Majnemer Annette, Dahan-Oliel Noemi, Rohlicek Charles, Hatzigeorgiou Sean, Mazer Barbara, Maltais Desiree B, Schmitz Norbert
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Division of Neurology, Montreal Children's Hospital - McGill University Health Centre, Montreal, QC, Canada.
Dev Med Child Neurol. 2017 Oct;59(10):1056-1062. doi: 10.1111/dmcn.13520. Epub 2017 Aug 17.
This historical cohort study describes the use of educational and rehabilitation services in adolescents born preterm or with a congenital heart defect (CHD).
Parents of 76 young people (mean age 15y 8mo [SD 1y 8mo]) with CHD and 125 born ≤29 weeks gestational age (mean age 16y [SD 2y 5mo]) completed a demographics questionnaire including educational and rehabilitation resource utilization within the previous 6 months. Rehabilitation services included occupational therapy, physical therapy, speech language pathology, psychology. Developmental (Leiter Brief IQ, Movement-ABC, Strengths and Difficulties Questionnaire) and functional (Vineland) status of the young people was assessed. Pearson χ tests were used to perform simple pairwise comparisons of categorical outcomes across the two groups (CHD, preterm). Univariate logistic regression was used to examine predictors of service utilization.
Developmental profiles of the two groups (CHD/preterm) were similar (29.9%/30% IQ<80; 43.5%/50.0% motor difficulties; 23.7%/22.9% behavior problems). One-third received educational supports or attended segregated schools. Only 16% (preterm) and 26.7% (CHD) were receiving rehabilitation services. Services were provided predominantly in the school setting, typically weekly. Few received occupational therapy or physical therapy (1.3-7.6%) despite functional limitations. Leiter Brief IQ<70 was associated with receiving educational supports (CHD: OR 5.53, 95% CI 1.29-23.68; preterm: OR 14.63, 3.10-69.08) and rehabilitation services (CHD: OR 4.46, 1.06-18.88; preterm: OR 5.11, 1.41-18.49). Young people with motor deficits were more likely to require educational (CHD: OR 5.72, 1.99-16.42; preterm: OR 3.11, 1.43-6.77) and rehabilitation services (preterm: OR 3.97, 1.21-13.03).
Although young people with impairments were more likely to receive educational and rehabilitation services, many may not be adequately supported, particularly by rehabilitation specialists. Rehabilitation services at this important transition phase could be beneficial in optimizing adaptive functioning in the home, school, and community.
这项历史性队列研究描述了早产或患有先天性心脏病（CHD）的青少年对教育和康复服务的使用情况。
76名患有CHD的年轻人（平均年龄15岁8个月[标准差1岁8个月]）和125名孕周≤29周出生的年轻人（平均年龄16岁[标准差2岁5个月]）的父母完成了一份人口统计学调查问卷，包括过去6个月内教育和康复资源的利用情况。康复服务包括职业治疗、物理治疗、言语语言病理学、心理学。对年轻人的发育状况（莱特简明智商测试、运动ABC测试、长处和困难问卷）和功能状况（文兰适应行为量表）进行了评估。使用Pearson χ检验对两组（CHD组、早产组）的分类结果进行简单的两两比较。使用单因素逻辑回归分析服务利用的预测因素。
两组（CHD组/早产组）的发育概况相似（智商<80的比例分别为29.9%/30%；运动困难的比例分别为43.5%/50.0%；行为问题的比例分别为23.7%/22.9%）。三分之一的人接受了教育支持或就读于特殊学校。只有16%（早产组）和26.7%（CHD组）正在接受康复服务。服务主要在学校环境中提供，通常每周一次。尽管存在功能限制，但很少有人接受职业治疗或物理治疗（1.3 - 7.6%）。莱特简明智商<70与接受教育支持（CHD组：比值比5.53，95%置信区间1.29 - 23.68；早产组：比值比14.63，3.10 - 69.08）和康复服务（CHD组：比值比4.46，1.06 - 18.88；早产组：比值比5.11，1.41 - 18.49）相关。有运动缺陷的年轻人更有可能需要教育（CHD组：比值比5.72，1.99 - 16.42；早产组：比值比3.11，1.43 - 6.77）和康复服务（早产组：比值比3.97，1.21 - 13.03）。
尽管有损伤的年轻人更有可能接受教育和康复服务，但许多人可能没有得到充分的支持，尤其是康复专家的支持。在这个重要的过渡阶段提供康复服务可能有助于优化家庭、学校和社区中的适应性功能。
