11/18. Total hip replacement in the neuromuscularly impaired.Controversy exists over the appropriate use of total hip arthroplasty in patients with significant neuromuscular disease. This study investigated the use of THR in neuromuscular disease patients. A criterion for patient inclusion was a diagnosis of mental retardation, cerebral palsy or Down's syndrome. The study population consisted of nine patients (12 hips), average age, 42 years. Average follow-up was 3.5 years. Results: (1) 100% of patients demonstrated decreased pain, expanded range of motion and improved overall function. (2) All institutionalized patients were cared for more easily. (3) There were no infections, dislocations or major complications. Conclusion: Total hip arthroplasty is a reasonable and safe therapeutic option for the treatment of painful osteoarthritis of the hip in select patients with neuromuscular disease.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/18. Goniometric reliability for a child with spastic quadriplegia.Intrarater and interrater reliabilities were assessed for upper-extremity goniometric measurements of a 5-year-old girl with severe spastic quadriplegia. Percentage agreement was the method used to evaluate goniometric reliability of three motions bilaterally: shoulder flexion, shoulder abduction, and elbow extension. Intrarater reliability for each of the two raters was higher than interrater reliability. The mean differences and the range of differences between raters for each of the six motions measured also were recorded. There was wide variability in measurements both within and between raters. These results suggest that a difference of /- 10-15 degrees in range of motion over time does not justify conclusions of either significant improvement or significant regression in a child with severe spastic cerebral palsy.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
13/18. gait analysis in cerebral palsy.Ambulation problems in cerebral palsy have been very difficult to analyse because it is the central control system rather than the motor system that is at fault. Until recently, decisions regarding surgical management has been made on clinical grounds, which by and large, have been subjective. Attempts to remedy this situation has resulted in the setting up of gait Analysis laboratories to provide a more objective method of evaluation of disorders of human motion. We have recently been using an opto-electronic computer-based gait analysis system to analyse normal as well as abnormal gait. gait analysis can provide information regarding movements of both lower limbs in three planes, ground reaction forces, joint torque and dynamic electromyography. Children with various types of cerebral palsy have been assessed. The results of four clinical gait assessment cases are presented and discussed. Information provided by the gait Analysis Laboratory has introduced more objectivity in pre-operative planning for these children.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/18. The vertical wheeler: a device for ambulation in cerebral palsy.The vertical wheeler is a new mobility aid that was specifically designed to help improve the quality of life for the handicapped child by providing mobility while standing. Results of a clinical trial in a population of patients with cerebral palsy are presented. Criteria were selected to allow evaluation of the rehabilitative effect of the device on the population. Results showed that the children in this cerebral palsy group all benefited from ambulation with the wheeler. patients with spastic quadriparesis seemed to gain the most immediate benefit. The device contributed to improved mobility, posture, and self-image. The wheeler was safe and fun for the children. It has the potential for improving the psychologic and medical status of the child with severe locomotion impairment.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/18. infant mental health and biological risk.parents seldom seek help directly for infant mental health problems. parents enter the health care system seeking advice for identified or presumed biological problems in their infants. Many of these biological problems, however, have major psychosocial components of importance to infant mental health. It is important that physicians deal directly with the psychosocial issues and avoid converting them into biological medical problems unintentionally. Three common types of problems and appropriate methods of management are discussed to ensure special recognition and effective handling by the physician of psychosocial problems and the promotion of mental health. The problems discussed are the following: Infants seen with defined medical conditions that generally have associated psychosocial problems including child abuse. Infants seen who have fully recovered from critical illnesses but are considered "at risk" for later developmental disability. Infants seen with normal variations of behavior that are misinterpreted by their parents or physicians as due to a medical problem. In infancy medical and psychosocial issues are so closely interwoven that it is critical that physicians learn to recognize the major psychosocial consequences of primary medical problems and the medical manifestations of primary psychosocial problems and their management.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/18. Managing equinus in children with cerebral palsy: electrical stimulation to strengthen the triceps surae muscle.A new therapeutic proposal for the management of equinus in children with cerebral palsy is to strengthen the calf muscles instead of weakening them surgically. Prior research indicates that in children with cerebral palsy the triceps surae muscle is weak and needs strengthening. Neuromuscular electrical stimulation (NMES) was used as an adjunct to physical therapy. A portable NMES unit with a hand-held remote switch stimulated an active muscle gait cycle. Results are discussed for four children, who showed improved gait, balance, posture, active and passive ankle range of motion, and foot alignment. The toe walkers became plantigrade and the equinovalgus posture of the foot decreased. Spasticity did not increase.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
17/18. Multidimensional assessment of motor function in a child with cerebral palsy following intrathecal administration of baclofen.This case report describes an 11-year-old boy with spastic diplegia whose reflex status, range of motion (ROM), strength, and motor performance were measured before and after implantation of an indwelling system for delivery of intrathecally administered baclofen. Before baclofen use, the subject experienced clonus that interfered with walking, needed assistance with transfers, and was unable to independently put on underwear and socks. Measures of spasticity, kinematics and electromyographic activity during voluntary movements, ROM, Gross Motor Function Measure (GMFM) scores, and self-reports of change were obtained at baseline, before and after bolus baclofen injection, during a double-blind placebo-controlled clinical trial of baclofen administration via an indwelling pump, and after 1 and 2 years of baclofen therapy. Spasticity, Babinski reflexes, clonus, strength, and coactivation of antagonist muscles during voluntary movement were decreased shortly after baclofen administration began. hip and ankle ROM increased, upper-extremity movement speed increased, independence in dressing and transfers improved, and orthoses were discarded. After 1 and 2 years, GMFM scores were 7.8% and 6.4% above baseline, respectively; the subject won a fitness award. After 2 years, ROM was worse than at baseline and concerns regarding hip subluxation arose. Single-joint movement control and independence improved and spasticity decreased during baclofen administration.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
18/18. Effect on ambulation of continuous intrathecal baclofen infusion.Intrathecal baclofen (ITB) infusion has been shown to be an effective treatment for spasticity secondary to both cerebral palsy and spinal cord injury. Its effect on the ambulatory status of individuals with cerebral spasticity, however, has not previously been addressed. We reviewed the effect of ITB on functional ambulation in 24 patients who were ambulatory to some extent, either with or without assistive devices. Twenty-one pumps were placed in patients with spastic cerebral palsy and 3 in patients with spasticity secondary to traumatic brain injury (13 boys and 11 girls, mean age 18 years). The mean ITB dose was 200 microg/day (range 22-550 microg/day) and the mean length of follow-up was 52 months. Ambulation was retrospectively graded on four functional levels: community, household, non-functional, and non-ambulatory. The level of ambulation improved by one functional level in 9 patients, did not change for 12 patients, and was worse in 3 patients. gait was considered to be improved in 20 of 24 patients by the patients or their families. The overall functional improvement not directly related to ambulation was found to be improved in 20 patients, unchanged in 2 patients, and worse in 2 patients. ITB allows for improved ambulation in a certain subset of patients with lower extremity spasticity. It is not contraindicated in patients who rely upon their spasticity for support during ambulation. ITB infusion allows for baclofen dosage titration to balance between extensor tone for support and suppression of hyperactive reflexes which may impede normal locomotion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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