Biomedical subjects

Terje Terjesen

Publications and source records attributed to Terje Terjesen.

8 recordsLinked to original sources

PubMed2006

[Cerebral palsy in children--motor function and new treatment strategies].

Substantial changes have taken place in the management of motor function in children with cerebral palsy during the last decade. The objective of this article is to describe some of these changes. The article is based on search of databases and own clinical experiences. New treatment methods have been introduced and the management is more specialised and individualised. No single treatment method has proven to be sufficient alone and the challenge is to find the best combination of methods. This requires the ability to cooperate across disciplines. Medical treatment of spasticity (botulinum toxin A, intrathecal baclofen) may be an alternative or a supplement to orthopaedic surgery. For children who can walk, preoperative gait analysis has made it easier to find the right time for an operation and to choice the right type of intervention. Physiotherapy has become task oriented and specifically goal directed, based on documented principles of motor learning, strength and fitness training. Correct choose and use of orthosis is an essential part of the treatment. The different types of cerebral palsy have different natural progressions, risk factors and needs of follow-up. A multidisciplinary clinical evaluation is therefore needed as a basis for choosing the right management strategy. Given the complexity of this disorder, priority between various focus areas for different age groups is a challenge. A close collaboration with the parents is therefore essential. Children with cerebral palsy are a relatively small group, and the increased specialisation may indicate that parts of the treatment should be centralised.

Cerebral Palsy↗

PubMed2006

Development of the hip joints in unoperated children with cerebral palsy: a radiographic study of 76 patients.

BACKGROUND: The aims of the present study were to assess the development of hip dysplasia in children with bilateral spastic cerebral palsy and to evaluate the factors that influence the progression. PATIENTS AND METHODS: 76 children, 42 with spastic quadriplegia and 34 with diplegia, were included in the study. Their mean age at the first radiographic examination was 3.5 (1-11) years. The patients were followed up until operative treatment (54 subjects) or until the most recent radiograph in those who did not undergo hip surgery. The mean length of follow-up was 4.8 (1-13) years. On the initial and most recent radiographs, the migration percentage (MP) was measured, which is the percentage of the femoral head lateral to the acetabular rim. RESULTS: The mean MP of the side with the largest displacement was 25% (-18-66) at the initial radiographic examination and 51% (9-100) at the last follow-up. The mean increase in MP was 7% (-2-33) per year. Linear multiple regression revealed that gait function and age were the most important variables that influenced the rate of MP progression. Children who could not walk had significantly greater MP progression per year (12%) than those who walked with or without support (2%). In the quadriplegics, the maximal yearly increase in MP was 13% under 5 years of age and 7% in older children. This difference was statistically significant, whereas no significant difference in relation to patient age was seen in the diplegics. INTERPRETATION: There is a pronounced trend towards displacement of the hips in quadriplegic CP patients who are under 5 years of age and cannot walk. Because hip dislocation may lead to severe problems, close follow-up is important in finding the appropriate time for hip surgery in order to avoid progression towards dislocation. The risk of severe hip dysplasia is considerably less in spastic diplegia.

Cerebral Palsy↗

PubMed2005

[Gait analysis--a new diagnostic tool].

Three-dimensional gait analysis is a systematic measurement, description, and assessment of human gait. Gait analysis is established as a useful diagnostic tool in patients with gait problems, as it is not possible to obtain an adequate and detailed understanding of such a complex mechanism as gait in a conventional clinical examination. The method has provided a better understanding of both normal gait and abnormal gait patterns; it is a suitable instrument for evaluation of treatment results as well as for scientific work. The first gait laboratory for clinical use in Norway was established in 2002 in the Section for child neurology at Rikshospitalet University Hospital in Oslo, Norway. In this article the procedure for gait analysis is described and the clinical value is indicated by a case record of a child with cerebral palsy. Gait analysis has entailed a change of policy with regard to surgical treatment in this patient group. Previously, operative intervention at a single level was usual, whereas current practice involves simultaneous interventions at several levels of both lower extremities. After three years' experience we recommend gait analysis in routine diagnostics, particularly as a preoperative evaluation, in all children with gait problems and in the follow up after surgery or other treatment.

Adolescent↗

PubMed2005

Adductor tenotomy in spastic cerebral palsy. A long-term follow-up study of 78 patients.

BACKGROUND: There is a risk of hip dislocation in children with spastic cerebral palsy. We evaluated the prophylactic effect of adductor tenotomy in patients with long-term follow-up. PATIENTS AND METHODS: Our material comprised 78 patients (46 boys) with a mean age of 8 (2-17) years who underwent adductor tenotomy during the period 1986-1991. 40 patients had spastic diplegia and 38 had quadriplegia. For patients who had further hip surgery, follow-up was until the next hip operation. Those who had not undergone further surgery were invited to a follow-up examination. The migration percentage (MP) was measured on the preoperative and follow-up radiographs. The radiographic result was termed good if MP at follow-up was reduced or had increased less than 10%. The follow-up period was 10 (1.6-16) years, with a mean of 6 years for patients with later hip surgery and 13 years without such surgery. RESULTS: The clinical outcome was good in 51 cases, poor in 12, and uncertain in 15. The radiographic result was good in 39 of the 53 patients with radiographs available both preoperatively and at follow-up. The patients with good radiographic results had lower preoperative MP than those with poor results (MP 34% versus 49%) and lower preoperative acetabular index. The mean increase in MP (worst hip in each patient) was 1.9% per year, which is considerably less than that in nonoperated patients. Further hip surgery was necessary in 27 patients, because of increasing MP in 14 cases and for clinical reasons in 13. INTERPRETATION: Adductor tenotomy reduced the trend towards lateral displacement of the hip joints. The operation had a favorable outcome in approximately two-thirds of the patients. The operation should be performed before the MP reaches 50%.

Adolescent↗

PubMed2004

[Orthopaedic problems in adults with cerebral palsy].

BACKGROUND: There is little information about the need for orthopaedic surgery in adults with cerebral palsy; we wanted to assess this problem. MATERIAL AND METHODS: The material included 37 adults with cerebral palsy (19 women and 18 men), mean age 39. The degree of physical disability was mild in 19 cases, moderate or severe in 18. The patients were assessed by clinical examination and radiographs of hips and spine. RESULTS: 15 patients had pain located to the spine or lower extremities but no-one had severe or invalidating pain. Subjects with moderate or severe disability had a markedly reduced range of motion in the hip and knee joints. Subluxation or dislocation of the hip joints was found in six patients but only one of them had hip pain. Orthopaedic surgery had been performed in 23 patients. In 8 patients we found indications for additional orthopaedic surgery aimed at relieving pain, reducing contractures or improving function. The most frequent procedures would be tenotomies in the hip and knee regions, heel cord lengthening, and triple arthrodesis of the foot. INTERPRETATION: Regular follow-up of adults with cerebral palsy is recommended in order to reveal musculoskeletal problems that can be improved by orthopaedic surgery.

Adult↗

PubMed2004

Evaluation of the subchondral fracture in predicting the extent of femoral head necrosis in Perthes disease: a prospective study of 92 patients.

The aim of this study was to evaluate the subchondral fracture as a predictor for the extent of femoral head necrosis in Perthes disease. Out of 392 patients, 92 (23.5%) had a detectable subchondral fracture at the time of diagnosis. There was concordance between predicted Catterall groups on the basis of the extent of the subchondral fracture and the actual Catterall groups at the time of maximal resorption in 61% of the cases, when assessed by an experienced observer. When using the extent of the subchondral fracture to predict Salter-Thompson groups, this observer obtained 89% concordance with the actual Salter-Thompson groups at the time of maximal resorption. The inter-observer agreement between the experienced and a less experienced observer regarding the presence or absence of a subchondral fracture was moderate (weighted kappa 0.59, 87% agreement). When using the extent of the subchondral fracture as a measure of femoral head involvement (Catterall groups), the inter-observer agreement was moderate (weighted kappa 0.46). Patients with detectable subchondral fracture were significantly older (mean 6.5 years) at the time of diagnosis than those without visible fracture (mean 5.2 years). The delay in diagnosis was significantly shorter in the group with subchondral fracture (mean 3.2 months) than among patients without visible fracture (mean 4.9 months). There was no significant difference with regard to sex, pain level, pain localization, or limping gait between the two groups. We conclude that the subchondral fracture is a relatively rare early sign in Perthes disease. When present, it is a useful sign when assessed by an experienced observer as its extent was in fairly good concordance with the extent of femoral head involvement at the time of maximal resorption. Awareness of this radiographic sign will aid the orthopaedic surgeon to establish diagnosis and, to some degree, to predict prognosis early in the course of the disease.

Adolescent↗

PubMed2003

Residual challenges after healing of congenital pseudarthrosis in the tibia.

The purpose of the current study was to evaluate the clinical results of the Ilizarov bone transport method in the treatment of congenital pseudarthrosis in the tibia. In seven patients operated on between 2.6 and 7.8 years of age, primary healing of the pseudarthrosis was achieved in all patients (after additional bone grafting in two patients). Within a followup of 6 to 8 years, major complications occurred in all patients. Five refractures occurred, and in one patient the refracture did not heal. At the last followup, axial deformities and an abnormal malalignment test with lateral mechanical axis deviation of 10 mm or greater was found in all patients. Three patients had leg length inequality of 20 mm or more. The Ilizarov bone transport method is useful in achieving primary healing in congenital pseudarthrosis of the tibia, but residual challenges with secondary reconstructive surgery caused by refracture and postoperative deformities must be expected.

Bone Transplantation↗

PubMed2002

Inter-observer reliability of radiographic classifications and measurements in the assessment of Perthes' disease.

We evaluated the inter-observer agreement of radiographic methods when evaluating patients with Perthes' disease. The radiographs were assessed at the time of diagnosis and at the 1-year follow-up by local orthopaedic surgeons (O) and 2 experienced pediatric orthopedic surgeons (TT and SS). The Catterall, Salter-Thompson, and Herring lateral pillar classifications were compared, and the femoral head coverage (FHC), center-edge angle (CE-angle), and articulo-trochanteric distance (ATD) were measured in the affected and normal hips. On the primary evaluation, the lateral pillar and Salter-Thompson classifications had a higher level of agreement among the observers than the Catterall classification, but none of the classifications showed good agreement (weighted kappa values between O and SS 0.56, 0.54, 0.49, respectively). Combining Catterall groups 1 and 2 into one group, and groups 3 and 4 into another resulted in better agreement (kappa 0.55) than with the original 4-group system. The agreement was also better (kappa 0.62-0.70) between experienced than between less experienced examiners for all classifications. The femoral head coverage was a more reliable and accurate measure than the CE-angle for quantifying the acetabular covering of the femoral head, as indicated by higher intraclass correlation coefficients (ICC) and smaller inter-observer differences. The ATD showed good agreement in all comparisons and had low interobserver differences. We conclude that all classifications of femoral head involvement are adequate in clinical work if the radiographic assessment is done by experienced examiners. When they are less experienced examiners, a 2-group classification or the lateral pillar classification is more reliable. For evaluation of containment of the femoral head, FHC is more appropriate than the CE-angle.

Body Weights and Measures↗