BACKGROUND: Compliance with the 24-Hour Movement Guidelines (24-HMG: physical activity (PA), screen time (ST), and sleep) has been associated with numerous beneficial health outcomes among children and adolescents. However, there is a lack of consensus on the overall compliance with the 24-HMG specifically among children and adolescents with disabilities. Therefore, this systematic review and meta-analysis aimed to examine the extent to which children and adolescents with disabilities adhere to the 24-HMG globally.
METHODS: Quantitative studies published in English until May 2023 were sought by searching seven electronic databases: Web of Science, PubMed, SPORTDiscus, CINAHL, MEDLINE, Scopus, Psychology and Behavioural Sciences Collection. This review included studies that identified participants as individuals with disabilities and reported the overall (non) compliance with the 24-HMG among children and adolescents with disabilities.
RESULTS: A total of 13 studies, involving 21,101 individuals (65.95% males), aged 6 to 21 years from 9 countries, were included in the analysis. In general, 7% (95%CI: 0.05-0.09, p < 0.01) of children and adolescents with disabilities met all three 24-HMG, while 16% (95%CI: 0.13-020, p < 0.01) did not meet any of the three recommendations. Regarding adherence to individual 24-hour movement behaviour, the rates of compliance were 22% (95%CI: 0.18-0.25, p < 0.01) for PA, 49% (95%CI: 0.41-0.56, p < 0.01) for ST, and 59% (95%CI: 0.56-0.61, p < 0.01) sleep. In relation to numbers of those meeting the 24-HMG, 43% (95%CI: 0.41-0.45, p < 0.01) met one guideline, while 32% (95%CI: 0.28-0.36, p < 0.01) met two guidelines.
CONCLUSIONS: There is a notable percentage of children and adolescents with disabilities who do not meet the recommended the 24-HMG, which encompasses PA, ST, and sleep. This underscores the pressing requirement to create and execute evidence-based strategies that effectively encourage and assist these individuals with disabilities in adopting and maintaining these movement behaviours.

OBJECTIVE: to identify content on play and interaction with children with special health care needs recommended in clinical guidelines; analyze play and interaction activities applicable to children with special health care needs and complex care requirements.
METHODS: qualitative documentary research based on guides, protocols, or guidelines on playing and interacting with children with special and living with complex care. Search terms in English (guidelines, playing OR play, complex needs, OR chronic disease) and in Portuguese ( guia, brincar ou brincadeiras, condições crônicas ) on the first ten pages of_Google Search ® . Thematic analysis was applied to the information extracted from the documents.
RESULTS: a total of nine documents with similar content were grouped into units of analysis, keeping only the interacting and playing activities applicable to children with special health care needs and living with complex care requirements, namely stimulation of potential, stimulation of adult-child interaction, and stimulation of the senses (touch, sight, and hearing), to be carried out by health professionals and family caregivers in the different care contexts.
CONCLUSIONS: interaction and play are potential promoters of adult-child interaction, with application in the stimulating and life-delivering complex care for children.

BACKGROUND: The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness.
OBJECTIVE: An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age.
METHODS: A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively.
RESULTS: Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols.
CONCLUSIONS: Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.

暂无摘要。

The purpose of this study is to determine the association between school-based fitness testing awards and meeting physical activity guidelines among children with disabilities.
Cross-sectional secondary data analysis using NHANES 2013-2016.
Data from NHANES 2013-2016 were used.
3915 children without disabilities and 647 children with disabilities between ages of 5 to 15 years.
Self-reported from children or proxy response from guardians in above parameters.
Chi-square test and multivariable logistic regression.
There is no significant different between children with and without disabilities in receiving school-based fitness testing awards (×2 = 4.14, p = .05). According to both crude and adjusted model, children with disabilities are more likely to received school-based fitness testing awards than children without disabilities (OR = 1.44, 95% C.I. [.98, 2.12]; OR = 1.27, 95% C.I. [.85, 1.89]). Also, for children with disabilities, children who did not received school-based fitness testing awards are more likely to meet PA guidelines than children who received school-based fitness testing awards according to both crude and adjusted models (OR = 1.71, 95% C.I. [.66, 4.47]; OR = 1.37, 95% C.I. [.59, 3.16]).
Receiving school-based fitness testing could potentially increase self-efficacy in engaging in physical activity among children with disabilities. However, there is a need to determine if the current approach of utilizing awards are sufficient enough to promote physical activity among children with disabilities.

Researchers have reported relatively low estimates of physical activity among children with various developmental disabilities. However, there are inconsistencies within these reports due to methodological issues.
The goals of this study were to estimate the prevalence of meeting national physical activity guidelines among children with various developmental disabilities and examine the relative influence of different disability descriptors on meeting the guidelines.
A sample of 3,010 U.S. children between the ages of 6 and 17 years with parent-reported diagnoses of autism spectrum disorder, cerebral palsy, Down syndrome, developmental disability, and/or intellectual disability was drawn from the combined 2016 and 2017 datasets of the National Survey of Children\'s Health. Multivariate logistic regression analyses explored the unique contributions of multiple child characteristics and disability descriptors, such as diagnosis type, severity, complexity, and functionality, toward meeting physical activity guidelines and compared the likelihood of meeting guidelines between children with these diagnoses.
The results of this study reveal that the majority of children with developmental disabilities are not achieving adequate levels of daily physical activity, with only 19% of the study sample engaging in 60 min of physical activity daily. Child age and functionality were significant predictors of meeting physical activity guidelines among children within the sample.
The findings of this study highlight the potentially limiting view of physical activity participation when diagnosis type is considered alone and demonstrate the importance of considering function and other individual factors as significant predictors of physical activity among children with disabilities.

Conveying a diagnosis of a disability to the parents of young children is difficult both for the parent and the clinician, however there is an ethical and medical imperative to do so. However, the process and manner of disclosure needs to be done well. When communication between parent and clinicians fails, parental mental health can be adversely affected. This paper adapts and explains how to use the SPIKES protocol to deliver \"bad news\" about a developmental disability diagnosis with families of infants <12-months old, using cerebral palsy as an example. Next, the range of responses parents experience to the delivery of bad news from \"watchful waiting\" to \"acceptance\" are outlined and explained. The knowledge needs of parents range from causes and prognosis to treatments and outcomes. Using clinical scenarios of recently diagnosed infants, commonly asked questions and suggested answers are tabled.

Aims: The purpose of this study was to obtain the perspectives of occupational and physical therapists working in pediatric rehabilitation about the factors that influence implementation of clinical practice guidelines (CPG) using the case of constraint induced movement therapy (CIMT). We aimed to identify factors that hinder implementation of CPGs and strategies for overcoming barriers when widespread implementation is stalled.Methods: Qualitative case study methodology was bounded within the parameters of CIMT implementation in pediatric rehabilitation in one jurisdiction. Twenty-one occupational and physical therapists participated in one of three focus groups. Data were analyzed using an inductive qualitative approach.Results: Participants viewed CPGs as useful, and emphasized the importance of consistency between guidelines and relevance to practice context. Therapists considered the \"art and science\" in clinical decision-making. Barriers and facilitators to CPG implementation were identified at the client, clinician, intervention location and systemic level. Potential solutions to help \"unstick\" guideline implementation were consistent with theories of collective knowledge exchange and mindlines.Conclusion: The presence of CPGs does not ensure evidence uptake; understanding of local barriers is required. This case study highlights the value of a collective knowledge exchange approach and attention to the social structures of knowledge development and evidence use.

To describe the process of obtaining consensus of outcome priorities between families of children with medical complexity (CMC) and their healthcare providers (HCPs) for the purpose of evaluating changes to service delivery.
The consensus of outcomes involved surveying families of CMC and HCPs and an in-person consensus meeting. Priorities were obtained from the survey using a stratified ranking approach ensuring equal representation among unequally sized subgroups. An in-person meeting was held using the survey results to inform Delphi voting.
Families of CMC (n=40) and HCPs (n=74) responded to the survey. Consensus generated three main target areas (child health, family health, experience of care) covered by 15 specific outcomes needed to evaluate care. Differences between family and HCP perceptions of importance were found for child self-care, play, social skills, and recreation as well as emotional health (for both parent and child) outcomes.
Families of CMC and HCPs identified common priorities for outcome evaluation of CMC initiatives. Outcomes that differ in importance between families of CMC and HCPs should be studied further.
Families of children with medical complexity and their providers can reach consensus on important outcomes. Stratifying subgroups ensures diverse representation, which is important to outcome prioritization.
CONSENSO EN LOS OBJETIVOS ENTRE LA FAMILIA Y LOS PROFESIONALES DE LA SALUD PARA NIÑOS CON COMPLEJIDAD MÉDICA: OBJETIVO: Describir el proceso para lograr un consenso sobre los objetivos prioritarios entre las familias de niños con complejidad médica (NCCM) y los profesionales de la salud (PS) con el fin de evaluar cambios en la prestación de servicios. METODO: La búsqueda del consenso en los objetivos involucró una encuesta a las familias de NCCM y PS y luego una reunión en persona para lograr un consenso. Se identificaron las prioridades en la encuesta utilizando una clasificación estratificada para garantizar una representación equitativa entre los subgrupos de tamaño desigual. Luego se llevó a cabo una reunión en persona, utilizando los resultados de la encuesta para crear una votación tipo Delphi. RESULTADOS: Las familias de NCCM (n = 40) y los PS (n = 74) respondieron a la encuesta. El consenso generó tres áreas principales (salud del niño/a, salud familiar, experiencia de atención) cubiertas por 15 resultados específicos necesarios para evaluar la atención. Se encontraron diferencias en la percepción de importancia de los objetivos entre la familia y los profesionales de la salud en las áreas del autocuidado del niño, el juego, las habilidades sociales y la recreación, así como los objetivos para la salud emocional (tanto para padres como para niños). INTERPRETACIÓN: Las familias de NCCM y los PS identificaron prioridades comunes para la evaluación de resultados de iniciativas para hacer cambios en la atención médica. Las diferencias entre los objetivos de las familias de NCCM y PS deben estudiarse con más detalle.
RESULTADOS CONSENSUAIS ENTRE FAMÍLIA-PROFISSIONAL PARA CRIANÇAS COM COMPLEXIDADE MÉDICA: OBJETIVO: Descrever o processo de obter consenso dos resultados prioritários entre famílias de crianças com alta complexidade médica (ACM) e profissionais de saúde (PSs) para avaliar mudanças na prestação de serviços. MÉTODO: A obtenção de consenso dos resultados envolvidos foi obtida entrevistando ACMs e PSAs e por meio de um encontro pessoalmente. Prioridades foram obtidas a partir da entrevista usando uma pontuação estratificada assegurando representação igual entre grupos com tamanhos diferentes. Um encontro pessoalmente aconteceu usando os resultados da pesquisa para informar a votação Delphi. RESULTADOS: Famílias de AMCs (n=40) and PSs (n=74) responderam às questões. O consenso gerou três áreas principais (Criança, família, experiência de cuidado) cobertas por 15 resultados específicos necessários para avaliar o cuidado. Diferenças entre percepções da família e de PSs e as percepções de importância foram obtidas para auto-cuidado da criança, brincar, habilidades sociais, e recreação, assim como saúde emocional (para pais e filhos). INTERPRETAÇÃO: Famílias de AMCs e PSs identificaram prioridades comuns para avaliacão de resultados em iniciativas de ACM. Resulados que diferem em importância entre famílias de AMCs e PSs devem ser considerados em futuros estudos.

The Canadian 24-Hour Movement Guidelines for Children and Youth (age 5-17 yr) consolidate evidence-informed daily requirements for physical activity, sedentary behavior, and sleep into 1 comprehensive resource. The primary objective of this study was to explore how parents of children and youth with disabilities (CYWD) perceive the guidelines. The secondary objective was to explore whether parents consider the guideline branding to be inclusive. A total of 15 mothers of CYWD participated in one 60-min semistructured interview, either in person or by telephone. The diffusion-of-innovation theory provided a theoretical basis for the interview guide. Mothers\' perspectives of the guidelines and branding are represented as seven themes. The results indicate that the guidelines and the branding are not inclusive or compatible with the abilities and needs of CYWD. Findings from this study provide a foundation for ongoing knowledge-translation activities aiming to address these limitations. Further revisions are necessary to promote full inclusion and uptake of the guidelines among CYWD.