variation (CV%), and intra-class correlation coefficient (ICC) were used to assess the error and reliability of measures. Results: The average CV% among three trials of strength testing was 7.07%-9.94% and improved when using the top two trials (4.49%-5.61%). The average TEM was 2.21 Nm for strength and 0.03 cm for muscle thickness. Intra-rater and inter-rater reliability of muscle thickness was good to excellent (0.91-1.00).Conclusions: The results of this study suggest quadriceps muscle strength and thickness measurements using HHD and ultrasonography are reliable in children, adolescents, and young adults.

Alterations in Muscle Architecture: A Review of the Relevance to Individuals After Limb Salvage Surgery for Bone Sarcoma.

Osteosarcoma and Ewing's sarcoma are the most common primary bone malignancies affecting children and adolescents. Optimal treatment requires a combination of chemotherapy and/or radiation along with surgical removal when feasible. Advances in multiple aspects of surgical management have allowed limb salvage surgery (LSS) to supplant amputation as the most common procedure for these tumors. However, individuals may experience significant impairment after LSS, including deficits in range of motion and strength that limit function and impact participation in work, school, and the community, ultimately affecting quality of life. Muscle force and speed of contraction are important contributors to normal function during activities such as gait, stairs, and other functional tasks. Muscle architecture is the primary contributor to muscle function and adapts to various stimuli, including periods of immobilization-protected weightbearing after surgery. The impacts of LSS on muscle architecture and how adaptations may impact deficits within the rehabilitation period and into long-term survivorship is not well-studied. The purpose of this paper is to [1] provide relevant background on bone sarcomas and LSS, [2] highlight the importance of muscle architecture, its measurement, and alterations as seen in other relevant populations and [3] discuss the clinical relevance of muscle architectural changes and the impact on muscle dysfunction in this population. Understanding the changes that occur in muscle architecture and its impact on long-term impairments in bone sarcoma survivors is important in developing new rehabilitation treatments that optimize functional outcomes.

Cancer Rehabilitation in the Pediatric and Adolescent/Young Adult Population.

OBJECTIVES: To identify body impairments, activity limitations, and participation restrictions in children, adolescents, and young adults with cancer amenable to rehabilitation, and provide the recommended screening, assessment and rehabilitation referral information for the health care community. DATA SOURCES: A review of the rehabilitation and pediatric oncology literature regarding functional impairments in combination with clinical expertise from practicing pediatric oncology rehabilitation therapists. CONCLUSION: Rehabilitation intervention has great potential to mitigate the impact of cancer and its treatment and may even have a role in reducing morbidity and mortality. All health care providers have a role in optimizing the function and quality of life in the pediatric cancer population. IMPLICATIONS FOR NURSING PRACTICE: It is imperative for nurses to utilize subjective and clinical screening to identify persons appropriate for rehabilitation referral, collaborate with the rehabilitation team, and support the patients and families in adhering to rehabilitation recommendations.

Characterization of a peribunyavirus isolated from largemouth bass (Micropterus salmoides).

We report the complete genome sequencing of the first fish peribunyavirus determined using a next-generation sequencing approach. The virus was isolated during a routine health assessment of wild largemouth bass (Micropterus salmoides) in Wisconsin in April of 2009. Further research is needed to determine the epidemiology and pathogenicity of the largemouth bass bunyavirus.