Journal of Pediatric Rehabilitation Medicine - Volume 1, issue 2
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Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach is an international journal designed to parallel the multi-disciplinary team approach of caring for a child with an acute or chronic disease. The issues will primarily be themed and broad in scope including, but not be limited to cerebral palsy, traumatic brain injury, spinal cord injury, spina-bifida, amputation, muscular dystrophies of all types, stroke, cancer, mental retardation, developmental delays, and others.
The aim is to include a wide range of experts who care for children with the above diagnosis. Authorship by two different disciplines is requested though not required to encourage an interdisciplinary and collaborative approach. The goal is for the reader to obtain not just the medical perspective, but also nursing, occupational, physical and speech therapy, psychology, home care, etc., in providing the most comprehensive care for children. Manuscripts will be blinded and peer reviewed with appropriate feedback. Statistical analysis will be reviewed by the biostatistician. Readers are encouraged to submit and or suggest case reviews, commentaries, editorials, original research, conference schedules, or reviews.
Abstract: This article describes the approach to intervention programs for children with cerebral palsy in India. It provides an overview of services available in particular in the fields of physiotherapy, speech therapy and AAC.
Keywords: Cerebral palsy, India, physiotherapy, speech therapy, AAC, programs, training
Abstract: Setting: Regional children's specialty hospital. Patient: 11 year old boy with a history of quadriparetic cerebral palsy (CP), shunted hydrocephalus, and continuous infusion of intrathecal baclofen (ITB) to treat hypertonicity. Case Description: The patient presented for a second opinion after experiencing three weeks of increased tone treated by shunt revision three times after two studies injecting contrast into the ITB pump catheter via the catheter access port did not demonstrate any extravasation of…contrast material. Parents report that there was little change in his lower extremity tightness. His speech showed increased dysarthria during this time, and he had unusual difficulty with handling food. On evaluation, the patient had severely increased muscle tone. He also was noted to have palpable fluid in his pump pocket. Review of the X-rays that accompanied the patient revealed findings that caused us to be suspicious of a tear of the sleeve that is part of the mechanism that connects the intrathecal catheter to the pump. A 100 microgram bolus of ITB was administered, which did result in some relaxation. Assessment/Results: Patient underwent surgery at which time a torn pump-catheter connector was confirmed and replaced with a different type of connector. His symptoms resolved and he required a lower dose of ITB than on admission for significantly better tone control. Discussion: Individuals typically reach a stable dose of ITB and if they develop a need for increasing dose later, most frequently a catheter problem exists. Also, if there is fluid in the pump pocket, we have a high index of suspicion for this type of catheter/pump connector tear. Conclusion: In this case, careful evaluation of plain radiographs coupled with careful history taking, including the individual's response to interventions, was all that was necessary to make an accurate diagnosis.
Abstract: Spinal muscular atrophy (SMA) is an autosomal recessive anterior horn cell disease that results in progressive muscular weakness and atrophy without sensory involvement. A wide clinical spectrum that ranges from early death to essentially normal adult live exists. We describe a case of two 12 years olds, who represent two of three surviving non-identical quadruplets, born at 25 weeks gestational age. A diagnosis of hypotonic cerebral palsy (CP) was made in early childhood and early intervention…services were initiated. At 3 years of age, MRI's showed white matter changes. Both briefly attained Gross Motor Functional Classification Scale (GMFCS) 3 status, but by 12 years of age their ambulatory abilities had decreased to Level 4. Physical Medicine and Rehabilitation (PM&R) physicians were consulted. On exam, distal lower extremities atrophy, hypotonia, hyporeflexia, and muscle weakness were noted. Neither child had upper motor neuron signs or spasticity. Cognition was normal. Neuromuscular disorder was suspected and genetic testing confirmed spinal muscular atrophy in both patients. While prior MRI/CT demonstrated static encephalopathy, recognition of symptoms and signs consistent with neuromuscular disease should have led to a secondary diagnosis. Therapeutic and surgical treatment decisions may have differed. Fragmentation of care and lack of a comprehensive team approach also contributed to the delay in recognition of their dual diagnosis.