Summary Purpose This study describes risk factors associated with language impairment in children with classic galactosaemia. Method Thirty-three 4–16-year-old participants with classic galactosaemia and a history of speech sound disorders completed a battery of cognitive and language measures and their parents completed a family history questionnaire. Results Nine of the sixteen (56%) participants with typical cognitive development and 15 of the 17 (88%) with borderline-low cognitive development had language impairments. Participants with typical cognitive development more often had an expressive language disorder, whereas those with borderline-low cognitive development more often had a mixed receptive-expressive language disorder. Participants with Q188R/Q188R genotypes had increased risk for both cognitive and language impairments. The IQs of younger siblings who did not consume milk postnatally were 10–56 points higher than the IQs of their older siblings with galactosaemia who had consumed milk postnatally. However, 4 of 5 younger siblings who were lactose-restricted from birth had language impairments. Typically-reported risk factors for language disorder, including parental history of speech/learning problems and low parental education level, were not significantly associated with cognitive or language impairments in the present sample of children with galactosaemia. Conclusions Children with galactosaemia and speech disorders have a 4–6 times greater risk for language impairment than children with early speech disorders of unknown origin. Early dietary lactose may increase the risk for cognitive and language impairments; however, the lack of significant associations of language impairment with days of milk consumption, and other familial and educational risk factors, is consistent with prenatal causation.

Objective For patients diagnosed with the novel coronavirus, COVID-19, evidence is needed to understand the effect of treatment by physical therapists in the acute hospital on patient outcomes. The primary aims of this study were to examine the relationship of physical therapy visit frequency and duration in the hospital with patients’ mobility status at discharge and probability of discharging home. Methods This retrospective study included patients with COVID-19 admitted to any of eleven hospitals in one health system. The primary outcome was mobility status at discharge, measured using the Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility (JH-HLM) scales. Discharge to home vs. to a facility was a secondary outcome. Associations between these outcomes and physical therapy visit frequency or mean duration were tested using multiple linear or modified Poisson regression. Potential moderation of these relationships by particular patient characteristics was examined using interaction terms in subsequent regression models. Results For the 312 patients included, increased physical therapy visit frequency was associated with higher 6-Clicks mobility (b = 3.63; 95% CI = 1.54–5.71) and JH-HLM scores (b = 1.15; 95% CI = 0.37–1.93) at hospital discharge and with increased probability of discharging home (adjusted relative risk = 1.82; 95% CI = 1.25–2.63). Longer mean visit duration was also associated with improved mobility at discharge and the probability of discharging home, though the effects were less pronounced. Few moderation effects were observed. Conclusion Patients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics. Impact Physical therapy should be an integral component of care for patients hospitalized due to COVID-19. Providing sufficient physical therapist interventions to improve outcomes must be balanced against protection from viral spread.

Background:There is an association between throwing activity and glenohumeral internal rotation deficit (GIRD). An 18° to 20° deficit has been adopted as the standard definition of pathological GIRD, but specific findings as to how GIRD relates to an injury are inconsistent.Purpose:To systematically review the literature to clarify the definition of GIRD diagnosis for adolescent and adult overhead athletes and to examine the association between GIRD and an increased risk of injuries in these athletes.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed. Observational studies comparing glenohumeral internal rotation range of motion (ROM) in injured and uninjured overhead athletes were included for the meta-analysis. Studies of adolescent and adult athletes were analyzed separately. ROM was compared for the injured and uninjured groups, and a weighted mean GIRD was estimated. To account for potential heterogeneity across studies, both fixed- and random-effects models were used to calculate a standardized mean difference (SMD).Results:Nine studies of level 3 or 4 evidence were included. From these, 12 study groups (4 adolescent, 8 adult) comprising 819 overhead athletes (226 injured, 593 uninjured) were included in the meta-analysis. The estimated SMD in GIRD between the injured and uninjured groups was 0.46 (95% CI, 0.15-0.77; P < .01) for the overall sample. The between-group effect was larger for adults (SMD, 0.60 [95% CI, 0.18 to 1.02]; P < .01) than adolescents (SMD, 0.20 [95% CI, –0.24 to 0.63]; P = .13). The weighted mean GIRD for the injured and uninjured groups was 13.8° ± 5.6° and 9.6° ± 3.0°, respectively, which also differed by age group. Moderate study heterogeneity was observed (I 2 = 69.0%).Conclusion:Based on this systematic review, the current definition of pathological GIRD may be too conservative, and a distinct definition may be required for adolescent and adult athletes. While the results indicate a link between internal rotation deficits and upper extremity injuries in the overhead athlete, higher quality prospective research is needed to clarify the role that GIRD plays in future injuries to overhead athletes of various ages.

Additional CVICU-dedicated PT staff was associated with increased PT treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors.