Objective: Aspiration is a major concern for children with dysphagia because aspiration has been known as the primary etiology leading to recurrent pneumonia, and severe impairment of lung function in pediatric populations.This study aimed to examine the differences in each temporal measure between children with and without aspiration and investigate the effect of bolus consistency on the temporal measures. Methods: Forty-two children ranging in age from 1 year to 3 years and 11 months were included in this study. A referral for a videofluoroscopic swallowing study (VFSS) was made. They were divided into two groups according to the presence or absence of aspiration. Sixteen children were aspirators, and twenty-six children were non-aspirators.Oropharyngeal temporal measures were analyzed using frame-by-frame analysis. Results: The delayed initiation of pharyngeal swallowing, delayed laryngeal closure, and poor bolus transition in the pharyngeal stage were associated with the risk of aspiration in children with dysphagia. The bolus consistency did not affect the oropharyngeal temporal measures. Conclusion The objective temporal data in this study, including the durations and onset of physiological events in relation to bolus movement, can be used for future research to compare the swallowing functions between groups of children with various etiologies and age ranges.

Background: To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasinational databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). Methods: We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane–Armitage trend test was performed according to the injured body region. Results: In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = – 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. Conclusions The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

Introduction: There is no global reference value for the 6-minute walking distance (6MWD) in paediatric populations, as it can vary greatly depending on local characteristics and anthropometric measures. This study aimed to identify a 6MWD reference value that could be applied in both local and regional settings. Methods: This cross-sectional multicentre study investigated a healthy paediatric population aged 4–18 years in Indonesia. The 6-minute walk test (6MWT) was conducted in accordance with the American Thoracic Society guidelines. Data were presented as the 6MWD according to age and sex per year. Univariate and multivariate analyses were conducted on the basis of the 6MWDpred Rizky formula. Results: A total of 634 participants were included in this study. Age, sex, weight, leg length and height affected the 6MWD (P<0.001). In the regression model, sex and height were the predictors of 6MWD, with height as the best single predictor. Conclusion The reference charts and 6MWDpred Rizky formula are applicable in multi-ethnic paediatric Indonesian populations but in limited settings.
Pediatrics ; Walk Test ; Reference Values

Objective: To develop and validate a scale to assess people’s attitudes and perspectives toward persons with disabilities. Methods: The three-stage development of the scale included a preliminary version drafted from the literature review and a nominal group process. Thereafter, the draft was examined further and revised through two rounds of Delphi survey by 16 disability experts. Lastly, the psychometric properties of the scale were assessed through an online survey of 1,359 employees at three university hospitals. Results: A 32-item scale, defined after two Delphi surveys, was refined into 14 items with four subcategories: community integration, discomfort, charitability, and sense of burdening. The Cronbach’s alpha coefficient was 0.839 and domain reliability from 0.638 to 0.845. Recent education on disabilities yielded more positive attitudes toward persons with disabilities. Meaningful acquaintances with disabilities yielded more positive attitudes toward persons with disabilities. Conclusion This newly developed scale that measures attitudes toward persons with disability is reliable and valid. A future use of the scale could be to measure attitudinal improvements toward persons with disabilities after awareness education.

Objective: To develop and validate a scale to assess people’s attitudes and perspectives toward persons with disabilities. Methods: The three-stage development of the scale included a preliminary version drafted from the literature review and a nominal group process. Thereafter, the draft was examined further and revised through two rounds of Delphi survey by 16 disability experts. Lastly, the psychometric properties of the scale were assessed through an online survey of 1,359 employees at three university hospitals. Results: A 32-item scale, defined after two Delphi surveys, was refined into 14 items with four subcategories: community integration, discomfort, charitability, and sense of burdening. The Cronbach’s alpha coefficient was 0.839 and domain reliability from 0.638 to 0.845. Recent education on disabilities yielded more positive attitudes toward persons with disabilities. Meaningful acquaintances with disabilities yielded more positive attitudes toward persons with disabilities. Conclusion This newly developed scale that measures attitudes toward persons with disability is reliable and valid. A future use of the scale could be to measure attitudinal improvements toward persons with disabilities after awareness education.

Spinal muscular atrophy (SMA) is a neuromuscular disease that requires multidisciplinary medical care, including rehabilitation management. The emergence of a genetic therapy-based approach for SMA has markedly changed the disease course.Nonetheless, currently, updated physical therapy and rehabilitation are warranted for individuals with SMA in the era of gene therapy. In this review, we discuss the physical therapy and rehabilitation strategies currently performed for people with SMA, such as positioning and bracing, supported standing, management of musculoskeletal deformities, stretching, physical exercise training like aerobics and strengthening exercises, assistive devices, pulmonary rehabilitation, and dysphagia treatment.

Objective: To investigate the reliability of knee extensor strength measurements using a supine hand-held dynamometer (HHD) anchoring frame in patients with limited physical activity. Although an HHD is suitable for bedside use, its inter-rater reliability is low because measurements can be influenced by tester strength. Methods: Maximal knee extensor isometric strength was measured using an HHD anchored to the supine frame. Three trials of three maximal contractions were assessed by two raters. Results: A total of 33 inpatients who were non-ambulatory due to acute illness participated in the study. The intraclass correlation coefficients were 0.974 (inter-rater) and 0.959 (intra-rater). The minimal detectable changes in intra- and inter-observer measurements were 29.46 N (24.10%) and 36.73 N (29.26%), respectively. The limits of agreement ranged from -19.79% to 24.81% for intra-rater agreement and from -21.45% to 37.07% for inter-rater agreement. Conclusion The portable dynamometer anchoring system can measure the isometric strength of the knee extensor reliably in the supine position, and could be used for measurements in patients who have difficulty visiting the laboratory and maintaining a seated posture.

The population of adults diagnosed with cerebral palsy (CP) is increasing along with the survival rate of children born with the disability. Adults with CP need health services for the continued monitoring and management of their condition. Moreover, the development of additional health problems in adulthood increases the need for ongoing access to health services. Adults with CP manifest a higher rate of chronic health conditions and eventual decline in strength and functional reserve, deterioration in physical activity, increased risk of musculoskeletal complications, and gradual changes in swallowing ability. They are also reported to exhibit difficulty engaging socially and have a low health-related quality of life (QOL). However, there are a large number of adults with CP who cannot access medical services adequately and are therefore not effectively treated. To overcome these apparent challenges, we need to fully comprehend the healthcare needs of adults with CP to develop adult-focused health services. Further research is needed regarding the impact of physical activity, nutrition, sarcopenia, myeloradiculopathy, and swallowing function on QOL.
Adult ; Aging ; Cerebral Palsy ; Child ; Deglutition ; Delivery of Health Care ; Health Services ; Humans ; Motor Activity ; Quality of Life ; Sarcopenia ; Survival Rate

OBJECTIVE: To evaluate the factors affecting long-term prognosis for dysphagia in tonsil cancer patients, after treatment. METHOD: This was a retrospective study of subjects who underwent a videofluoroscopic swallowing study (VFSS) following treatment for stage 3 or 4 tonsil cancer. Data including sex, age, cancer characteristics, and methods of cancer treatment were collected. To evaluate the swallowing-related outcome, we collected data including findings regarding the last VFSS, method of feeding, and history of aspiration pneumonia requiring in-patient care. We evaluated the correlation between these data and the characteristics of cancer and treatment methods. RESULT: Among 32 subjects included in this study, eight had aspiration or penetration confirmed by the last VFSS. There were no significant differences in swallowing-related factors according to the presence of aspiration or penetration in the last VFSS. Patients who underwent curative tonsillectomy retained more residues on the last VFSS than those who did not. CONCLUSION: Among subjects with tonsil cancer, history of curative tonsillectomy was correlated with more pharyngeal residue. However, other cancer- or treatment-related factors did not affect the outcome of swallowing.
Deglutition ; Deglutition Disorders ; Humans ; Methods ; Palatine Tonsil ; Pneumonia, Aspiration ; Prognosis ; Retrospective Studies ; Tonsillar Neoplasms ; Tonsillectomy

OBJECTIVE: To compare the scores of the Bayley Scales of Infant Development second edition (BSID-II) and the third edition, Bayley-III, in children with suspected developmental delay and to determine the cutoff score for developmental delay in the Bayley-III. METHODS: Children younger than 42 months (n=62) with suspected developmental delay who visited our department between 2014 and 2015 were assessed with both the BSID-II and Bayley-III tests. RESULTS: The mean Bayley-III Cognitive Language Composite (CLC) score was 5.8 points higher than the mean BSID-II Mental Developmental Index (MDI) score, and the mean Bayley-III Motor Composite (MC) score was 7.9 points higher than the mean BSID-II Psychomotor Developmental Index (PDI) score. In receiver operating characteristic (ROC) analysis of a BSID-II MDI score < 70, Bayley-III CLC scores showed a cutoff of 78.0 (96.6% sensitivity and 93.9% specificity). In ROC analysis of a BSID-II PDI score < 70, the Bayley-III MC score showed a cutoff of 80. CONCLUSION: There was a strong correlation between the BSID-II and Bayley-III in children with suspected developmental delay. The Bayley-III identified fewer children with developmental delay. The recommended cutoff value for developmental delay increased from a BSID-II score of 70 to a Bayley-III CLC score of 78 and Bayley-III MC score of 80.
Child Development ; Child* ; Developmental Disabilities ; Humans ; ROC Curve ; Weights and Measures*