Pediatric rehabilitation最新文献

Objective: To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities.

Methods: Twenty-eight children with disabilities, ages 6-14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions. Nutrition sessions consisted of three individual and two group sessions. Individual nutrition goals were developed for each child using 3-day food intake diaries and parent interview. Body Mass Index (BMI) and progress towards nutrition goals were documented.

Results: No significant BMI changes were recorded for the entire group (n=28) or a sub-group with a goal to decrease BMI (n=8). Most of the children made improvements in individual goals indicating improvements in healthy eating habits. This included eating the daily recommended amount of servings of each food group, trying new foods and limiting foods containing saturated and trans fats, sodium and sugar.

Conclusion: Short-term changes were noted in eating habits and behaviours during the 16-week fitness programme, although the effects did not influence overall BMI during the 16-week programme. Children with disabilities are at nutritional risk, and long-term follow-up is needed to determine if initial changes in parent-reported child eating behaviours will impact long-term nutrition, BMI and overall health.

The aim of this report is the appraisal of a possible correlation of trunk asymmetry assessed with a scoliometer and lateralization of the brain as expressed by handedness in a school aged population. Many (8245) students (4173 girls and 4072 boys), 6-18 years of age were examined. A checklist was completed for each student including handedness and trunk asymmetry. The standing forward bending test was performed using the Pruijs scoliometer and the examined children were divided into three groups for each of the three examined regions (mid-thoracic, thoracolumbar and lumbar) according to the recorded asymmetry (no asymmetry, 2-7 degrees and > or =7 degrees ). Ninety-one per cent of children were right-handed, while 9% were left-handed. A significant statistical correlation of trunk asymmetry and handedness was found both in boys and girls in the group of asymmetry 2-7 degrees at mid-thoracic (p < 0.038) but not at thoracolumbar and at lumbar region. These findings show that there is significant correlation of mild mid-thoracic asymmetry and the dominant brain hemisphere in terms of handedness, in children who are entitled at risk of developing scoliosis. These findings are implicating the possible aetiopathogenic role of cerebral cortex function in the determination of the thoracic surface morphology of the trunk.

Purpose: Children with cerebral palsy (CP) often require surgery, but may be at higher risk for surgical complications and poorer outcomes than children without CP. This study provides a national perspective of the children, hospitals and hospital course associated with the five most commonly performed surgeries in children with CP and compares this perspective to that of children without CP undergoing the same procedures.

Methods: Analysis of the 1997 Healthcare Cost and Utilization Project Kids' Inpatient Database.

Results: The most common surgeries performed in children with CP (n = 37 000) were gastrostomy tube placements (n = 1743), soft tissue musculoskeletal procedures (n = 1393), fundoplications (n = 1062), spinal fusions with instrumentation (n = 765) and bony hip surgeries (n = 651). Together, the five procedures accounted for nearly 50 000 hospital days and over 150 million dollars in hospital charges in 1997. The largest difference in outcomes between children with and without CP was seen in those undergoing surgery for scoliosis.

Conclusions: Surgical procedures are frequent in children with CP. Their costs and impact on the US health care system are substantial. The findings provide a strong incentive to carefully study the benefits of the procedures and to develop interventions to improve outcomes, particularly in the case of scoliosis surgery.

Purpose: To investigate the perspective of the individual receiving intrathecal baclofen (ITB) or his/her caregiver concerning its effects and to describe characteristics of those that were satisfied or not satisfied.

Methods: After IRB approval, potential subjects were identified who had undergone ITB pump implantation at least 1 year prior to the study. One hundred subjects/caregivers were interviewed by phone. Interview consisted of a scripted questionnaire to obtain subject/caregiver opinions about changes in function and caregiver assistance, as well as satisfaction with ITB. Medical records were reviewed to collect information including diagnosis, ITB related surgeries and medications.

Results: Subjects ranged in age from 5-42 years and 88 had a diagnosis of cerebral palsy. Improvement was noted in the following areas: positioning 69%, transfers 58%, dressing 69% and toileting/hygiene 51%. Fifty-four per cent reported reduction in startle movements. Sleep was improved in 43% and comfort in 53%. Twenty-two subjects experienced 32 events related to the ITB hardware or surgery. Only 12% indicated they would not choose to undergo the procedure again.

Discussion: Generally, subjects and their caregivers were satisfied with the results after ITB pump implantation. A majority reported improvements in positioning, transfers, dressing, toileting/hygiene and comfort.

This article provides an overview of some of the important factors that impinge on people with cerebral palsy and their families, on medical and rehabilitation personnel, and on systems of healthcare and education in South Africa. Information is provided with regard to the national contextual variables that influence intervention in the country. The incidence of cerebral palsy is related to some of the more prominent aetiological variables including poverty, malaria, HIV/Aids and premature birth. Health care systems available for children with cerebral palsy are discussed, including the role of traditional healers. Access to education, training and care of children with cerebral palsy is described, including a brief history of specialized education in South Africa. An overview of the personnel, approaches and work contexts involved in rehabilitation highlights the unique nature of intervention in South Africa. The article concludes with recommendations for interventionists with reference to lessons that can be learned in terms of adapting skills and knowledge to local needs, in order to work successfully with children with cerebral palsy and to develop the resilience of their families. In addition, it is suggested that the definition of cerebral palsy needs to reflect the context in which the person lives.

Objectives: Physiotherapy programmes so far mainly address the lateral deformity of scoliosis, a few aim at the correction of rotation and only very few address the sagittal profile. Meanwhile, there is evidence that correction forces applied in the sagittal plane are also able to correct the scoliotic deformity in the coronal and frontal planes. So it should be possible to improve excellence in scoliosis rehabilitation by the implementation of exercises to correct the sagittal deformity in scoliosis patients. An exercise programme (physio-logic exercises) aiming at a physiologic sagittal profile was developed to add to the programme applied at the centre or to replace certain exercises or exercising positions.

Material and methods: To test the hypothesis that physio-logic exercises improve the outcome of Scoliosis Intensive Rehabilitation (SIR), the following study design was chosen: Prospective controlled trial of pairs of patients with idiopathic scoliosis matched by sex, age, Cobb angle and curve pattern. There were 18 patients in the treatment group (SIR + physio-logic exercises) and 18 patients in the control group (SIR only), all in matched pairs. Average Cobb angle in the treatment group was 34.5 degrees (SD 7.8) Cobb angle in the control group was 31.6 degrees (SD 5.8). Age in the treatment group was at average 15.3 years (SD 1.1) and in the control group 14.7 years (SD 1.3). Thirteen of the 18 patients in either group had a brace. Outcome parameter: average lateral deviation (mm), average surface rotation ( degrees ) and maximum Kyphosis angle ( degrees ) as evaluated with the help of surface topography (Formetric-system).

Results: Lateral deviation (mm) decreased significantly after the performance of the physio-logic programme and highly significantly in the physio-logic ADL posture; however, it was not significant after completion of the whole rehabilitation programme (2.3 vs 0.3 mm in the controls). Surface rotation improved at average 1.2 degrees in the treatment group and 0.8 degrees in the controls while Kyphosis angle did not improve in both groups.

Discussion: The physio-logic programme has to be regarded as a useful 'add on' to Scoliosis Rehabilitation with regards to the lateral deviation of the scoliotic trunk. A longitudinal controlled study is necessary to evaluate the long-term effect of the the physio-logic programme also with the help of X-rays.

Purpose: The social model of disability considers participation to be determined by the social, attitudinal and physical environments experienced by an individual. This study aims to ascertain from families of children with cerebral palsy the features of such environments which facilitate or restrict participation.

Method: Thirteen in-depth interviews using a topic guide were conducted with the parents of children with cerebral palsy. Interviews were tape-recorded, transcribed and analysed with NVivo software.

Results: The main themes emerging from the interviews were the importance of mobility, transport, support by and to parents and attitudes of individuals and institutions towards children. Most parents did not raise the policies and legislation determining participation barriers, although these are also likely to be influential.

Conclusions: This study confirms the importance of the environment for the participation of children with cerebral palsy. Statutory agencies need to attend the attitudes and policies in their organization in order to plan the inclusive environments which parents report will facilitate their child's participation. This study also contributes to the development of a tool to quantify the environment to allow the development of models to determine the environments which maximize children's participation.

Both children and adolescents are frequently affected by low back pain--mainly when they are involved in sporting activities--but they rarely ask for medical help, because their symptoms are often mild and self-resolving. However, in the young patients who seek orthopaedic evaluation, especially in referral centres, there is a high incidence of organic causes of their back pain. Mechanical, developmental, inflammatory and tumoural or tumour-like disorders are the most frequent aetiologic factors. A diagnosis of psychosomatic back pain should be made only when all the other possible organic causes have been excluded. Rehabilitation is part of the treatment of low back disorders in children and adolescents. Postural low back pain is likely to be resolved by physical therapy alone. In other disorders that initially require medical, orthotic or surgical treatment, rehabilitation plays an important role either in combination with them or as a subsequent treatment.

Purpose: To determine if there is any association between the findings of visual evoked potentials (VEPs), somatosensory evoked potentials (SEPs), and magnetic resonance imaging (MRI) findings with the neurodevelopment and severity in children with cerebral palsy (CP).

Methods: The present study included 15 children with spastic diplegic CP and five children with spastic hemiplegic CP and 42 healthy children as controls. The number of the controls was two-times greater than the study group to increase statistical power of this study. VEPs and SEPs were recorded in the CP children and compared with healthy controls. All MR scans were obtained using a 1.5 T MR scanner.

Results: A significant difference was found in the latencies P100 (VEP) between the CP and controls. No correlations between increased P100 latencies and asphyxia, prematurity, the CP severity, MRI findings and mental retardation were noted. A significant difference in N13-N20 conductions (SEPs) between the subjects with CP and the control group was found. SEPs were positively correlated with mental retardation in CP children. The brain lesions in MRI showed a significant correlation with the CP severity scores and mental retardation.

Conclusion: The differences in VEPs and SEPs were determined between CP children and healthy children. The MRI findings were positively correlated with the CP severity and mental retardation.