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.

Exploring relationships between inspiratory muscle strength and functional capacity in childhood cancer survivors: a pilot study.

Childhood cancer survivors (CCS) experience short- and long-term side effects from cancer treatment that often impair functional capacity. Inspiratory muscle weakness is a potential mechanism for reduced functional capacity. The objective of this pilot study was to examine the relationship between inspiratory muscle strength and functional capacity in 10 CCS. Inspiratory muscle strength was measured by maximal inspiratory pressure (MIP) while functional capacity was measured by the two-minute walk test (2MWT), the physiological cost index and hemodynamic response to exercise according to changes in heart rate, blood pressure and rate-pressure product (RPP). Overall, MIP and 2MWT distance were below predicted values. Hemodynamic responses to the 2MWT were consistent with little variation, except for elevated diastolic blood pressure (DBP) response. MIP had significant relationships with resting DBP (Spearman's rank correlation coefficient [rs] = -0.70; p = 0.03) and DBP response (rs = 0.72; p = 0.02). Time since completion of cancer treatment had a significant positive relationship with RPP response (rs = 0.67; p = 0.03). Inspiratory muscle weakness in childhood cancer could be an indicator of skeletal muscle dysfunction and should be considered when symptoms of dyspnea or poor functional capacity arise. Inspiratory muscle strength was found to be related to changes in blood pressure in CCS. Future studies should further investigate these relationships and the impact of inspiratory muscle training on hemodynamics and functional capacity in CCS.

Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma.

PURPOSE: The purpose of this study was to examine the impact of physical function performance and pulmonary function on patient outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM). MATERIALS AND METHODS: A retrospective review of 54 patients with MPM from 2015 to 2020 was performed. The primary objective was to assess whether physical function, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG), and pulmonary function tests were predictive of postoperative patient outcomes (ventilator days, chest tube days, hospital length of stay). A secondary objective was to explore demographic and preoperative variables that best predict postoperative physical function and patient outcomes. RESULTS: Data include 54 patients who underwent extended pleurectomy-decortication. Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability. Preoperative ECOG was also predictive of preoperative lung function. Age on the day of surgery was the best predictor of postoperative physical function, which was significantly reduced postoperatively. CONCLUSIONS: Preoperative physical function performance was a significant predictor of postoperative outcomes. The results of our study highlight the importance of physical function in patients with MPM and support the need for early rehabilitation and further research to determine optimal rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONPreoperative physical function can predict outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM).Physical function in patients with MPM should be carefully examined.To accurately reflect patients' abilities, patient assessment should include both patient-reported outcomes and performance-based measures.Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care.

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.

Exploring pulmonary function and physical function in childhood cancer: A systematic review.

BACKGROUND: Children with cancer experience pulmonary and physical function side effects from the cancer itself and the medical interventions. This systematic review examines the known relationship between pulmonary function and physical function in childhood cancer and identifies gaps in the literature. METHODS: A search of Ovid Medline, CINAHL (EbscoHost) and Embase to identify literature from 2009 to March 2020. RESULTS: Fifty-seven studies met inclusion criteria. Thirty-seven studies reported impaired pulmonary function. Incidence of pulmonary dysfunction ranged from 45.5 % to 84.1 %. Eighteen studies reported impaired physical function. Three studies investigated the relationship between pulmonary function and physical function. No studies explored inspiratory muscle strength. CONCLUSION: Pulmonary function and physical function are related and frequently impaired in children during and after cancer treatment. A literature gap was found in diaphragm function and its relationship with physical function. Future studies should focus on interventions that target the pulmonary mechanisms impacting physical function.

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 Publications (2008-2018) With a Focus on Physical Function: A Scoping Review.

BACKGROUND: Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. PURPOSE: This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. DATA SOURCES: PubMed and CINAHL were searched up to September 2018. STUDY SELECTION: Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. DATA EXTRACTION: Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. DATA SYNTHESIS: Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). LIMITATIONS: Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. CONCLUSIONS: This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.

A comparison of function after limb salvage with non-invasive expandable or modular prostheses in children.

BACKGROUND: Modular and non-invasive expandable prostheses have been developed to provide a functional knee joint that allows future expansion as growth occurs in the contralateral extremity in children with bone sarcomas that require removal of the growth plate. This study aimed to evaluate the functional outcomes of paediatric patients who received either a non-invasive expandable or modular prosthesis for bone sarcomas arising around the knee. METHODS: We evaluated clinician-reported, patient-reported and measured function in 42 paediatric patients at least one year (median age at assessment 19.1 years) after limb salvage surgery, and compared patients who received modular system prostheses (N = 29, median age 15.5), who did not require lengthening procedures to those who received non-invasive expandable prostheses (N = 13, median age 11.1) requiring lengthening procedures (median 5). RESULTS: The number of revisions and time to first revision did not differ between the two groups. There were no differences between the two groups in total scores on the Enneking Musculoskeletal Tumor Society Scale, the Toronto Extremity Salvage Scale, and the Functional Mobility Assessment. Children with non-invasive expandable prostheses climbed stairs (11.93 ± 4.83 versus 16.73 ± 7.24 s, p = 0.02) in less time than those with modular prostheses. CONCLUSION: Our results suggest that the non-invasive expandable prosthesis produces similar functional results to the more traditional modular prosthesis.

The psychosocial benefits of an inclusive community-based aquatics program.

PURPOSE: To examine the psychosocial effect of participation in an inclusive community-based aquatics program for children with and without disabilities. METHODS: Twenty-three participants completed an 8-week inclusive aquatics program. Quality of life, self-concept, and acceptance were measured using the PedsQL 4.0, Piers-Harris 2 Children's Self-Concept Scale, and Peer Sociometric Nomination Assessment (Friendship Questionnaire). Data were analyzed using a 2 × 2 analysis of variance with repeated measures. RESULTS: After the 8-week intervention, a statistically significant decrease was found on the School subsection of the PedsQL 4.0 for the children without disabilities, and in the happiness subsection of the Piers-Harris 2 for the children with disabilities. The Peer Sociometric Nomination Assessment showed a trend that children with disabilities received less negative peer nominations at posttest when compared with pretest. CONCLUSION: Participation in an inclusive aquatics program may lead to improved acceptance of children with disabilities by their peers without disabilities.