Biomedical subjects

Helene M Dumas

Publications and source records attributed to Helene M Dumas.

At least 19 recordsLinked to original sources

PubMed2006

A physical performance measure for individuals with mucopolysaccharidosis type I.

The purpose of this article is threefold: (1) to describe the development, reliability, and validity of a revised physical performance measure for individuals with mucopolysaccharidosis type I (MPS I); (2) to standardize the test on a normal sample; and (3) to compare results from a selected sample of individuals with MPS I with age-based centiles. The MPS Physical Performance Measure (MPS-PPM) is composed of eight timed functional tasks (FT-8) and two endurance tasks with a modified Energy Expenditure Index for comfortable walking (CW) and fast walking (FW) speeds. Age norms were derived from a convenience sample of 150 typically developing children and adolescents (75 males, 75 females; mean age 11y 2mo [SD 4y 5mo]; range 5-22y). Using a Rasch model for speed tests and confirmatory factor analysis, we established the unidimensionality of the FT-8. Interrater reliability of the FT-8 (intraclass correlation [ICC]=0.98) and test-retest reliability of the FT-8 (ICC=0.96), CW (ICC=0.91), and FW (ICC=0.83) were good. Results of the age-based profiles in 10 individuals with MPS I (five males, five females; mean age 14y 2mo [SD 7y 6mo]; range 6-29y) indicate that the amount of time needed to perform functional tasks is severely affected by the disease, and most individuals were at or below the fifth centile for their age. The patterns of limitations in endurance were more varied. These results suggest the utility of using this revised MPS-PPM to identify the extent of limitation in age-expected physical performance. Implications for using the MPS-PPM for monitoring physical performance changes during clinical interventions are discussed.

Activities of Daily Living↗

PubMed2005

Head circumference and chronic positive pressure ventilation in children: a pilot study.

METHODS: We reviewed the cases of 11 children <12 years of age with complex medical conditions and respiratory failure requiring chronic positive pressure ventilation (CPPV). We conducted a within-group comparison of average head circumference (HC) percentiles with each child's age-expected 50th percentile value and a between-groups comparison with children with no history of ventilation. We examined the relationship between HC, peak levels of positive inspiratory pressure (PIP), and length of time on CPPV. RESULTS: We found that children on CPPV had an average HC value at the 71st percentile, significantly greater (p=0.009) than the age-expected 50th percentile; that children on CPPV had a greater (p=0.003) average HC percentile compared with children with complex medical conditions not on CPPV; and that peak levels of PIP had a moderately strong correlation to HC (r=0.689, p=0.019). CONCLUSION: We conclude that children on CPPV have larger than expected HC and HC appears related to the peak level of PIP. Research to further investigate the relationship between HC and CPPV in children appears to be warranted.

Cephalometry↗

PubMed2005

Assessing mobility in children using a computer adaptive testing version of the pediatric evaluation of disability inventory.

OBJECTIVE: To assess score agreement, validity, precision, and response burden of a prototype computerized adaptive testing (CAT) version of the Mobility Functional Skills Scale (Mob-CAT) of the Pediatric Evaluation of Disability Inventory (PEDI) as compared with the full 59-item version (Mob-59). DESIGN: Computer simulation analysis of cross-sectional and longitudinal retrospective data; and cross-sectional prospective study. SETTING: Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics, community-based day care, preschool, and children's homes. PARTICIPANTS: Four hundred sixty-nine children with disabilities and 412 children with no disabilities (analytic sample); 41 children without disabilities and 39 with disabilities (cross-validation sample). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from a prototype Mob-CAT application and versions using 15-, 10-, and 5-item stopping rules; scores from the Mob-59; and number of items and time (in seconds) to administer assessments. RESULTS: Mob-CAT scores from both computer simulations (intraclass correlation coefficient [ICC] range, .94-.99) and field administrations (ICC=.98) were in high agreement with scores from the Mob-59. Using computer simulations of retrospective data, discriminant validity, and sensitivity to change of the Mob-CAT closely approximated that of the Mob-59, especially when using the 15- and 10-item stopping rule versions of the Mob-CAT. The Mob-CAT used no more than 15% of the items for any single administration, and required 20% of the time needed to administer the Mob-59. CONCLUSIONS: Comparable score estimates for the PEDI mobility scale can be obtained from CAT administrations, with losses in validity and precision for shorter forms, but with a considerable reduction in administration time.

Adolescent↗

PubMed2004

Social participation of children and youth with acquired brain injuries discharged from inpatient rehabilitation: a follow-up study.

PRIMARY OBJECTIVE: To determine the nature and extent of participation in home, school and community life in children and youth with acquired brain injuries (ABI) and identify factors associated with their participation. RESEARCH DESIGN: Cross-sectional survey. METHODS AND PROCEDURES: Measures of participation, environment and child factors were completed by family caregivers. Data were obtained on 60 children and youth with acquired brain injuries up to 6.7 years post-discharge from one inpatient rehabilitation programme in the USA. Descriptive, correlation and regression analyses were conducted. MAIN OUTCOMES AND RESULTS: Children were most restricted in peer social-play, structured community activities and managing daily routines. Eighty-two per cent of the variance accounted for in participation scores was explained by discharge self-care and post-discharge child and environmental factor scores. CONCLUSIONS: Results suggest that greater efforts are needed to address social participation in children and youth with ABI. Information about functional activity at discharge and child and environmental factors may provide insight into post-discharge levels of participation and service needs.

Activities of Daily Living↗

PubMed2004

Congenital neurodevelopmental diagnoses and an intensive care unit: defining a population.

OBJECTIVE: To identify and describe the population of children with congenital or perinatally acquired neurodevelopmental diagnoses in a pediatric intensive care unit and to assess the nature and extent of their utilization of critical care resources. DESIGN: Twelve-month, inception cohort study. SETTING: Intensive care unit at an urban, tertiary care pediatric hospital. PATIENTS AND METHODS: All pediatric intensive care unit admissions were screened for preexisting neurodevelopmental diagnoses. Computerized and chart-based medical records were reviewed for demographic, clinical, and outcome data. RESULTS: A total of 309 children with congenital neurodevelopmental diagnoses accounted for 427 pediatric intensive care unit admissions. This represented 23% of the total 1,820 admissions in 1 yr. Trisomy 21 was the most identifiable developmental abnormality (n = 25, 8%). Eighty-five percent of the children were cared for at home before hospitalization. A total of 220 of the admissions (52%) demonstrated a preexisting technology dependence. Fewer children admitted from the home-care setting had tracheostomies or were ventilator dependent. The majority of admissions were scheduled surgical admissions (45%) or for management of acute respiratory illness (26%). Of the patients with preexisting tracheostomy, nonrespiratory conditions accounted for 70% of acute admitting diagnoses. Two hundred twenty-three of the admissions (52%) required noninvasive or transtracheal ventilatory support, yet the length of stay and mortality rate were consistent with those reported in other general pediatric intensive care unit populations. The average and median length of stay were 5.4 and 2.0 days, respectively. Mortality rate was 3%. Technology support needs at discharge increased significantly from admission for enterostomy support (p =.008) and mechanical ventilation (p =.008). CONCLUSIONS: Children with congenital or perinatally acquired neurodevelopmental diagnoses represented nearly one quarter of all pediatric intensive care unit admissions at a tertiary academic center. This population has substantial ongoing medical needs, requiring utilization of intensive care resources. More rigorous investigations are needed to determine the effect of this burgeoning population in pediatric critical care, to optimize their care, and to meet the comprehensive needs of their families.

Adolescent↗

PubMed2004

The relationship between functional mobility and the intensity of physical therapy intervention in children with traumatic brain injury.

PURPOSE: The purposes of this study were to describe the types of physical therapy (PT) procedural interventions used during inpatient rehabilitation for children and adolescents with traumatic brain injury (TBI) and to examine the relationship between intensity of intervention and mobility changes. METHODS: We examined a consecutive series of 80 records of children and adolescents (mean age = 10.3 years) with TBI. Intensity of PT was calculated as the number of 15-minute PT units of service per day/length of stay. We used the Pediatric Evaluation of Disability Inventory (PEDI) to calculate mobility change scores between admission and discharge and the achievement of a minimal clinically important difference (MCID) consisting of an 11-point change. We used a series of hierarchical and logistic regression analyses to identify the relationship of PT intensity to mobility changes, while controlling for potential confounding variables. RESULTS: Therapeutic exercise was the most frequently recorded intervention. On average, PT intensity was provided at a level of 3.1 units (46.5 minutes) per day. After controlling for severity and age, intensity was significantly related to change in PEDI mobility scores; this effect was removed when controlling for admission scores. The MCID was related to PT intensity, even when controlling for initial status. CONCLUSIONS: Although the magnitude of the correspondence is small, the intensity of PT intervention in an inpatient rehabilitation hospital is related to positive changes in functional mobility scores and the achievement of an MCID. However, initial mobility status is an essential factor in the interpretation of change scores. Future studies are needed to determine whether controlled variations of PT service intensity have a differential effect on mobility recovery during inpatient rehabilitation.

Journal Article↗

PubMed2004

Recovery of ambulation during inpatient rehabilitation: physical therapist prognosis for children and adolescents with traumatic brain injury.

BACKGROUND AND PURPOSE: Evidence to guide physical therapist prognosis for recovery of the ability to ambulate in children and adolescents with traumatic brain injury (TBI) is limited. The aim of this study was to delineate a predictive model and determine the value of key demographic and clinical variables in establishing a prognosis for ambulation without the assistance of a device or person over 15.24 m on a flat, level surface following inpatient rehabilitation. SUBJECTS AND METHODS: For this retrospective study, a consecutive series of 95 children and adolescents with TBI (aged 2-18 years) admitted to an inpatient rehabilitation program was assessed using information from medical records. A multiple logistic regression analysis was conducted to identify predictors for ambulation at the time of discharge from the rehabilitation setting. RESULTS: Fifty-six percent of the children achieved ambulation at discharge. Lower-extremity hypertonicity (measured on physical therapist examination as resistance to passive stretch), brain injury severity, and lower-extremity injury together were predictors of the ability to ambulate. DISCUSSION AND CONCLUSION: Impairment and injury-related variables were important in predicting a minimal level of unassisted ambulation after discharge from inpatient rehabilitation. Awareness of predictors of recovery of the ability to ambulate that are gathered as part of a physical therapist's examination may assist in developing a prognosis for ambulation and in establishment of an appropriate plan of care.

Adolescent↗

PubMed2003

Lower extremity spasticity as an early marker of ambulatory recovery following traumatic brain injury.

METHODS: A consecutive series of 107 children and young persons with traumatic brain injury (TBI) admitted to a hospital-based inpatient rehabilitation program was assessed to determine whether lower extremity spasticity could be utilized as an early clinical marker for recovery of ambulation. Presence of spasticity was determined by clinical examination at admission, and the ability to ambulate safely indoors (15.24 m) was evaluated at discharge. Sensitivity, specificity and positive and negative predictive values for spasticity were calculated. RESULTS: Lower extremity spasticity is a sensitive (71.4%) and specific (81.5%) predictor of the inability to ambulate at discharge. The absence of lower extremity spasticity, however, was a better predictor of ambulation recovery than the presence of spasticity was a predictor of nonambulatory status at hospital discharge. DISCUSSION: Implications for spasticity assessment and prognosis in terms of ambulation and recovery are discussed.

Adolescent↗

PubMed2003

Oxygen and ventilator weaning during inpatient pediatric pulmonary rehabilitation.

Rates of oxygen and ventilator weaning, and factors related to successful weaning in inpatient pediatric pulmonary programs for infants and young children, have not been frequently reported in the literature. A retrospective review was conducted of 34 infants and toddlers with either a diagnostic condition of prematurity (PM) or congenital anomalies/neuromuscular disease (CA/NM) discharged from an inpatient pulmonary program. These cases represent 67 hospital admission-discharge episodes over a 6-year period. The rate of successful oxygen weaning (decrease to 0 hr per day) and ventilator weaning (decrease to <12 hr per day) and predictive factors related to successful ventilator weaning per admission-discharge episode were examined. Successful oxygen weaning was achieved during 24% and successful ventilator weaning was achieved during 30% of the admission-discharge episodes. No significant relationships were found between the selected demographic and clinical factors and oxygen weaning. Using a logistic regression model, the major variable associated with successful ventilator weaning per admission-discharge episode was diagnostic condition. Age at admission and the presence of comorbidities added slightly to the prediction model. The overall model yielded 86% accuracy for predicting a decrease in ventilator hours. However, projecting in which episodes children will not be weaned (negative predictive value = 88.9%) was more accurate than projecting in which episodes children will be weaned (positive predictive value = 73.3%). Although the program achieved a relatively low rate of successful ventilator weaning, children with a diagnostic condition of prematurity were more likely to be successfully weaned during inpatient pulmonary rehabilitation.

Bronchopulmonary Dysplasia↗

PubMed2003

Early recovery of walking in children and youths after traumatic brain injury.

A consecutive series of 106 children and adolescents (mean age 10 years, 6 months; SD 4 years, 8 months) with recent traumatic brain injury admitted to a regional hospital-based rehabilitation program was assessed to determine the rate of walking recovery, and characteristics that distinguish between independent walkers, non-walkers, and device-assisted walkers at hospital discharge. Data were collected through a retrospective medical record review of patients admitted between 1994 and 2001. Mean hospital stays were 66.7 days (SD 88.5, range 7 to 140 days). All children (72 male, 34 female) had recent injuries (from 1 to 8 weeks after onset of traumatic brain injury) and were independent walkers before injury. Sixty-four children (60.4%) were discharged as independent walkers, 13 (12.3%) walked with the assistance of a device, and 29 (27.3%) were non-walkers. Non-walkers had a higher proportion of prolonged loss of consciousness, lower-extremity injury, impaired responsiveness, and lower-extremity spasticity than independent walkers. In addition, non-walkers had poorer discharge mobility and social function scores, longer average hospital stays, and a greater proportion of non-community discharges. Device-only walkers were older, more likely to be male, and had a higher proportion of lower-extremity injuries than independent walkers. Results highlight several demographic, clinical, and outcome variables that distinguish independent walkers from device-assisted walkers and non-walkers. These variables might help to determine the prognosis for ambulation, resource needs, and discharge plans for children and adolescents with traumatic brain injury after episodes of inpatient rehabilitation.

Adolescent↗

PubMed2003

Strategies to promote activity and participation in children and youths with acquired brain injuries.

Strategies used by hospital and community-based rehabilitation and educational professionals and parents for promoting activity performance and participation of children and youths with acquired brain injuries (ABI) in the hospital, at home, at school and in the community are described in this article. Semi-structured interviews with interdisciplinary staff from a pediatric rehabilitation hospital in the Northeast USA and focus groups comprised of hospital and community-based educational and rehabilitation professionals and parents were conducted. Interviews and focus groups were audiotaped, transcribed verbatim and qualitatively analyzed. The strategies described fell into three categories: Routine, Repetition, and Consistency; Supports and Models; and Curriculum and Environmental Modifications. In addition, three broader factors emerged related to the use of strategies: Communication; Age, Development and Recovery Time; and Attitudes and Expectations. Findings may provide insights to professionals and families to promote activity performance and participation in children and youth with acquired brain injuries across the continuum of care.

Adolescent↗

PubMed2003

Item-specific functional recovery in children and youth with acquired brain injury.

PURPOSE: The purpose of this study was to examine changes in item-specific functional activities and caregiver support in children and youths with acquired brain injury (ABI) in an inpatient setting using the Pediatric Evaluation of Disability Inventory (PEDI). METHODS: The PEDI was administered by therapy staff at admission and discharge to a consecutive sample of 94 children and youths with brain injury (62 males and 32 females; age range = one to 19 years of age) admitted to the inpatient service at Franciscan Children's Hospital and Rehabilitation Center during a two-year, 10-month period. Individual PEDI item scores were abstracted from the medical records. RESULTS: Using the Wilcoxon matched-pairs signed rank test (two-tailed), significant differences between admission and discharge scores were found for most mobility, self-care, and social activity item groups and for all domains of caregiver support. Patterns of activity-specific improvements were contrasted between children with traumatic ABI and those with nontraumatic ABI. CONCLUSIONS: Recovery in children with ABI can be detected during inpatient rehabilitation across many areas of functioning as represented by item content of the PEDI. Changes at the item level may serve as a guide for defining specific physical therapy goals for inpatient episodes. Item groups in which changes are not detected provide information about sections of the PEDI that are less relevant for hospital-based recovery of children with ABI.

Journal Article↗

PubMed2003

Effects of lower extremity passive stretching: pilot study of children and youth with severe limitations in self-mobility.

PURPOSE: The purpose of this pilot study was to investigate changes in passive range of motion (PROM) of children with severe limitations in self-mobility during periods of physical therapy intervention and naturally occurring periods of no intervention (school vacations). METHODS: A multiple-case time-series design was used to monitor hip and knee PROM over a seven-month period for seven students aged four to 18 years receiving physical therapy in a school setting. PROM measurements were graphed and the Wilcoxon signed rank test was used to evaluate the PROM changes during intervention and nonintervention phases for each individual student and for the students as a group. RESULTS: When PROM changes were pooled for all subjects and all joint motions, the Wilcoxon signed rank test revealed a significant decrease in PROM only after the first nonintervention phase. Significant decreases in PROM were observed in only two of the students after the first nonintervention phase. CONCLUSION: Children and youth with severe limitations in self-mobility may lose PROM during nonintervention periods lasting more than five weeks.

Journal Article↗

PubMed2003

Physical therapy intervention for children with cerebral palsy who receive botulinum toxin a injections.

PURPOSE: This study describes changes in physical therapy (PT) service delivery, intervention strategies, and anticipated goals after botulinum toxin A (BtA) injections for children with cerebral palsy and lower extremity spasticity. METHODS: Subjects were six physical therapists who were the primary therapists for children who received BtA injections. A questionnaire was developed for this study. Data were collected by structured telephone interview during a six-month period that included a two-month preinjection and four-month postinjection phase for each child. A descriptive analysis was done to determine changes in PT over time. RESULTS: Three therapists reported increased levels of PT in the postinjection phase. Trends in interventions indicated use of strategies that were impairment and function based to achieve goals. Most goals emphasized functional change. CONCLUSION: This study identifies PT interventions and trends in goal achievement for children with cerebral palsy after BtA injections.

Journal Article↗

PubMed2003

Measuring functional change in children with acquired brain injury (ABI): comparison of generic and ABI-specific scales using the Pediatric Evaluation of Disability Inventory (PEDI).

BACKGROUND AND PURPOSE: The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change. SUBJECTS: Eighty-seven children and adolescents (mean age=9.2 years, SD=5.2, range=1-20) with ABI during inpatient rehabilitation admissions were included. METHODS: Data were collected by retrospective chart review. Rasch one-parameter analyses were conducted to construct the ABI-specific PEDI scale focusing on the Mobility and Self-care domains (content areas) only. Each domain consists of a Functional Skills subscale and a Caregiver Assistance subscale. Thus, in all, 4 scales were constructed within the ABI-specific PEDI scale. Differences in item hierarchies and sensitivity between generic and ABI-specific PEDI subscales for each domain were then examined. RESULTS: Both generic and ABI-specific PEDI scales were sensitive for measuring functional changes during inpatient rehabilitation hospitalization. Even though the generic and ABI-specific item hierarchies differed substantially, only one of the 4 ABI-specific PEDI subscales (Caregiver Assistance Self-care subscale) was more sensitive for measuring change than the generic PEDI scale. DISCUSSION AND CONCLUSION: The ABI-specific scales added relatively little improvement in sensitivity compared with the generic PEDI scales of the Mobility and Self-care domains. Thus, for group analyses, the authors recommend use of the generic PEDI subscales for children with ABI. Future work with ABI-specific subscales may improve the physical therapist's ability to describe an individual's pattern of functional recovery.

Activities of Daily Living↗

PubMed2003

Establishing minimal clinically important differences for scores on the pediatric evaluation of disability inventory for inpatient rehabilitation.

BACKGROUND AND PURPOSE: Standardized pediatric assessment tools such as the Pediatric Evaluation of Disability Inventory (PEDI) numerically quantify changes during rehabilitation through test scores, but they are unable to provide client-specific information regarding important changes in function. The purpose of this study was to identify the smallest change in PEDI scores during inpatient rehabilitation that was considered to be a minimal clinically important difference (MCID) by physical therapists and other clinicians. SUBJECTS AND METHODS: A retrospective review was done of the medical charts of 53 children and youth (1-19 years of age) discharged from an inpatient rehabilitation hospital. Fifteen clinicians (5 physical therapists, 6 occupational therapists, and 4 speech and language pathologists) who were masked to the PEDI scores provided ratings of the magnitude of functional changes during inpatient rehabilitation using a Likert scale and a visual analog scale (VAS). Ratings by clinicians were reduced to 4 categories, including the MCID, and compared with PEDI change scores. RESULTS: The MCIDs ranged from 6 to 15 points (X=11.5, 95% confidence interval= +/- 2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (tau =.73-.80). DISCUSSION AND CONCLUSION: Across all scales, PEDI change scores on the order of about 11% (0-100 scale) appear to be meaningful to clinicians during a child's or adolescent's inpatient rehabilitation. These data can serve as a starting point for interpreting group and individual changes on the PEDI during physical therapy intervention in inpatient rehabilitation.

Activities of Daily Living↗

PubMed2002

Classifying mobility recovery in children and youth with brain injury during hospital-based rehabilitation.

PRIMARY OBJECTIVE: This article describes mobility recovery for children and youth with traumatic and non-traumatic brain injury during hospital-based rehabilitation. RESEARCH DESIGN: A retrospective, descriptive pre-test/post-test design was used. METHODS AND PROCEDURES: One hundred and fifty-seven individuals with brain injury who were admitted for rehabilitation over a 5-year period were enrolled in this study. The Paediatric Evaluation of Disability Inventory (PEDI) was used to document functional mobility at admission and discharge from the rehabilitation programme. The PEDI mobility classification system consisting of seven discrete levels of mobility was developed to provide clinically relevant and succinct outcome information. MAIN OUTCOMES AND RESULTS: The majority of children with brain injury (69%) improved one or more mobility classification levels. Children in the traumatic brain injury group made greater changes (p = 0.001) in mobility recovery than children in the non-traumatic group. CONCLUSIONS: Information about recovery using a well-defined functional classification system may assist with programme evaluation and facilitate optimal service delivery.

Adolescent↗

PubMed2002

Functional changes during inpatient rehabilitation for children with musculoskeletal diagnoses.

PURPOSE: The purpose of this study was to describe functional self-care and mobility changes of children with musculoskeletal diagnoses during inpatient rehabilitation. METHODS: A retrospective record review was completed for 50 children and youth aged three to 20 years admitted to inpatient rehabilitation after a traumatic musculoskeletal injury or after orthopedic surgery because of a preexisting musculoskeletal or neuromuscular disorder. Admission to discharge changes in summary scaled scores on the Pediatric Evaluation of Disability Inventory's (PEDI) Functional Skills and Caregiver Assistance Self-Care and Mobility scales for the total group and two diagnostic subgroups were examined using paired t tests and effect-size coefficients. Independent t tests were used to determine differences between change scores for the subgroups. RESULTS: Mean PEDI Functional Skills Self-Care and Mobility scaled scores were significantly higher at discharge for the total group. For the subgroups, both Functional Skills and Caregiver Mobility scaled scores were significantly higher at discharge, but only the trauma group made a significant change in Self-Care, on the Caregiver Assistance scale. Effect-size coefficients ranged from 0.23 to 1.76. The trauma group demonstrated significantly greater changes than the postsurgical group on both scales in both domains. CONCLUSIONS: During inpatient rehabilitation, children with musculoskeletal diagnoses demonstrated significant functional improvements. Children with traumatic injuries made greater gains than children with preexisting conditions after orthopedic surgery. These results support the PEDI as a responsive measure of change during inpatient rehabilitation for children with musculoskeletal diagnoses.

Journal Article↗