Building a Case for Pediatric Fall Prevention

Falls and Associated Factors among Adolescents and Young Adults with Arthrogryposis Multiplex Congenita

Background:

Falls research among individuals with arthrogryposis multiplex congenita (AMC), a group of congenital conditions characterized by joint contractures in two or more body regions, is sparse. The primary objectives of this study were to estimate the prevalence of single, multiple, and injurious falls among adolescents and adults with AMC and identify factors associated with multiple and injurious falls.

Methods:

Individuals, aged 10–50 years, with a diagnosis of AMC completed questionnaires obtaining demographic and AMC-specific information, falls history (e.g., number, injurious/non-injurious), markers of bone health, orthopedic surgical history, and mobility aid use, as well as the Gillette Functional Assessment Questionnaire and the Saltin-Grimby Physical Activity Level Scale. Falls were defined as “any body part above the ankle coming to rest on the ground, floor, or a lower level”. Falling was defined as ≥ 1 fall, while multiple falls were defined as ≥ 2 falls in the past year.

Differences in falling, multiple falls, and injurious falls rates between adolescents (10–17 years) and adults (aged 18–50 years) were evaluated. Using univariate binary logistic regression models, associations between participant characteristics and multiple falls, as well as injurious falls, were evaluated, while considering age as a covariate (p ≤ 0.050); odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results:

Adolescents (N = 28; median age = 14 years) and adults (N = 40; median age = 32 years) with AMC had similar falling, i.e., 89.3% versus 70.0%, and injurious fall rates, i.e., 32.1% versus 27.5%, respectively (p > 0.050).

Adolescents with AMC, however, were more likely to report multiple falls in the past year, i.e., 89.3%, when compared to adults with AMC, i.e., 57.5% (p = 0.005). Beyond age, multiple falls were associated with a greater number of lower-limb surgeries [p = 0.036, OR (95%CI): 1.18 (1.01–1.39)], ability to transfer floor-to-stand with support [p = 0.002, OR (95%CI): 8.98 (2.30–35.06)], and increased mobility per the Gillette Functional Assessment Questionnaire [p = 0.004, OR (95%CI): 1.48 (1.13–1.92)]. Factors associated with a reduced odds of multiple falls were spinal involvement [p = 0.025, OR (95%CI): 0.23 (0.07–0.84)], history of spinal surgery [p = 0.018, OR (95%CI: 0.18 (0.04–0.74)], greater upper extremity involvement [OR (95%CI): 0.65 (0.44–0.95)], home assistive device use [p = 0.010, OR (95%CI): 0.15 (0.03–0.63)], and community wheelchair use [p = 0.006, OR (95%CI): 0.16 (0.04–0.59)]. None of the explored characteristics were associated with injurious falls in the past year (p > 0.050).

Conclusion:

Falls are exceedingly common among adolescents and adults with AMC; potential risk and protective factors for multiple falls are identified for future prospective falls research.

Traumatic Brain Injury and School Readiness Among Preschool-Aged Children in the United States

BACKGROUND

The aim of this study is to examine the association between traumatic brain injury (TBI) and school readiness using a nationally representative sample of preschool-aged children in the United States.

METHODS

Using data on 15,402 preschool-aged children (ages three to five years) from the 2016 to 2018 cohorts of the National Survey of Children's Health, this study investigates the association between lifetime measure of TBI in children and four domains of school readiness: early learning skills, self-regulation, social-emotional development, and physical health/motor development.

RESULTS

Among this sample of preschool-aged children, 252 (1.64%) had experienced a TBI during their lifetime. Within school readiness domains, TBI was associated with a 62% to 99% increase in the rate of needs support/at-risk items and a 129% to 322% increase in the rate of at-risk items, contingent on the exact domain examined. Additional analyses reveal that, net of covariates, TBI reduced the predicted probability of being on-track across all four domains from approximately 0.424 for children with no history of TBI to 0.224 for children with a history of TBI.

CONCLUSIONS

A history of TBI was associated with reductions in school readiness within and across domains. Facilitating better communication between parents, pediatricians, and schools about both TBI and responses to TBI may result in the implementation of services and individualized, tailored instructional approaches that can improve educational outcomes.