Roberta Giustetto [Physical Therapy and Rehabilitation, Giannina Gaslini Children’s Hospital IRCCS, Genoa, Italy]
Matteo Pirinu [Rehabilitation Professional Unit, Meyer Children’s University Hospital IRCCS, Florence, Italy]
Pediatric Acquired Brain Injury (ABI) occurs in infants, children and adolescents, with a traumatic (TBI) or non-traumatic (n-TBI) origin (1). ABI is a long-life condition that affects many aspects of a child’s life and can profoundly influence physical and cognitive development skills (2). Early rehabilitation is crucial to managing the multidimensionality of the problem and preventing complications due to prolonged immobilization in intensive care (3). However, there are still no specific guidelines in the literature for the implementation and characterization of neuromotor interventions in critical care for pediatric ABI. This review aims to explore the types of neuromotor interventions, with reference to the domains of the “International Classification of Functioning, Disability and Health: Children and Youth” (ICF-CY), and their characteristics based on the “Frequency, Intensity, Time, and Type” (FITT) criteria, that can be applied in critical care for children and adolescents with ABI.
Scoping Review conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews’ (PRISMA-ScR) Checklist. Two pediatric physiotherapists independently conducted comprehensive research on Pubmed, Embase, and PEDro databases.
Articles were initially screened by title and abstract, and those considered potentially eligible were examined by full-text review. Data from the included studies were analyzed and synthesized concerning the types and characteristics of neuromotor interventions reported.
Five studies met the inclusion criteria, out of a total of 1900 articles reviewed. In the included studies, physiotherapy or occupational therapy interventions started between 72 and 96 hours post-injury. All articles reported interventions focused on Body Functions and Structures (e.g. postural hygiene, joint ROM and muscle strength maintenance) and Activities (e.g. training for postural transitions or walking), while only two studies addressed interventions to enhance independence in activities of daily living (ADL). Concerning the intervention characteristics, all studies specified the type of intervention, most provided details on frequency, but only one study detailed the duration and intensity of the interventions.
The studies included in this Scoping Review align with existing literature proposed in the acute phase of ABI for adults in relation to timing and types of interventions. Despite the benefits of early mobilization in critical care, several barriers exist to the implementation of such interventions, especially in traumatic brain injuries, where neuroprotection plays a critical role. Factors such as the patient’s stability, resource availability and the training of health professionals play key roles in the early implementation of neuromotor interventions in critical care settings (4). There is a need for further research to validate and refine early intervention protocols for pediatric neurocritical patients. Future studies should focus on determining the optimal timing of initiation, feasibility, and effectiveness of rehabilitative interventions in critical care, ideally using the ICF-CY classification and FITT criteria to describe the types and characteristics of the interventions (5).
