1/135. independent living and the physical environment: aspects that matter to residents.Field interviews were conducted with seven clients with disabilities for the purpose of developing design guidelines for apartments suitable for independent living. Analysis of these data generated six factors that were highly valued and felt to contribute to the success of these individuals' venture into community living. Control appears to be the central construct and to subsume the other concepts: safety/security, accessibility/mobility, function, flexibility and privacy. These findings are presented and discussed here as a working model of environmental control. These ideas are suggested as hypotheses which would need to be tested and refined further before being used as a model to guide clinical interventions.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/135. A comparison of two computer input devices for uppercase letter matching.OBJECTIVE: To determine whether the touch Window or the mouse with an enlarged on-screen arrow was more effective or efficient for an on-screen letter-matching task completed by a boy 9 years of age with spastic quadriplegic cerebral palsy and visual and cognitive deficits. METHOD: A single-subject research design of 5 treatment phases, A1, B1, A2, B2, and A & B, was used. The total percentage of correct letter matches per treatment session, the total percentage correct per letter, and the amount of time needed to match 5 consecutive letters correctly were evaluated. RESULTS: The range and variability of letters correctly matched per session decreased and trends for correct letter matches accelerated when the participant used the mouse interface. Accuracy with matching 18 of 26 (69%) letters of the alphabet increased when selections were made with the mouse interface. The participant was faster when using the touch Window to match 5 consecutive letters correctly; however, regardless of the interface device used, letter matching remained slow and tedious. CONCLUSION: The mouse with an enlarged on-screen arrow and cursor was the more effective interface device with this child. Making a minor adjustment such as increasing the size of the on-screen arrow can make a common piece of equipment accessible to a person with disabilities.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
3/135. The Innsbruck Sensorimotor Activator and Regulator (ISMAR): construction of an intraoral appliance to facilitate ingestive functions.Oral sensorimotor therapy is practiced widely with children who have neuromotor impairments, such as cerebral palsy and eating problems. Although improvement in ingestive skills can be achieved in the short term (5 months), long-term effects (over 12 months) remain to be examined. Interventions with intraoral appliances are used in children with moderate impairments of the oral-motor system and offer an opportunity for long-term treatment. Instead of the daily oral sensorimotor exercises, which must be provided by a qualified therapist, the intraoral appliance is worn during the night, so that the "therapy" is initiated and controlled by the child. The purpose of this paper is to describe the appliance: its prescription, fabrication and therapeutic use. A case study illustrates that improvement in ingestive skills, efficiency of eating, and marked weight gain can be achieved.- - - - - - - - - - ranking = 2keywords = rate (Clic here for more details about this article) |
4/135. Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy.BACKGROUND: patients with athetoid cerebral palsy may develop severe degenerative changes in the cervical spine decades earlier than their normal counterparts due to abnormal cervical motion. methods: Two patients, 48 and 52 years of age, presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and 3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in both patients. This necessitated multilevel anterior corpectomy with fusion (C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed by posterior wiring, fusion using Songer cables, and halo placement. RESULTS: Postoperatively, both patients improved, demonstrating only mild or mild to moderate (Nurick Grades II and III) residual myelopathy. Although both fused posteriorly within 3.5 months, the patient with the fibula graft developed a fracture of the anterior C7 body with mild anterior graft migration, and inferior plate extrusion into the C7-T1 interspace. However, because he has remained asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate has not yet been necessary. CONCLUSIONS: patients with athetoid cerebral palsy should undergo early prospective cervical evaluations looking for impending cord compromise. When surgery is indicated, circumferential surgery offers the maximal degree of cord decompression and stabilization with the highest rate of fusion.- - - - - - - - - - ranking = 4keywords = rate (Clic here for more details about this article) |
5/135. Motor benefit from levodopa in spastic quadriplegic cerebral palsy.We report on a 16-year-old girl with spastic quadriplegic cerebral palsy associated with premature birth and typical periventricular leukomalacia, who had a dramatic improvement in motor function after treatment with carbidopa/levodopa. Kinematic and electromyographic analyses of reaching movements demonstrate that levodopa decreased muscle co-contraction, decreased unwanted movements, and improved her ability to maintain a steady arm posture. These findings suggest that levodopa be considered as an adjunct therapy for the treatment of spastic quadriplegic cerebral palsy.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
6/135. Sudden bronchospasm on intubation: latex anaphylaxis?I present a case of a patient with a history of cerebral palsy and asthma, living in a group home, who developed acute onset bronchospasm immediately after intubation. The patient developed hypotension 5 minutes after intubation. The bronchospasm lasted 20 minutes, and the case was complicated further by continued hypotension and a pneumothorax. A diagnosis of latex-mediated anaphylaxis was made in the intensive care unit after immunoglobin E (IgE), serum tryptase, and latex-specific IgE antibody were shown to be markedly elevated. This case report demonstrates that immediate onset of bronchospasm on intubation of an asthmatic patient is not always an asthma attack, and that other causes of bronchospasm should be considered in the differential diagnosis. patients with a history of atopy, including those with a history of asthma, have an increased risk of developing latex sensitivity. It is important to remember that more than one etiology may be responsible for this kind of bronchospasm, and that it may be difficult to differentiate between multiple etiologies of bronchospasm.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
7/135. Chronic cerebellar stimulation in cerebral palsy.Data are presented for the first 50 patients with cerebral palsy who underwent chronic cerebellar stimulation for symptom alleviation. We observed significant shorter and longer term improvement in spasticity as well as athetosis, speech, and functional status. Continuing increments in improvement were noted as a function of time on stimulation. In many instances, psychometric test scores and behavior also were improved. There was one death in this series. There were no neurologic complications due to cerebellar stimulation. The results of this study warrant the judicious use of cerebellar stimulation for symptomatic and functional relief in cerebral palsy.- - - - - - - - - - ranking = 0.58453163309962keywords = death (Clic here for more details about this article) |
8/135. Intrathecal baclofen withdrawal simulating neuroepileptic malignant syndrome in a child with cerebral palsy.Intrathecal baclofen infusion (IBI) is being used with increasing frequency in children to treat spasticity and dystonia. In this report, we summarize the clinical course of a 9-year-old boy with quadriplegic cerebral palsy with mixed tonal abnormalities (spasticity and dystonia) experiencing withdrawal from intrathecal baclofen. His clinical course is compared to that of adults experiencing withdrawal from IBI and to neuroleptic malignant syndrome. If unrecognized, this disorder may have significant potential for morbidity and mortality. Clues to diagnosis, appropriate evaluation, and potential treatments are discussed. When a child treated with IBI presents with unexplained multiorgan system dysfunction, particularly if accompanied by evidence of rhabdomyolysis, the integrity of the IBI system must be evaluated. In some cases, evaluation might necessitate surgical exploration. caregivers most commonly seek urgent evaluation and treatment from their primary care provider when their child experiences fever or acute illness. Primary care providers of children treated with IBI should be made aware of this clinical scenario to prevent delays in diagnosis.- - - - - - - - - - ranking = 1.3043556281483keywords = mortality (Clic here for more details about this article) |
9/135. Medical problems in adults with cerebral palsy: case examples.The United cerebral palsy association estimates that there are approximately one-half million adults with cerebral palsy in the united states. The number may be growing due to advances in medical care and the increased life expectancy of adults in general. Little has been published regarding their medical issues and rehabilitation needs. What little has been published has indicated almost a total neglect of specialty care and preventive medical services. Five case examples are presented to help illustrate particular medical and surgical problems not identified by either pediatric or adult healthcare providers alone. Each individual shows improvement with comprehensive team-oriented specialty care. Further study is encouraged.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
10/135. Motor control testing of upper limb function after botulinum toxin injection: a case study.OBJECTIVE: To evaluate changes in upper extremity function in a hemiparetic patient after treatment with botulinum toxin (BTX) using motor-control testing (MCT) techniques. DESIGN: Interventional with longitudinal study, open label. SETTING: A children's hospital and a motor-control laboratory at a major academic center. PARTICIPANTS: A 16-year-old male with right hemiparetic cerebral palsy and a healthy 12-year-old control subject. INTERVENTIONS: BTX injections to the elbow and wrist flexors. MAIN OUTCOME MEASURES: MCT was used to examine 4 upper extremity movements: forward reach, bilateral rhythmic movements (both muscle homologous and direction homologous), isometric pinch, and hand tapping. The patient was tested before treatment and at 2, 4, 6, 12, 18, and 24 weeks after treatment. In addition, range of motion (ROM), the Ashworth scale of spasticity, Functional Independence Measure, and the mobility and activities of daily living (ADL) sections of the Pediatric Evaluation of the Disability Inventory were performed. RESULTS: Forward reach demonstrated little change initially despite patient reports of "feeling looser." Improvement was noted after 18 weeks, but returned to baseline level at 24 weeks. Bilateral rhythmic movements also showed slight improvement at 18 weeks. Pinch force increased significantly after 2 weeks, but declined again at 6 weeks. Improvements occurred in ROM and the Ashworth rating of spasticity, but were not temporally associated with each other or with MCT results. Functional assessment data did not change during the study period. CONCLUSIONS: Improvements in more complex motor tasks were noted after significant delay from the time of treatment, while simpler tasks demonstrated a more rapid improvement, followed by a rapid return to baseline levels. This case suggests that MCT techniques can provide quantitative and qualitative data, which can add new information about upper extremity motor disability and the outcome of treatment.- - - - - - - - - - ranking = 2keywords = rate (Clic here for more details about this article) |
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