Pediatric Dysphagia Risk Screening Instrument (PDRSI) in Children With Cerebral Palsy.

This study aimed to evaluate whether the Pediatric Dysphagia Risk Screening Instrument (PDRSI) was a suitable test for children with cerebral palsy (CP) and assess the instrument's Turkish validity and reliability. One-hundred twenty-six children with CP participated in this study. "Cronbach's alpha (ɑ)," "Cronbach's ɑ when one item is deleted," "inter-item correlation," and "corrected item-to-total correlation" were used to assess internal consistency. In addition, inter-rater agreement tests (Cohen's kappa coefficient) were conducted for reliability. Construct validity was used to assess the validity. Moreover, flexible fiberoptic endoscopic evaluation of the swallowing method was used to describe the receiver operating characteristic curve analysis and calculate the sensitivity and specificity of T-PDRSI. It was found that the PDRSI had adequate validity and reliability. The PDRSI can be used in children with CP as a valid and reliable instrument with high sensitivity and specificity.

Intramuscular botulinum toxin-A in complex regional pain syndrome resistant to standard treatment: a case report.

OBJECTIVE: To present a patient with complex regional pain syndrome type 1 (CRPS-I) and improvement of contracture of hand muscles and grip strength after successful treatment with botulinum neurotoxin­A (BoNT-A). CASE: A 53-year-old woman with CRPS­I experienced severe allodynia, swelling and autonomic changes in the left hand after a distal radius fracture. Over the succeeding months, she developed contracture of the left hand muscles which was treated with injection of BoNT­A into the hand muscles (10 points). RESULTS: In the patient treatment with BoNT­A an improvement was seen in the hand range of motion (ROM) and grip strength. CONCLUSION: Successful results can be obtained with BoNT­A injection in treatment-resistant CRPS­I cases which may develop joint contracture.

The patients with intrathecal baclofen pump in the age of COVID-19: a single center study.

PURPOSE: Intrathecal baclofen pump treatment is employed in the treatment of various diseases. Despite the benefits of intrathecal baclofen pump, patients may occasionally encounter severe complications. These complications may necessitate urgent assessment or intervention for patients with intrathecal baclofen pumps. This study aimed to evaluate the intrathecal baclofen pump-related problems, the utilization of health services, physical-psychosocial status, and the quality of life of patients with intrathecal baclofen pumps during the coronavirus disease 2019 pandemic. MATERIALS AND METHODS: We conducted a cross-sectional, phone-based survey study between 1 June 2021 and 15 July 2021 with a sample of 23 patients with intrathecal baclofen pumps. The patients' quality of life before the implantation of the pump, after one year of implantation, and during the pandemic was evaluated with the 3-level version of EQ-5D. RESULTS: Catheter migration developed in one of the patients, after which the pump was changed. While the dose of baclofen was altered in eight (38.1%) patients during the pandemic period, the filling period was modified in three (14.3%) patients. While 61.9% of the patients reported that their general health, mobility, spasticity and joint mobility were worse than before the pandemic, 90.5% of the patients stated that their communication and mood were worse than before the pandemic. The 3-level version of EQ-5D and EQ-Visual Analogue Scale scores of the patients were significantly decreased during pandemic (p < .05). CONCLUSIONS: Due to the complications of the intrathecal baclofen pump, its management should continue uninterruptedly during the pandemic period.

Evaluation of the effects of robot-assisted gait training on bowel function in children with cerebral palsy and the caregiver burden: A pilot study.

Objectives: The aim of this study was to investigate the effects of robot-assisted gait training (RAGT) on bowel function by measuring the frequency of evacuation, stool consistency, and severity of constipation in children with cerebral palsy (CP) and determining caregiver burden. Patients and methods: This retrospective pilot study was conducted with 30 children (16 males, 14 females; mean age 8.8±3.2 years; range, 6 to 11 years) with CP between January 2019 and July 2019. Patients were equally divided into two groups: the RAGT group and the control group. Both groups underwent conventional physical therapy. The RAGT group underwent RAGT in addition to physical therapy. The results of the Bristol Stool Scale, the Constipation Assessment Scale, and the frequency of defecation before and after the study were recorded. Caregivers of children in both groups were asked to answer five questions regarding their burden at the beginning of the study and the end of the study. Results: While a significant improvement was found in defecation frequency in the RAGT group (p=0.01), defecation frequency was not significantly improved in the control group (p>0.999). Bristol Stool Scale scores changed significantly within both groups (p<0.05). Constipation Assessment Scale scores significantly changed only in the RAGT group (p=0.01). A significant positive change in caregiver burden was observed in the RAGT group (p<0.05). Conclusion: Robot-assisted gait training has positive effects on the frequency of defecation, stool consistency, and constipation severity in children with CP and caregiver burden.

Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts.

BACKGROUND: Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. METHODS: This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). RESULTS: In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. CONCLUSIONS: This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.

The effect of robotic rehabilitation on posture and trunk control in non-ambulatory cerebral palsy.

The purpose of this study was to investigate the effects of a combined robot-assisted gait training (RAGT) with standard physiotherapy (PT) on trunk control and posture in non-ambulatory children with cerebral palsy (CP). This nonrandomized, controlled study included 31 CP assigned into two groups. Study Group: RAGT (three times a week, 30 min/session, for 6 weeks) + PT. Control group: PT only. The patients were evaluated using gross motor function measure (GMFM)-88 (Section B, Sitting) and Trunk Impairment Scale (TIS), pre-treatment and 3rd month post-treatment. In the RAGT group, significant improvements were observed in the GMFM-B and TIS scores at the 3rd month post-treatment (p < 0.05). Comparison of the changes in GMFM-B and TIS scores from end to beginning of the study, the change in TIS static are significantly higher in the RAGT group than control group (p < 0.05). Addition of RAGT to standard physiotherapy seems to improve trunk control, sitting balance, and posture in non-ambulatory CP.

Peroneal nerve palsy due to synovial cyst: An unusual cause of foot drop in a nine-year-old child.

Foot drop is the inability to dorsiflex the foot, and peroneal nerve palsy, a common cause of foot drop, is a rare condition in pediatric patients. Herein, we present a nine-year-old patient with foot drop due to peroneal nerve palsy verified by electrophysiologic examination. A cystic mass was observed in ultrasonography and magnetic resonance imaging, and hyaluronic acid was detected in the cystic material by histopathological examination. The patient was referred to surgery, and one month after surgery, an increase in muscle strength was observed. It should be kept in mind that peroneal nerve palsy due to synovial cysts may cause foot drop in pediatric patients.

Evaluation of the effects of the COVID-19 pandemic on children with cerebral palsy, caregivers' quality of life, and caregivers' fear of COVID-19 with telemedicine.

BACKGROUND: The sudden and unexpected pandemic changed the daily routine of the children with cerebral palsy (CP) and their caregivers. AIMS: This study aimed to investigate the impact of the novel coronavirus (COVID-19) pandemic on the utilization of health and rehabilitation services and the general health and physical status of children with CP. In addition, the second aim of the study was to examine the effects of the COVID-19 pandemic on caregivers' quality of life (QOL) and their fear of COVID-19. METHODS: The utilization of children health and rehabilitation services during the pandemic, the general health and physical status of the children during the pandemic, and the children and caregivers' history of COVID-19 infections were questioned. Furthermore, the caregivers' level of fear of COVID-19 and their QOL were examined. RESULTS: One hundred twenty caregivers were contacted by phone, and 94 (78.33%) caregivers agreed to participate in the study. Sixty-three of 94 children (67.1%) did not attend their routine control check-up during the pandemic. Twelve children (12.8%) discontinued their physical therapy sessions during the pandemic. Caregivers physical and mental QOL significantly decreased during the pandemic (p < 0.05). The median of caregivers' Fear of COVID-19 scale (FCV-19S) was 17.5 (7-35). CONCLUSION: We think that more attention should be given to telerehabilitation and telemedicine services of the clinicians who deal with the children with CP, and their caregivers in order to prevent the negative effects of future pandemic periods.

Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.

Investigation of the relationship between disease severity, caregiver burden and emotional expression in caregivers of children with cerebral palsy.

PURPOSE: The aim of this study was to investigate the relation between the physical problems of children with CP and caregiving burden and the emotional expression characteristics of caregivers. METHODS: The study included 144 caregivers of child with cerebral palsy and Zarit Burden Interview (ZBI) and Expressed Emotion Scale (EES) will be applied to the caregivers who will participate in the study. Disease severity of children with cerebral palsy will be evaluated by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) in children with cerebral palsy. Communication Function Classification System (CFCS) will be used to examine the communication of children with their families. RESULTS: Accordingly, a positive, statistically significant, moderate correlation was found between the GMFCS, MACS, and CFCS scores and ZBI scores in patients with cerebral palsy (r ~ 0.50; p < 0.01). In this study, a positive, statistically significant but weak correlation was found between GMFCS, MACS, and CFCS scores and EES scores in patients with cerebral palsy (r ~ 0.30; p < 0.01). A statistically significant, moderate correlation was found between ZBI and EES (r ~ 0.50; p < 0.01). CONCLUSION: According to the results of our study, as motor skills and communication skills decrease, especially the burden of caregivers increases and the family's emotional expression processes are related to these variables. We think that in the long-term follow-up of children with CP, it may be useful to provide appropriate psychiatric support by evaluating caregivers appropriately.

Is sensory-level electrical stimulation effective in cerebral palsy children with dysphagia? A randomized controlled clinical trial.

Dysphagia is one of the common findings in children with cerebral palsy (CP). Electrical stimulation (ES) has been demonstrated to positively contribute to swallowing functions, particularly in adult patients with various neurological disorders. Therefore, the objective of this study was to assess the effects of sensory-level ES treatment combined with conventional dysphagia rehabilitation in pediatric age group CP patients who had any oropharyngeal dysphagia symptoms and/or findings. Participants were randomly assigned to either the experimental group (Group 1, n = 52) who underwent intermittent galvanic stimulation to bilateral masseter muscles for 5 days/week, for 4 weeks combined with conventional dysphagia rehabilitation or the control group (Group 2, n = 50) who received sham stimulation with conventional dysphagia rehabilitation. The experimental group achieved significantly more improvement in swallowing functions including drooling, tongue movements, chewing, eating large food ability, feeding duration, as well as dysphagia screen test and dysphagia level, compared to control group. This study suggested that sensory-level ES might be a useful and safe therapeutic modality to improve oropharyngeal symptoms, symptom severity and dysphagia level in children with CP and dysphagia. Further research is needed to determine the long-term effects of ES on dysphagia, especially in different neurological disorders such as CP.