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Biomedical subjects

A P Cosgrove

Publications and source records attributed to A P Cosgrove.

18 recordsLinked to original sources
PubMed2002

Clinical screening for developmental dysplasia of the hip in Northern Ireland.

PROBLEM: The incidence of late diagnosed developmental dysplasia of the hip requiring surgery in Northern Ireland is high. The reported incidence was 1.14 per 1000 children born during 1983-7. DESIGN: Comparative retrospective study. BACKGROUND AND SETTING: Clinical screening programme in Northern Ireland. Key measure for improvement: Reduced rate of operative intervention in children with developmental dysplasia of the hip detected after 6 months of age. STRATEGIES FOR CHANGE: Increased emphasis on staff training, introduction of a centralised nurse led clinic to improve access to orthopaedic surgeons, and increased use of ultrasonography. EFFECTS OF CHANGE: The incidence of developmental dysplasia of the hip diagnosed after 6 months in children born between January 1991 and December 1997 fell to 0.59 per 1000, presumably due to improved early detection. Nevertheless, 29 (16%) of the affected hips were not diagnosed when the child was first referred in the first 3 months of life. In addition, for 27 affected hips in children diagnosed after the age of 6 months there was a known risk factor (family history or breech delivery). LESSONS LEARNT: Improvements to screening processes can reduce late incidence of developmental dysplasia of the hip. Further steps to improve detection in children with known risk factors and rate of detection at first referral could reduce late presentation further.

Age Factors↗
PubMed2002

Effect of a rigid ankle-foot orthosis on hamstring length in children with hemiplegia.

Eighteen children with hemiplegia, mean age 8 years 5 months, underwent gait analysis and musculoskeletal modelling using specially designed software. The maximum lengths of the hamstrings were determined for each child walking in and out of an ankle-foot orthosis (AFO). The muscles were deemed to be short if shorter than the normal average -1SD. In bare feet 8 participants had short medial hamstrings with a higher proportion of these in the less involved individuals. All participants showed an increase in maximum hamstring length when wearing an AFO. In all but one child this was sufficient to restore hamstring length to within normal limits. These finding suggest that hamstring pathology in hemiplegic gait is usually secondary to more distal lower limb pathology.

Ankle Joint↗
PubMed2002

Anterior physeal separation. A sign indicating a high risk for avascular necrosis after slipped capital femoral epiphysis.

A study of 78 children (110 hips) was undertaken in an attempt to assess the risk of avascular necrosis (AVN) after slipped capital femoral epiphysis based on the radiological appearances of the hip at the time of presentation. Physeal separation, which was defined as the amount of separation of the anterior lip of the epiphysis from the metaphysis on the frog lateral view, was assessed. Of the eight hips which developed AVN, seven had anterior physeal separation. We conclude that anterior physeal separation is associated with a high incidence of subsequent AVN after slipped capital femoral epiphysis and that screw fixation may not be appropriate in these patients.

Adolescent↗
PubMed2000

Deprivation, urbanisation and Perthes' disease in Northern Ireland.

It has been suggested that Perthes' disease is more prevalent in urban areas, and that the risk increases with deprivation. We present the findings of a preliminary analysis of Perthes' disease in Northern Ireland, which is shown to have one of the highest national annual rates of incidence in the world (11.6 per 100000). Of the 313 children diagnosed over a seven-year period, 311 were allocated to the enumeration districts of the 1991 census, thus allowing the incidence to be calculated using both spatial and non-spatial aggregation. The cases were grouped according to the size of the settlement from highly urbanised to open countryside and by level of area deprivation. While the incidence of Perthes' disease was found to be associated with indicators of the level of deprivation for areas, there was no evidence to suggest that there was an increased risk in urban areas; the highest rate was found in the most deprived rural category.

Adolescent↗
PubMed2000

The role of coagulation abnormalities in the development of Perthes' disease.

Recent reports have suggested an association between Perthes' disease and an underlying thrombophilic or hypofibrinolytic tendency. In Northern Ireland there is a high incidence of Perthes' disease (11.7 per 100,000 or 1 in 607 children) in a stable paediatric population. We reviewed 139 children with Perthes' disease and compared them with a control group of 220 aged- and gender-matched healthy primary schoolchildren with similar racial and ethnic backgrounds. There were no significant deficiencies of antithrombotic factors protein C, protein S, antithrombin III or resistance to activated protein C. A total of 53 (38.1%) of the children with Perthes' disease had a prolonged activated partial thromboplastin time (>38) compared with 13 (5.9%) of the control group (p < 0.001). Our findings have shown that using standard assays, thrombophilia secondary to antithrombotic factor deficiency or resistance to activated protein does not appear to be an aetiological factor for Perthes' disease. The cause of the prolonged activated partial thromboplastin time, usually associated with a clotting factor deficiency, is under further investigation.

Antithrombin III↗
PubMed1999

Botulinum toxin A in hamstring spasticity.

Hamstring injection of Botulinum toxin A (BtA) may have a role in the conservative management of flexed knee gait in cerebral palsy or in simulating the effect of surgery. Ten children who were likely to require future hamstring lengthening were injected. Short term outcome was assessed by clinical examination and 3-D gait analysis. Mean popliteal angle decreased by 16 degrees and maximum knee extension in stance increased by 8 degrees, the latter relapsing by 12 weeks. Mean pelvic tilt tended to increase suggesting that isolated hamstring weakening be approached with caution. Energy cost of walking was not significantly changed in six of the ten patients. A small increase in knee extension in stance was often associated with patient satisfaction. There are theoretical grounds for expecting an associated increased longitudinal muscle growth after BtA injection.

Botulinum Toxins, Type A↗
PubMed1998

Musculoskeletal modelling in determining the effect of botulinum toxin on the hamstrings of patients with crouch gait.

This study aimed to determine the effect of hamstring botulinum toxin A (Btx-A) injection in 10 children with crouch gait in terms of changes in muscle length and lower-limb kinematics. Before Btx-A injection limb kinematics were recorded. Maximum hamstring lengths and excursions were calculated by computer modelling of the lower limb. Data were compared with the averaged hamstring lengths of 10 control children. Hamstrings were defined as short if their length was shorter than the average maximum length minus one standard deviation. Gait analysis was repeated 2 weeks after isolated hamstring Btx-A injection. Pre- and postinjection kinematic data and muscle lengths were then compared. Four of 18 injected limbs in three subjects had short medial hamstring before injection, none of the subjects had short lateral hamstrings. Muscle excursion was significantly reduced in the short and adequate maximum muscle length groups. A significant increase in the semimembranosus and semitendinosus length in all of the injected limbs was noted. Only in the short muscle group was a significant increase in muscle excursion observed. Knee extension improved by 13 degrees in the adequate muscle length group and by 15.6 degrees in the short muscle length group. Pelvic tilt and hip flexion increased in both groups non-significantly. Average walking speed postinjection increased from 0.60 ms(-1) to 0.71 ms(-1). Short hamstrings are over-diagnosed in crouch gait. Hamstring Btx-A injection in patients with crouch gait produces significant, repeatable muscle lengthening and improved ambulatory function.

Botulinum Toxins, Type A↗
PubMed1997

Botulinum toxin A in the hemiplegic upper limb: a double-blind trial.

In a randomised, double-blind study, the effects of intramuscular injection of botulinum toxin type A (BtA) into the upper limb were compared with those of normal saline solution in 14 patients with cerebral palsy; their mean age was 9 years. Range of movement and function were assessed before injection and at 2 and 12 weeks after injection. BtA injection significantly increased maximum active elbow and thumb extension and significantly reduced tone at wrist and elbow. The hand grasp-and-release score improved, representing a modest functional change, but fine motor function, assessed by the ability to pick up coins, did not improve and in some cases deteriorated temporarily. The most notable subjective change was the cosmetic benefit of reduced involuntary elbow flexion. The tone-reducing effect of BtA was clinically detectable in comparison with the placebo and patients and parents perceived the change as beneficial. The median of changes in the treatment group was small but the range was large, suggesting that BtA can be useful in selected patients.

Adolescent↗
PubMed1996

Energy consumption in children with spina bifida and cerebral palsy: a comparative study.

The authors looked for differences in the energy expenditure patterns of ambulant children with cerebral palsy and spina bifida. Oxygen consumption was measured according to type of cerebral palsy or level of spina bifida lesion, and in healthy children. The rate of oxygen consumption (mL/kg/min) was significantly higher in the children with diplegia than in those with hemiplegia or with spina bifida or the healthy children. Oxygen cost (mL/kg/m) was significantly higher and velocity was significantly slower in all the groups with disability than in the healthy children. The reason children with diplegia consumed more oxygen than other children when walking may be that their abnormal equilibrium reactions impaired their balance and their ability to control their walking speed.

Cerebral Palsy↗
PubMed1994

Botulinum toxin A prevents the development of contractures in the hereditary spastic mouse.

The hereditary spastic mouse was studied as a model of cerebral palsy in childhood to test the hypothesis that intramuscular botulinum toxin A would prevent the development of calf-muscle contractures. A prospective randomised controlled trial of calf injection with botulinum A compared with injection of normal saline was performed on juvenile mice. At maturity, the calf muscles of the spastic mice were 16 per cent shorter than those of their normal siblings. The calf muscles of spastic mice injected with botulinum toxin A grew to within 2 per cent of normal length. This difference in mature muscle length was highly significant.

Achilles Tendon↗
PubMed1994

Botulinum toxin in the management of the lower limb in cerebral palsy.

The role of intramuscular botulinum toxin A in the treatment of 26 children with cerebral palsy was evaluated. The indication for injection was the presence of a dynamic contracture of lower-limb muscles interfering with positioning or walking. Spastic target muscles were identified by clinical examination and, in ambulant children, by gait analysis. Between 50 and 320 units of botulinum toxin were injected into each muscle group to a total dose of 100 to 400 units per child. The effects of injection were monitored by repeated clinical examination and gait analysis. There were no clinically detectable systemic side-effects, and all but one patient had a reduction in tone, which occurred within three days and persisted for two to four months. There were significant improvements in ambulatory status and in sagittal-plane kinematics. In some cases these gains persisted after the tone-reducing effects of the toxin had worn off.

Adolescent↗
PubMed1993

Minimally invasive surgery for osteoid osteoma of the proximal femur.

Seven patients with osteoid osteoma of the proximal femur were treated by percutaneous excision of the nidus. The combination of preoperative localisation by tomography and intraoperative localisation by image intensifier resulted in a curative procedure with minimal bone resection in all cases, although a second operation was required in one patient.

Adolescent↗
PubMed1992

Randomised clinical trial of chest drainage systems.

BACKGROUND: Problems in the management of thoracic trauma have stimulated the search for an alternative to underwater seals for drainage of the pleural cavity. A chest drainage bag incorporating a one way flutter valve has been compared with underwater seal drains in a randomised clinical trial. METHODS: During June-December 1989 119 patients undergoing elective thoracotomy were randomised to receive postoperative chest drainage by drainage bags (56 patients, 87 drains) or by underwater seal drains (63 patients, 98 drains). Daily drainage volumes, the requirement for pleural suction, mobility, and complications were recorded prospectively. RESULTS: There was no significant difference between the two groups in the mean volume drained, the requirements for pleural suction, or the occurrence of complications. Patients with drainage bags were fully mobile 23 hours (95% confidence interval 0-47 hours) earlier than the others. CONCLUSIONS: When used after elective thoracotomy drainage bags are safe and effective and permit earlier mobility than underwater seal drains.

Adolescent↗
PubMedDate not supplied

Three-dimensional gait analysis in spina bifida.

This study was designed to determine gait patterns in children with lumbar and sacral neurologic level spina bifida. We studied a group of 28 children: 10 had L4-level lesions and a mean age of 11 years; eight had L5-level lesions and a mean age of 8 years; and 10 had S1-level lesions with a mean age of 12 years. A group of 15 normal children, mean age 10 years, was used for comparison. Each child underwent three-dimensional gait analysis using the Vicon system. We found that there were recognisable gait patterns for each level of spina bifida and that the abnormalities accurately reflected the muscle deficiencies present. The gait patterns approximated more closely to those of the normal group as the neurological level descended. The most important findings were of increased pelvic obliquity and rotation with hip abduction in stance (reflecting the gross Trendelenburg-type gait seen in these children) and persistent knee flexion throughout stance as a result of the absence of the plantar flexion-knee extension couple. We found that gait was not improved by tendon transfers performed either at the hip (posterolateral psoas transfer) or at the ankle (tibialis anterior transfer).

Adolescent↗
PubMedDate not supplied

The influence of ankle-foot orthoses on gait and energy expenditure in spina bifida.

We examined the effect of ankle-foot orthoses (AFOs) on gait and energy expenditure in children with spina bifida. Nine boys and three girls, 6 to 16 years of age, took part in the study. There were four children each with L4, L5, and sacral level lesions. Each child underwent gait analysis and energy consumption studies with and without AFOs. Walking speed was faster with AFOs (mean, 58 m/min) than without (mean, 50 m/min, p < 0.01). Stride length improved significantly (p < 0.001) from 0.89 m barefoot to 1.08 m with AFOs. Double support time was decreased from 0.32 seconds barefoot to 0.28 seconds with AFOs (p < 0.05). The oxygen cost of walking was significantly better with (0.33 mL/kg/m) than without AFOs (0.41 mL/kg/m, p < 0.001). Hip flexion at initial contact was increased. Ankle kinematics were unchanged, but ankle power generation showed a significant improvement; from 0.5 W/kg barefoot to 1.3 W/kg with AFOs. Increased ankle power generation results in improved hip flexion and stride length, which contributes to increased walking speed and reduced oxygen cost. The stability conferred by the AFOs is reflected in the reduced time spent in double support.

Adolescent↗
PubMedDate not supplied

Relevance of the popliteal angle to hamstring length in cerebral palsy crouch gait.

The popliteal angle is a widely used clinical means of assessing hamstring length in cerebral palsy patients. The relevance of the popliteal angle as a measure of hamstring length was assessed in this prospective study. Sixteen patients with cerebral palsy with crouch gait had their conventional and modified popliteal angles measured by nine observers on two separate occasions. With use of the conventional and modified forms of the test, 74 and 70%, respectively, of the observed variability was inter-and intraobserver related. The range of SDs for each observer using the conventional test was 7.1-13.6 degrees (average 10.9 degrees ), and with use of the modified form of the test, the range was 6.3-4.2 degrees (average 10.5 degrees ). The maximum hamstring length of each subject during gait was determined by three-dimensional modelling of their lower limbs. The modified popliteal angle measurements of the most repeatable observer demonstrated an inverse relationship between modified popliteal angle and maximum hamstring length (p < 0.01) and muscle excursion (p < 0.01). Only 10 of 32 limbs had short medial hamstrings.

Adolescent↗
PubMedDate not supplied

Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial.

Conservative therapies for equinus in cerebral palsy may help to postpone calf surgery in younger children. This study reports a prospective randomised trial of intramuscular botulinum toxin A (BtA) as an alternative to serial casting in 20 children with a dynamic component to calf equinus. Outcome was assessed in the short term to show the effect of one treatment cycle. Assessments were by clinical examination, video gait analysis, and three-dimensional gait analysis. BtA was of efficacy similar to that of serial casting. Tone reduction in the BtA group allowed a more prolonged improvement in passive dorsiflexion, which may allow more opportunity for increase in muscle length. Gait analysis showed an improved mean ankle kinematic pattern in a subsection of both groups, which was maintained at 12 weeks in the BtA group, whereas the cast group relapsed. There were fewer side effects in the BtA group. Median time to reintervention was similar.

Botulinum Toxins, Type A↗