Journal of Pediatric Rehabilitation Medicine - Volume 4, issue 2
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The Journal of Pediatric Rehabilitation Medicine (JPRM): An Interdisciplinary Approach Throughout the Lifespan is designed to parallel the multidisciplinary teams caring for children, adolescents and adults with childhood-onset physical disabilities and complex care needs worldwide. Published quarterly, topics include, and are not limited to, cerebral palsy, traumatic brain injury, spinal cord injury, spina bifida, limb deficiency, muscular dystrophy, stroke, cancer, developmental delays, and rare disorders. Furthermore, the journal welcomes papers dedicated to pediatric rehabilitation from a global health perspective.
The aim of JPRM is to engage a diverse group of international experts with the goal of providing readers with comprehensive information regarding children and adolescents requiring rehabilitation. JPRM brings together specialists from medicine, nursing, psychology, social work, nutrition, child life, family centered care, and occupational, physical, and speech therapy. For manuscript submissions, authorship involving at least two different specialties is encouraged, although not required, to facilitate a transdisciplinary and collaborative approach. Manuscripts are blinded and peer reviewed including biostatistical analysis. Authors are invited to submit original research, systematic and scoping reviews, guidelines, protocols, care pathways, case reports, book reviews, commentaries, editorials, and dates for future conferences.
Abstract: Objective: Assess safety and tolerance of intravenous (IV) baclofen using a dog model. Design: Prospective pharmacokinetic study involving 6 adult dogs. Two dogs received baclofen 10 mg oral and IV bolus doses. Subsequent 4 dogs were given IV boluses of 0.5, 1.0 and 1.5 mg/kg followed by constant infusion of baclofen (rates of 0.1, 0.2 and 0.4 mg/kg/hour). Also, dogs were given single IV 2 and 3 mg /kg bolus doses. Outcome measures included clinical…observation scales and baclofen levels. Results: Oral bioavailability was 0.66 and 0.69 in 2 dogs. Following IV baclofen, terminal phase half-lives were 3.3 and 3.6 hours. Single bolus doses of 2 and 3 mg/kg caused mild to moderate clinical changes which were delayed at least 2 hours after peak blood levels. Boluses of 0.5 and 1.0 mg/kg with constant infusion between boluses were tolerated, however within 30 minutes of beginning constant infusion of 0.2 mg/kg/hr after the second bolus (1.0 mg/kg), dogs showed progressive sedation and ataxia. Clinical improvement occurred within 7 hours of stopping baclofen. Dogs appeared normal by the next morning. Conclusions: IV baclofen bolus doses of 0.5 to 3 mg/kg were well tolerated. Maximum clinical effect was delayed for at least 2 hours after peak plasma levels.
Abstract: The brachial plexus is a complex anatomical network of nerves that mainly supplies the upper limb. A thorough understanding of the anatomy of this region provides the clinician with valuable clinical information that is crucial for evaluating and planning treatment for patients with obstetrical brachial plexus palsy. We will highlight the anatomy of the brachial plexus and relevant clinical correlation between physical findings and the anatomical location of the level of the injury.
Abstract: Neonatal brachial plexus injury (BPI) is a birth outcome characterized by injury to the brachial plexus identified after delivery. Though uncommon, its potential occurrence following delivery is concerning for both the delivering clinician as well as the pediatric team. Considerable research looking at delivery factors, including forces applied at the time of delivery and management of the BPI after it has occurred, has led to a better understanding, if not a lower rate, of BPI. This…information is reviewed below.
Abstract: The incidence of neonatal brachial plexus palsy (NBPP) has remained relatively stable despite awareness of the problem and improved obstetric techniques. Deformities of the forearm and hand can result either from untreated NBPP or following early microsurgical nerve reconstruction. These deformities include limb length discrepancy, flexion contracture of the elbow, supination or pronation contractures of the forearm, ulnar deviation of the wrist, and varying types of finger paralysis. The treatment options for these…deformities consist of soft tissue releases, corrective osteotomies, tendon transfers, joint fusions, and/or free muscle transfers. Rehabilitation and physical therapy treatment are critical after these procedures. This article reviews the pathogenesis of the common deformities seen in a late presentation of NBPP, the assessment of these children, and provides a reconstructive strategy for the management of this difficult problem.
Abstract: Brachial plexus birth palsy occurs at a rate of 1/1000–4/1000 live births despite advances in prenatal and obstetric care. The majority of children recover spontaneously, however some are left with permanent neurologic deficit. Shoulder pathology results from muscle imbalance created by pairing of weak or paralyzed muscles with unaffected muscle groups around the shoulder. This imbalance results in soft tissue contracture and can cause progressive glenohumeral joint morphological changes. Contractures of internal rotation are…most common and may be a source of disability for the child. Treatment of the infant with brachial plexus palsy is initially centered around therapy and prevention of contracture. Surgical intervention can improve global shoulder function, and is reserved for patients who develop functionally limiting contractures, glenohumeral joint morphological changes, or findings of instability. A thorough physical examination, appropriate imaging, and assessment of the goals and expectations of the family are warranted prior to proceeding with any treatment course. The progressive and functionally limiting course of the shoulder sequelae in brachial plexus palsy emphasizes the need for early recognition and appropriate management. The purpose of this manuscript is to review orthopedic evaluation and management of neonatal brachial plexus palsy (NBPP) to promote early recognition and prompt referral.
Abstract: Neonatal brachial plexus palsies may cause lifelong limitations to function of the upper limb. Early nerve reconstructive surgery may be indicated in selected cases. An overview is given of our current understanding of this type of nerve lesion in the developing child. The neuropathology of the injury is presented to provide a background for the understanding of its natural history, as well as for the rationale and methods for nerve surgical treatment. The assessment of upper…limb function and the range of severity of the lesions at the very young age are outlined. Decision-making regarding surgical selection and determination of the appropriate procedures is presented, as are the outcomes. Improved function can be obtained with surgical repair.
Keywords: Neonatal brachial plexus palsy, nerve surgery
Abstract: Thoracic Outlet Syndrome (TOS) describes a variety of symptoms caused by the compression of the neurovascular structures in the cervicoaxillary region as they leave the thorax toward the upper limbs. Causes of TOS are vascular and neurogenic, with neurogenic symptoms being the most common presentation (95% of patients). Symptoms related to neurogenic TOS include intrinsic hand muscle and thenar region atrophy and weakness, as well as medial hand and forearm numbness, which are all suggestive of…lower trunk involvement. This condition is very rare in the pediatric population. We are reporting a case of true neurogenic TOS caused by a fibrotendinous band in an adolescent with bilateral cervical ribs who was submitted for surgical treatment at the right side.
Abstract: Background and methods: In patients with severe cerebral palsy, pneumonias are a frequent occurrence and can lead to excessive morbidity and mortality. Similar poor outcomes can occur in patients with cystic fibrosis. Nebulized tobramycin has been shown to be effective in preventing pneumonias, and in improving lung function in cystic fibrosis patients. This study reports results from three patients with severe cerebral palsy who were suffering from recurrent pneumonias. We compared the 12 months prior to…starting nebulized tobramycin, to the first 12 months of intermittent therapy (28 days of nebulized antibiotic, followed by 28 days with no antibiotic, then repeated). We noted the number of pneumonias, the number of hospitalizations due to pneumonia, and length of hospitalizations for pneumonia. Results: Adding the results from the three patients together, the number of pneumonias went from 19 during the year prior to starting the nebulized tobramycin, to 11 during the year of treatment. The number of hospitalizations for pneumonia went from 11 to 0. The number of days in hospital for pneumonia went from 110 to 0. Conclusion: As in cystic fibrosis patients, patients with severe cerebral palsy may benefit from the intermittent use of nebulized tobramycin to prevent pneumonias and hospitalizations due to pneumonia. Further studies are warranted.