BACKGROUND

During the COVID-19 pandemic, social isolation and quarantine measures set to control the spread of the infection paved for the increased utilization of virtual methods of consultation and follow-up. Telerehabilitation allows access to rehabilitation services despite distance and makes possible the continuation of rehabilitation services despite the lack of face-to-face interaction. This is difficult for pediatric patients who are dependent on their caregivers for understanding and making decisions regarding their health. Loss of continuity of rehabilitation services led to poorer outcomes in children with disabilities. Although advantageous for them, pediatric patients may not benefit from telerehabilitation if caregivers have negative perceptions of the process and are unwilling to utilize the service.

OBJECTIVES

This study determined caregivers’ perceptions and willingness to participate in telerehabilitation as a method of outpatient follow-up for pediatric patients admitted to a COVID-referral center in a developing country.

METHODS

The study utilized a descriptive cross-sectional design. Respondents were adults (≥19 years old) caring for pediatric patients admitted at non-COVID wards of the Philippine General Hospital and who were referred for rehabilitation services. A survey tool adapted from a previous study on willingness to utilize telemedicine among caregivers of pediatric patients was translated into the Filipino language and used in the study. A dataset from Excel was imported in STATA 16 (StataCorp, Texas, USA) and was exhaustively checked for completeness, accuracy, and consistency before analysis. The association between patient characteristics and willingness to utilize telerehabilitation for any app was determined using Pearson’s chi-squared test or Fisher’s exact test, as appropriate. The latter was used when more than 20% of the cells had an expected value of less than or equal to five. A P value of less than 0.05 was considered significant for all tests.

RESULTS

Of 123 respondents, 92 (75%) reported willingness to utilize telerehabilitation for outpatient consultation and therapy using video calls or a customized telerehabilitation app when available. Among 31 (25%) respondents who were not willing or unsure of participation, the main reasons identified were preference for face-to-face, lack of financial resources/load, poor connectivity, and doubt about the effectiveness of telerehabilitation.Patients with younger age (Fisher’s exact test, P=0.023), low usage of video call service (Fisher’s exact test, P=0.020), and lack of available devices (Fisher’s exact test, P=0.015) significantly reduced willingness to utilize telerehabilitation. Caregiver age, sex, educational attainment, estimated monthly income, number of devices used, speed of internet connectivity, and technological behaviors did not show statistical significance in association with willingness to participate in telerehabilitation.Most caregivers recognized the usefulness of a service allowing transmission of health data to and from the hospital, consultation with a doctor in case of an emergency, sending of reminders for medical visits and therapy, and provision of a list of home exercises and nutritional recommendations. Telerehabilitation was perceived advantageous, but concerns regarding privacy, trust, lack of human contact, and technological difficulty were also present.

CONCLUSION

With high levels of willingness among caregivers, telerehabilitation is a viable method of providing rehabilitation services for the continuation of management after inpatient admission among pediatric patients. Limitations in its utilization include technological issues including the lack of devices, low level of service use, and slow internet connectivity. Although well perceived as advantageous, there are concerns regarding loss of human contact, difficulty in using technological devices, and trust and privacy issues that may affect utilization.

Human ; Telerehabilitation ; Caregivers ; Pediatrics ; Children With Disability ; Disabled Children ; Covid-19 ; Developing Countries

Children with an intellectual disability often demonstrate lack of cooperation during dental treatment and require behavioral management. A child with mild intellectual disability can be managed adequately using restraints and medication. However, in cases of profound intellectual disability, dental treatment under general anesthesia is usually required. In cases where the patient is an intellectually disabled child who has intellectually disabled parents, it is difficult to evaluate the patient's preoperative condition and to obtain consent for treatment under general anesthesia. Furthermore, they are unable to respond to emergencies after treatment. Therefore, dental treatment should be performed under general anesthesia with hospitalization for children with an intellectual disability. This case presents the dental treatment of an intellectually disabled child, who has intellectually disabled parents, and who required general anesthesia and hospitalization.
Anesthesia, General* ; Child ; Dental Care for Disabled ; Disabled Children* ; Emergencies ; Hospitalization ; Humans ; Intellectual Disability ; Parents*

Though Fragile X syndrome is one of the most common inherited causes of mental retardation, it is not much detected yet in Korean population. One of the reason may be that the syndrome is not well known to the special education teachers as well as to the clinicians in this country. Thus, molecular test was undertaken to screen out fragile X syndrome in 122 children of two Korean schools for emotionally severely handicapped children. The subjects were all boys, previously known as having pervasive developmental disorder with or without mental retardation. Southern blot analysis of peripheral blood showed the abnormally enlarged (CGG)n repeat sequence associated with fragile X syndrome in two children. This finding suggests that the DNA testing for fragile X syndrome is warranted for Korean high risk population and that more concern about this syndrome is needed for the professionals who work for mentally handicapped children. The issues involved in genetic counseling for fragile X syndrome are discussed.
Blotting, Southern ; Child ; Disabled Children* ; Disabled Persons* ; DNA* ; Education, Special ; Fragile X Syndrome* ; Genetic Counseling ; Humans ; Intellectual Disability ; Korea* ; Mentally Disabled Persons

OBJECTIVES: We atlempted to determine the prevalence rate of attention deficit-hyperactivity disorder, learning disorder, and mental retardation of elementary school children in a rural area, and to evaluate a cost, and time-efficient method for identifying of children with such disabilities. METHODS: We studied 1,256 children from 6 elementary schools in a rural aiea using used two-stage design. At the first step, we used the key informant and the total population survey methods for identifying children with disability. Teacher checklists were used as screening instruments in total population survey. And at the second step, child interview and KEDI-WISC were employed to make diagnoses. RESULTS: 1)The prevalence rate of attention-deficit/hyperactivity disorder(ADHD)was 1.99%. The prevalence rates of learning disorder(LD)and mental retardation(MR)were 0.40% and 2.23%, respectively. 2)The prevalence rate of MR was significantly higher in total population method compared with key informant method(3.29% vs. 1.23%) Other comparison of prevalence rates in two methods was not significantly different. Positive predictabilities of ADHD and learning disabilities by key informants were higher than by DBDRS and APRS, the checklists used in total population methods. 3)The probability of illness was much higher when the teacher and parents reported the problems of child concurrently. CONCLUSIONS: The prevalence rate of ADHD in elementary school children in the rural area was 1. 99%. And the prevalence rates of LD and MR were 0.40% and 2.23%, respectively. Key informant method was more effective compared with total population survey in positive predictability and diagnostic concordance. In identifying children with disabilities, the combined data from teacher and a parent was most reliable.
Attention Deficit Disorder with Hyperactivity ; Checklist ; Child ; Surveys and Questionnaires ; Diagnosis ; Disabled Children ; Epidemiologic Studies* ; Humans ; Intellectual Disability ; Learning Disorders* ; Learning* ; Mass Screening ; Parents ; Prevalence

Purpose of this study was to compare nutrient intakes of disabled children and non-disabled children. Subjects consisted of 86 disabled children from a special education school and 127 non-disabled children from an elementary school in Seoul. Nutrient intakes were assessed by modified 24-hr recall method, with the help of children's parents and teachers. Almost all nutrient intakes (energy, protein, fat, carbohydrates, vitamin B1 and niacin) of children with cerebral palsy were significantly lower than those of other groups. But nutrient intakes per body weight of children with cerebral palsy were not significantly different with those of other groups. There was no significant difference between disabled and non-disabled children in almost % RDA (rate of actual intake to RDA) except of energy %RDA in children with cerebral palsy. NARs (nutrient adequacy ratio) for energy and vitamin B1 of children with cerebral palsy were significantly lower than those of children with autism and mental retardation, and non-disabled children. The proportions of energy, carbohydrate and protein intakes from lunch were significantly higher than those from breakfast and dinner in children with mental retardation and autism. The nutrient intakes of disabled children were different between other groups according to the type of handicap. For example, children with cerebral palsy had the risk of undernutrition. On the other hand, autistic children had the tendency of overnutrition. These results suggest that nutrition educational programs and educational materials for disabled children, their teachers and their parents should be developed considering the type of handicap.
Autistic Disorder* ; Body Weight ; Breakfast ; Carbohydrates ; Cerebral Palsy ; Child* ; Disabled Children ; Education, Special ; Hand ; Humans ; Intellectual Disability ; Lunch ; Malnutrition ; Meals ; Overnutrition ; Parents ; Seoul ; Thiamine

INTRODUCTIONIntellectual disabilities are as prevalent in East Asian countries as in the West (0.06%-1.3%). Widespread discrimination against intellectual disabilities in Asia may initiate stigma that places unfair restrictions on the social life of these individuals and their caregivers. We utilised established stigma frameworks to assess the extent to which a child's intellectual disability contributes to the social exclusion of caregivers in Vietnam.

METHODSA mixed quantitative and qualitative approach was employed to examine the experience of social life restriction among parents of children with intellectual disabilities. The child's disability level and restrictions on caregivers' social experiences were assessed among 70 mothers and fathers recruited from schools in Hue City, Vietnam. Qualitative responses describing social exclusion were also recorded.

RESULTSCaregivers reported elevated levels of social exclusion. As hypothesised, parents of children with greater intellectual disability experienced more restrictions on their social life (Beta = 0.79, 95% confidence interval 0.27-1.30, standard error = 0.26, p < 0.01). Qualitative analyses indicated that the threatening of core cultural norms (inability to be employed or married upsets community harmony) initiated labelling, social exclusion and efforts to keep the condition secret or withdraw from others.

CONCLUSIONThis study is among the first to demonstrate the impacts of intellectual disabilities on caregivers' social functioning in Asia. The findings illustrate how traditional Asian norms initiate stigma, which in turn restricts key social interactions among caregivers. Psycho-educational interventions may address the social domains in which caregivers are impacted and encourage sustained help-seeking among caregivers for their children.

Attitude to Health ; Caregivers ; Child ; Child, Preschool ; Disabled Children ; Female ; Humans ; Intellectual Disability ; psychology ; therapy ; Male ; Parents ; Social Adjustment ; Social Behavior ; Social Stigma ; Social Support ; Stress, Psychological ; Surveys and Questionnaires ; Vietnam

Delayed emergence of speech or language are frequent causes for concern about development during early childhood. Delay in evaluation and proper management until school entry in more likely to result in frustration, anxiety and school failure. Many language disturbances and their attendant behavior disorders respond to intensive language therapy. Authors analyzed the medical records of 52 children with delayed language development evaluated during 30 months from January 1986 through June 1988. The results were as follows: 1. The majority of cases were evaluated at the age of 2-2.9 year old (16 cases, 30.8%) and 3-3.9 year old (11 cases, 21.2%) 2. Male to female ratio was 3:1 3. The most common cause was mental retardation (53.8%), followed by developmental language disorder (23.1%) and autism (13.5%) 4. The most common associated condition was dysarticulation (17.3%), followed by strabismus (9.6%) and seizures (7.7%) 5. Special education was recommended in cases of 23 (44.2%), speech therapy in 12 cases (23.1%) and consultation to child psychiatry in 7 cases (13.5%) Making diagnosis of underlying disorders in not simple because assessment of intelligence in young children in difficult and only a few tests are standardized. More detailed study on children with delayed language development and development of psychometric tests for handicapped children are necessary, especially in Korea.
Anxiety ; Autistic Disorder ; Child Psychiatry ; Child* ; Clinical Study* ; Diagnosis ; Disabled Children ; Education, Special ; Female ; Frustration ; Humans ; Intellectual Disability ; Intelligence ; Korea ; Language Development Disorders ; Language Development* ; Language Therapy ; Male ; Medical Records ; Mental Disorders ; Psychometrics ; Seizures ; Speech Therapy ; Strabismus

The permanent impairment evaluation for children in developmental stage is very difficult and it is even impossible in some cases. The impairment evaluation for developing children has not yet been included in the guideline of the American Medical Association. Due to frequent medical and social demands in Korea, we developed an impairment evaluation guideline for motor impairment, intellectual disability/mental retardation, developmental speech-language disorder and epilepsy caused by pediatric cerebral injuries, or cerebral lesions other than the developmental disorders such as autism. With the help of various literature and foreign institutions, we developed our in order to develop a scientific guideline for pediatric impairment that is suited to Korean cultural background and social condition.
Brain/physiopathology ; Brain Diseases/*complications ; Brain Injuries/complications ; Child ; Developmental Disabilities/classification/*diagnosis/etiology ; *Disability Evaluation ; *Disabled Children ; Humans ; Korea ; Language Development Disorders/classification/diagnosis/etiology ; Mental Disorders/classification/diagnosis/etiology ; Program Development ; Seizures/classification/diagnosis/etiology ; Severity of Illness Index

OBJECTIVETo explore the epidemiological status of disabilities on vision impairment (VI), hearing loss (HL), mental retardation (MR), autism spectrum disorder (ASD) and motor disorder (MD) in aged 0-6 years old children in Beijing.

METHODSA total of 28 738 children under 7 years old were recruited from permanent residents of Beijing City by 2-phase cluster sampling. The screening procedure was 2-phase, and the diagnosis criteria were developed by the experts group.

RESULTSThe overall disability rate was 11.45 per thousand (95 % CI:10.22-12.68). The false negative rates in HL and ASD were 0.14 per thousand, 0.80 per thousand, respectively, with a adjusted overall rate of 12.19per thousand. The prevalence rates of different kind disabilities from high to low were MR 9.31per thousand, MD 2.12per thousand, ASD 1.53per thousand (0.73per thousand before adjusted), HL 1.04per thousand (0.91per thousand before adjusted) VI 0.73per thousand. The results of logistic regression analysis showed that the possible non-biological risk factors for those disabilities were being male, living in city area, advancing age, mother with low education, mother engaged in labor work, and family with low income. It was primarily (49.62%) those prenatal factors other them the known suspected factors that causing disabilities.

CONCLUSIONSCompared with data from a countrywide study in 1987, the overall disability rate had a mild decrease (16.36%) with the most (56.85%) appeared in HL. It is indispensable to establish a disabilities surveillance program for the early recognition and intervention of children with disabilities. It is also crucial to clarify a disability definition for children combined with their characteristics of growth and development. We strongly recommended in developing a new definition on children' disabilities and establishing new criteria according to the contents of developmental disabilities of Center for Disease Control, USA.

Age Distribution ; Child Development Disorders, Pervasive ; epidemiology ; Child, Preschool ; China ; epidemiology ; Cross-Sectional Studies ; Disabled Children ; statistics & numerical data ; Educational Status ; Female ; Health Surveys ; Hearing Loss ; epidemiology ; Humans ; Income ; statistics & numerical data ; Infant ; Infant, Newborn ; Intellectual Disability ; epidemiology ; Male ; Motor Skills Disorders ; epidemiology ; Occupations ; statistics & numerical data ; Parents ; Risk Factors ; Sex Distribution ; Vision Disorders ; epidemiology

Background. Children comprise a significant proportion of persons with disabilities (PWDs) in the Philippines, and represent a major public health challenge. One under-explored topic is the "lived experiences" of their parents and guardians as well as the roles they play in caring for their children. This qualitative study responds to this research gap by eliciting and foregrounding their experiences and narratives.

Methods. Six focus group discussions (FGDs) were conducted among parents of children with disabilities (CWDs) in Davao City and Tagum City. These were complemented by 12 key informant interviews among healthcare providers in both cities.

Results. For many parents, coming to terms with a disability is a difficult and lengthy process, but one that ends with a measure of relief and eventual adaptation. Living with disability, meanwhile, is fraught with medical, financial, educational, and social challenges. A positive religious outlook allows them to make sense of disability, helping them to overcome these challenges. Support groups and the health care system are likewise crucial factors towards family resilience.

Conclusion. Our findings show that the experience of disability is shared among family members, particularly, the parents of CWDs; thus, underscoring the need for a family-centered approach in policies, clinical care, and communications efforts involving children with disability in the Philippines.

Disabled Children