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Foot and Ankle Clinics Sep 2019Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical... (Review)
Review
Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical management in athletes is often favored for a number of reasons, although evidence guiding the optimal treatment is limited. Functional rehabilitation has been supported as a key component of operative and nonoperative treatment plans. Return-to-play protocols in the literature are sparse and varied due to often ambiguous definitions of what it means to return to sport and a lack of explicit criteria. Optimal sport-specific return-to-play milestones should be defined to guide the rehabilitation of injured athletes.
Topics: Achilles Tendon; Athletic Injuries; Humans; Return to Sport; Rupture; Tendon Injuries
PubMed: 31370995
DOI: 10.1016/j.fcl.2019.04.003 -
Developmental Medicine and Child... Jan 2020To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).
AIM
To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).
METHOD
We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'.
RESULTS
Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes.
INTERPRETATION
Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP.
WHAT THIS PAPER ADDS
Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.
Topics: Cerebral Palsy; Child; Child, Preschool; Family; Female; Humans; Infant; Longitudinal Studies; Male; Occupational Therapy; Outcome and Process Assessment, Health Care; Patient Satisfaction; Physical Therapy Modalities; Recreation Therapy; Severity of Illness Index; Speech Therapy
PubMed: 31353456
DOI: 10.1111/dmcn.14325 -
Current Pediatric Reviews 2020Children with developmental disabilities may need support with motor skills such as balance improvement, cognitive skills such as vocabulary learning, or social skills... (Review)
Review
BACKGROUND
Children with developmental disabilities may need support with motor skills such as balance improvement, cognitive skills such as vocabulary learning, or social skills such as adequate interpretation of emotional expressions. Digital interactive games could support the standard treatments. We aimed to review clinical studies which investigated the application of serious games in children with developmental disabilities.
METHODS
We searched MEDLINE and Scopus on 05 May 2019 limited to the English language. We included people between two and 24 years of age who were affected by neurodevelopmental disorders and who received digital serious game-based medical interventions such as any computer- based or video-based games. We considered any study design reporting primary data. We used title, abstract, and full-text of journal articles to build diagnostic groups, and we described some selected specific game applications.
RESULTS
The majority of the 145 relevant studies reported on autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and disabilities affecting intellectual abilities (DAIA). 30 of the 145 studies reported a randomized design. We detailed six specific applications aimed at improving abilities in children with ASD, ADHD, cerebral palsy, and Down syndrome. We visualized the diagnostic groups by bibliographic mapping, and limited the text to the title and abstract of journal articles.
CONCLUSION
We identified promising results regarding anxiety reduction, stress regulation, emotion recognition, and rehabilitation. Currently, there appears to be a lack of clinical evidence that children with neurodevelopmental disorders can benefit from the application of serious games.
Topics: Adolescent; Child; Child, Preschool; Developmental Disabilities; Humans; Play Therapy; Video Games; Young Adult
PubMed: 31393252
DOI: 10.2174/1573396315666190808115238 -
International Journal of Environmental... Jan 2020Overweight and obesity are the result of a complex interaction between genetic and environmental factors, which begins prenatally. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Overweight and obesity are the result of a complex interaction between genetic and environmental factors, which begins prenatally.
AIM
To analyse an intervention based on play as a means of improving the body composition of children who are overweight or obese.
METHODS
The Kids-Play study is a randomized clinical trial (RCT) consisting of 49 children aged 8-12 years on a nine-month intervention programme based on physical activity, play and nutritional advice. Controls had another 49 children, who received only nutritional advice.
RESULTS
The play-based intervention achieved a moderate-vigorous level of physical activity in the study group of 81.18 min per day, while the corresponding level for the control group was only 37.34 min. At the start of the intervention, the children in the study group had an average body fat content of 41.66%, a level that decreased to 38.85% by the end of the programme. Among the control group, body fat increased from 38.83% to 41.4% during the same period.
CONCLUSIONS
The intervention programme considered, based on both play and nutritional recommendations, produced a decrease in body fat among children aged 8-12 years. However, the control group, which received only nutritional recommendations, experienced an increase in body weight.
Topics: Behavior Therapy; Child; Exercise; Female; Humans; Male; Overweight; Pediatric Obesity; Play Therapy; Students
PubMed: 31947884
DOI: 10.3390/ijerph17010346 -
Physical Therapy Feb 2021Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders.
METHOD
This randomized controlled trial compared usual care early intervention (UC-EI) with START-Play plus UC-EI. Analyses included 112 infants with motor delay (55 UC-EI, 57 START-Play) recruited at 7 to 16 months of age across 5 sites. START-Play included twice-weekly home visits with the infant and caregiver for 12 weeks provided by physical therapists trained in the START-Play intervention; UC-EI was not disrupted. Outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley); the Gross Motor Function Measure; reaching frequency; and the Assessment of Problem Solving in Play (APSP). Comparisons for the full group as well as separate comparisons for infants with mild motor delay and infants with significant motor delay were conducted. Piecewise linear mixed modeling estimated short- and long-term effects.
RESULTS
For infants with significant motor delay, positive effects of START-Play were observed at 3 months for Bayley cognition, Bayley fine motor, and APSP and at 12 months for Bayley fine motor and reaching frequency outcomes. For infants with mild motor delay, positive effects of START-Play for the Bayley receptive communication outcome were found. For the UC-EI group, the only difference between groups was a positive effect for the APSP outcome, observed at 3 months.
CONCLUSION
START-Play may advance reaching, problem solving, cognitive, and fine motor skills for young infants with significant motor delay over UC-EI in the short term. START-Play in addition to UC-EI may not improve motor/cognitive outcomes for infants with milder motor delays over and above usual care.
IMPACT
Concepts of embodied cognition, applied to early intervention in the START-Play intervention, may serve to advance cognition and motor skills in young infants with significant motor delays over usual care early intervention.
LAY SUMMARY
If you have a young infant with significant delays in motor skills, your physical therapist can work with you to develop play opportunities to enhance your child's problem solving, such as that used in the START-Play intervention, in addition to usual care to help your child advance cognitive and motor skills.
Topics: Child Development; Cognitive Dysfunction; Disability Evaluation; Exercise Therapy; Female; Humans; Infant; Male; Motor Skills Disorders; Nervous System Diseases; Problem Solving; Surveys and Questionnaires
PubMed: 33382406
DOI: 10.1093/ptj/pzaa232 -
Physical Therapy Aug 2020The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of Supporting Play Exploration and Early Development Intervention in the First Months of Life for Infants Born Very Preterm: 3-Arm Randomized Clinical Trial Protocol.
OBJECTIVE
The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy.
METHODS
This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the Supporting Play, Exploration, and Early Development Intervention (SPEEDI)_Late or SPEEDI_Early group to a usual care group.
SETTINGS ARE URBAN
Urban and rural areas surrounding 2 academic medical centers. There will be 90 preterm infants enrolled in this study born at <29 weeks of gestation. SPEEDI is a developmental intervention provided by collaboration between a physical therapist and parent to support a child's motor and cognitive development. The primary outcome measure is the Bayley Scale of Infant and Toddler Development Cognitive and Gross Motor Scaled Scores. Secondary measures include behavioral coding of early problem solving skills, the Gross Motor Function Measure, and Test of Infant Motor Performance.
IMPACT
More than 270,000 infants are born very preterm in the United States each year, 50% of whom will have neurological dysfunction that limits their ability to keep pace with peers who are typically developing. This study is a step toward understanding the impact that intensive developmental intervention could have in this population in the first months of life.
Topics: Cerebral Palsy; Child Development; Child, Preschool; Developmental Disabilities; Early Medical Intervention; Exercise Therapy; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Longitudinal Studies; Motor Disorders; Motor Skills; Play Therapy; Problem Solving; Time Factors
PubMed: 32329778
DOI: 10.1093/ptj/pzaa077 -
The Physician and Sportsmedicine Nov 2020: Recent research demonstrates a connection between psychological factors and return to play following a musculoskeletal sports injury. Although it has been shown that... (Meta-Analysis)
Meta-Analysis
: Recent research demonstrates a connection between psychological factors and return to play following a musculoskeletal sports injury. Although it has been shown that psychological factors can influence when and if an athlete returns to play, it is unclear if the implementation of psychosocial interventions during the recovery process can address these factors and potentially increase the likelihood of return to play after physical recovery from injury. : To examine the efficacy of interventions designed to address psychosocial factors that influence return to play after sports injuries. : A systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, Embase, and Google Scholar databases were searched from the earliest entry through May 2018. Search terms included 'psychology,' 'sports injury,' 'anterior cruciate ligament injury,' 'anterior cruciate ligament reconstruction,' 'intervention,' 'return to play,' and 'return to sport.' Studies were included and reviewed if they reported on the efficacy of a psychosocial intervention program in injured athletes. : Initial searches of Pubmed, Embase, and Google Scholar databases identified 560 articles, 329 articles, and 34,400 hits, respectively. After inclusion and exclusion criteria were applied, eight articles remained that met inclusion criteria. Interventions of relaxation/guided imagery, positive self-talk, goal setting, counseling, emotional/written disclosure, and modeling videos were found to be effective interventions for promoting recovery after a musculoskeletal sports injury. These interventions facilitated positive mood changes, pain management, exercise compliance, and rehabilitation adherence. No study examined the effect of psychosocial interventions on return to play. : This systematic review demonstrates that psychosocial interventions can facilitate post-injury recovery in athletes by promoting a positive emotional state and rehabilitation adherence. Further research is necessary to determine the most effective psychosocial interventions for specific psychological factors, the ideal duration of interventions, the best method of implementation following a sports injury, and the impact of these interventions on return to play.
Topics: Affect; Anterior Cruciate Ligament Injuries; Athletic Injuries; Humans; Pain Management; Patient Compliance; Psychosocial Intervention; Return to Sport
PubMed: 32186423
DOI: 10.1080/00913847.2020.1744486 -
Ophthalmic Plastic and Reconstructive... Dec 2023Dysthyroid optic neuropathy (DON) is a sight-threatening complication of thyroid eye disease (TED). This review provides an overview of the epidemiology, pathogenesis,... (Review)
Review
PURPOSE
Dysthyroid optic neuropathy (DON) is a sight-threatening complication of thyroid eye disease (TED). This review provides an overview of the epidemiology, pathogenesis, diagnosis, and current therapeutic options for DON.
METHODS
A literature review.
RESULTS
DON occurs in about 5% to 8% of TED patients. Compression of the optic nerve at the apex is the most widely accepted pathogenic mechanism. Excessive stretching of the nerve might play a role in a minority of cases. Increasing age, male gender, smoking, and diabetes mellitus have been identified as risk factors. Diagnosis of DON is based on a combination of ≥2 clinical findings, including decreased visual acuity, decreased color vision, relative afferent pupillary defect, visual field defects, or optic disc edema. Orbital imaging supports the diagnosis by confirming apical crowding or optic nerve stretching. DON should be promptly treated with high-dose intravenous glucocorticoids. Decompression surgery should be performed, but the response is incomplete. Radiotherapy might play a role in the prevention of DON development and may delay or avoid the need for surgery. The advent of new biologic-targeted agents provides an exciting new array of therapeutic options, though more research is needed to clarify the role of these medications in the management of DON.
CONCLUSIONS
Even with appropriate management, DON can result in irreversible loss of visual function. Prompt diagnosis and management are pivotal and require a multidisciplinary approach. Methylprednisolone infusions still represent first-line therapy, and surgical decompression is performed in cases of treatment failure. Biologics may play a role in the future.
Topics: Humans; Male; Glucocorticoids; Graves Ophthalmopathy; Methylprednisolone; Optic Nerve; Papilledema
PubMed: 38054987
DOI: 10.1097/IOP.0000000000002555 -
Journal of Autism and Developmental... Sep 2022The purpose of this study was to identify appropriate outcome measures and assess preliminary efficacy of occupational therapy in an equine environment (OT HORSPLAY) for... (Randomized Controlled Trial)
Randomized Controlled Trial
The purpose of this study was to identify appropriate outcome measures and assess preliminary efficacy of occupational therapy in an equine environment (OT HORSPLAY) for youth with autism spectrum disorder (ASD). Twenty-four youth with ASD aged 6-13 were randomized to 10 weeks of OT HORSPLAY or to a waitlist control condition, occupational therapy in a garden. Youth demonstrated significantly improved goal attainment and social motivation, and decreased irritability after OT HORSPLAY. When compared to the subset of participants who completed the waitlist control condition, the OT HORSPLAY group still demonstrated significant improvements in goal attainment. This study provides preliminary evidence that horses can be integrated into occupational therapy for youth with ASD to improve social and behavioral goals.
Topics: Adolescent; Animals; Autism Spectrum Disorder; Horses; Humans; Occupational Therapy
PubMed: 34557985
DOI: 10.1007/s10803-021-05278-0 -
OTJR : Occupation, Participation and... Apr 2020Play in children with autism spectrum disorder (ASD) is often atypical, yet consensus regarding effective occupational therapy strategies for improving play is not...
Play in children with autism spectrum disorder (ASD) is often atypical, yet consensus regarding effective occupational therapy strategies for improving play is not established. To examine the efficacy of strategies used in occupational therapy to improve play in ASD, authors completed a systematic review of papers from January 1980 through January 2019. Search terms included autism, Asperger's, ASD, autistic in combination with play, playfulness, pretend, imagination, praxis, creativity, and generativity. Twenty papers met inclusion criteria and were reviewed. Reviewed interventions included parent education, modified play materials or environments, imitation of the child, and modeling by an adult, a peer, or video. Moderate to strong support exists for the specific strategies of imitation of the child and modeling for the child, with lesser or mixed support for other strategies. Certain strategies commonly used in occupational therapy may be effective in improving the occupation of play in ASD.
Topics: Autism Spectrum Disorder; Autistic Disorder; Child; Child, Preschool; Humans; Imitative Behavior; Occupational Therapy; Play and Playthings
PubMed: 31642399
DOI: 10.1177/1539449219880531