Journal of Pediatric Rehabilitation Medicine - Volume 6, issue 3
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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: PURPOSE: The purpose of the study was to examine the quality of life (QOL) of Finnish children with cerebral palsy (CP), both from the child's and the caregiver's point of view, and to analyze the effect of background factors on QOL. METHODS: This study is a part of a national CP research project. The study is based on validated questionnaires measuring QOL (CP QOL-Child). 128~questionnaires were sent to caregivers who had a 4 to…12 year-old child with CP. Children between 9 and 12 years were asked to fill in the child-self-report version. RESULTS: Responses were obtained from 78 guardians and 27 children, with a response rate of 61% in both cases. The overall QOL was reported to be good in Finnish children with CP. The correlation of QOL scores between the caregivers and children was good (n=25, r=0.687, p< 0.001), except in the domain of pain and the impact of disability. Parental estimates were consistently lower in all domains. Regarding the background factors, all the functional classification scales were associated inversely with QOL in both groups. CONCLUSION: Despite the good overall QOL, CP is perceived to limit participation. Pain impairs QOL, and pain symptoms should be systematically considered at every follow-up visit.
Keywords: Cerebral palsy, child, quality of life, questionnaire
Abstract: PURPOSE: The intact right hemisphere presents an omissive response-bias and the left hemisphere a commissive response-bias in adults. This research sought to determine whether these hemispherically lateralized response-biases manifest early developmental and uncompensable brain implementation. METHODS: Sixteen teenager and adult participants with focal left hemisphere lesions and fourteen with focal right hemisphere lesions (all with childhood onset: M=13 year recovery period) and 14 normal control participants were recruited. A computerized multitask high order working…memory procedure was designed to generate many errors of omission and of commission. RESULTS: The expected double dissociation of response-bias distortion as a function of lesion side was significantly demonstrated on this task and was significantly frontal-lobe dependent. CONCLUSION: The hemispheres of the brain have an opposed response bias that is robustly implemented in infancy through adulthood.
Keywords: Response-bias, hemispheric specialization, multitasking, early vulnerability, errors of commission, errors of omission, frontal lobes, executive functions, energetics
Abstract: BACKGROUND: Severe knee contractures that develop soon after muscle imbalance may not improve with stretching exercises and splinting. An alternative treatment is serial casting, which has been used to promote increased range of motion. PURPOSE: The purpose of this study was to compare the effectiveness of using serial casting and passive stretching approaches to treat knee flexion contracture in children with spina bifida. METHODS: In a pre/post randomized controlled study, ten participants were…included in the serial casting group, while eight participants were included in the passive stretching intervention group. The degree of knee extension was measured at baseline, immediately after intervention, and at a one-year follow-up using a standard goniometer. RESULTS: Both groups showed significant improvements in the degree of flexion contracture at the post-treatment evaluation and the follow-up evaluation. The serial casting group showed significant improvements in knee flexion contracture at the post-treatment evaluation, t (9)=13.4, p < 0.001, and the one-year follow-up evaluation, t (9) = 7.46, p < 0.001. The passive stretching group also showed significant improvements in knee flexion contracture at the post-treatment evaluation, t (7) =2.6, p < 0.05, and the one-year follow-up evaluation, t (7) = 3.6, p < 0.05. However, statistically significant improvements in the serial casting group compared with passive stretching group in relation to the degree of flexion contracture were found at the immediate post-treatment evaluation, F(1, 15)=246, p=0.0001, and the one-year follow-up evaluation, F (1, 15)=51.5, p=0.0001. CONCLUSION: The outcomes of this study provide the first evidence that serial casting may be a useful intervention in treating knee flexion contracture in children with spina bifida. However, further investigations into serial casting, as well as investigations into the use of serial casting with other interventions, are warranted.
Keywords: Serial casting, children with spina bifida, passive stretching, rehabilitation
Abstract: PURPOSE: This article presents four cases of patients with spina bifida who developed bladder cancer while under our care and provides a literature review on the incidence, initial presentation, possible etiologies, and role for screening for bladder cancer in the neurogenic bladder population. METHODS: Case reports of four patients are presented followed by a literature review of the current available studies. RESULTS: Patients with spina bifida present with bladder cancer at an atypically young age with very…advanced disease. The dire prognosis associated with bladder cancer in these patients demands that we provide better treatment, diagnosis, and prevention modalities. However, the potential morbidity, financial burden, and lack of proven benefit discourage cystoscopic screening in this patient population. Until we have more data on how to best serve spina bifida patients, this population should receive careful and regular urologic follow-up. CONCLUSION: Given the atypical young age of presentation and very advanced nature of bladder cancer in the spina bifida population, the authors strongly recommend that any new bladder changes, such as including increased urinary leakage, pain, recurrent infections, or increased gross hematuria, prompt immediate urologic referral for endoscopic evaluation and biopsy as indicated.
Abstract: INTRODUCTION: Patterns and predictors of recovery from encephalitis are poorly understood. METHODS: This study examined functional status and reviewed charts of all children who presented to a pediatric inpatient rehabilitation facility with encephalitis between 1996 and 2010. Functional status at admission and discharge from inpatient rehabilitation was evaluated using the Functional Independence Measure for Children (WeeFIM) Self-care, Mobility, Cognitive, and Total Developmental Functional Quotient scores (DFQ, % of age-appropriate function).…Charts were reviewed to characterize key clinical features and findings. RESULTS: Of the 13 children identified, the mean age was 9 years (range 5–16) with 54% males. Mean WeeFIM Total DFQ at admission was 37 (range: 15–90) and at discharge was 64 (range: 16–96). Average change in WeeFIM Total DFQ from admission to discharge was 26.7 (range 0–55, p < 0.001). WeeFIM domain scores improved between admission and discharge (Self-Care: p < 0.001, Cognition: p < 0.01, Mobility: p < 0.001). Eleven children displayed significant impairments in functional skills, defined as DFQ of ⩽ 85, at discharge. Key clinical features and findings were diverse and not related to functional outcome. CONCLUSIONS: Results suggest that significant functional improvement in children with encephalitis occurs during inpatient rehabilitation. Further research is necessary to identify predictors of outcome in children with encephalitis.
Keywords: Encephalitis, children and adolescents, functional independence measure, outcome, rehabilitation
Abstract: PURPOSE: The objective of this paper is to present a case series of patients with diagnosis of torticollis due to Grisel's syndrome and, in doing so, raise awareness of an unusual condition that could be fatal. A review of the literature is presented regarding diagnosis and treatment. METHODS: Case series of three patients that were 7, 10, and 12 years old with history of tonsillitis or neck surgery consulted to the service of Rehabilitation Medicine. RESULTS:…Physical examination showed a fixed head or limitation of movement to neutral position and initially a normal neurological examination. Initial cervical X-rays were not diagnostic. The final diagnosis was made by CT scan or MRI. All 3 patients were treated with anti-inflammatory medications, immobilization, and/or cervical traction or surgery. CONCLUSION: Grisel's syndrome is a non-traumatic atlanto-axial rotatory fixation (AARF) with or without subluxation following infection or surgery in the head or neck region. This paper presents an unusual cause of torticollis that could be fatal or cause neurological injury if not recognized and treated appropriately.
Keywords: Torticollis, Grisel's syndrome, atlantoaxial rotatory fixation, atlantoaxial subluxation, children
Abstract: INTRODUCTION: The Gross Motor Function Classification System (GMFCS) was developed to establish uniform communication between healthcare providers, patients, and the patients' families. It is also used to prognosticate the outcome of motor function. Based on previous reports, prognostication of ambulation status in cerebral palsy is based on the motor development curve, which shows a plateau at a certain known age. CASE REPORT: This report illustrates the case of a boy with spastic triplegic cerebral…palsy secondary to postnatal insult at early childhood. The patient was noted to have tremendous progressive improvement in his GMFCS level beyond 7 years old: from level IV at 4 years old to level II at 9 years old. CONCLUSION: Prognostication of ambulation in cerebral palsy based on the motor development curve provides a basis for physicians to predict motor function outcome and plan appropriate intervention. This case report shows that other important factors need to be considered in the clinical evaluation before rendering the prognostication of motor function outcome, including environmental factors as well as the etiology of cerebral palsy, for which special consideration should be given in cases of postnatal insult-related cerebral palsy.