Death after acute withdrawal of intrathecal baclofen: case report and literature review.
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Administration, Oral↗
Biomedical subjects
V S Nelson
Publications and source records attributed to V S Nelson.
Parental report of pediatric tracheostomy care.
OBJECTIVE: There are little data on the actual care given pediatric tracheostomy patients in their homes. Information on the use of supplies and on techniques and frequency of care is valuable for a better understanding of the needs of this population. DESIGN: Questionnaires were distributed by mail or at clinic visits from May 1995 to June 1996 to a convenience sample of tracheotomized patients at the University of Michigan Pediatric Physical Medicine and Rehabilitation clinic. SETTING: Tertiary care clinic. RESULTS: Clean technique for suctioning was reported by 96.7% of subjects and the rest reported sterile technique. Fifty percent of subjects reported reusing suction catheters. Cleaning solutions used to clean suction catheters for reuse varied. Tracheostomy tube reuse was reported by 55% of subjects. Sixty percent of those who reused tracheostomy tubes had had pneumonia within the previous year, whereas only 25% of those who never reused the tracheostomy tube had pneumonia in the same time period. CONCLUSIONS: Suctioning frequency, suction catheter, and tracheostomy tube reuse and cleaning methods are variables that warrant further investigation of safety and efficacy.
Adolescent↗
Bowel management in children and adolescents with spinal cord injury.
There is little in the literature regarding bowel management in children and adolescents with spinal cord injuries (SCI). This study was undertaken to examine specific patterns of bowel care, individual levels of satisfaction with bowel management, the incidence of incontinence in this population, and effects on lifestyle because of time commitment and dependence in bowel management. Surveys were sent to all persons (n = 45) under age 19 with a diagnosis of SCI who had received care at our medical center since 1985. Thirty-one subjects (69 percent) returned the surveys. The average age at injury was 8.1 years, with an average follow-up period of 3.9 years. Fifty-five percent were individuals with tetraplegia and 77 percent had a complete injury (ASIA Class A). A bowel management program, including medications or manual manipulation, was required for 81 percent of the subjects; only two were independent in their bowel management. Over half of the subjects performed evening bowel care and over half performed their care daily. Digital stimulation tended to be used more commonly by younger children. Medications, either oral, rectal, or both, were used by 88 percent. Sixty percent of the subjects reported they were completely or very satisfied with their bowel management. About half the subjects had limited freedom because of their bowel programs, which caused some dissatisfaction. Sixty-eight percent reported occasional or frequent interference with school activities because of their bowel programs. No correlation was found between bowel accidents and satisfaction with bowel management, despite the fact that almost 84 percent of the children reported at least rare accidents. Lifestyle limitations, bowel accidents, dependence in bowel management, and subject and family dissatisfaction continue to be significant problems for children and adolescents with SCI.
Adolescent↗
Bladder management in patients with pediatric onset neurogenic bladders.
Our objective was to determine which clean intermittent catheterization (CIC) methods and supplies were used by patients with pediatric onset neurogenic bladders and to relate methodology and materials to reported urinary tract infections. Data were collected via questionnaires distributed by mail and at clinic visits at our university tertiary care outpatient pediatric rehabilitation clinic. Questionnaires were given to 165 patients. Fifty-nine percent were returned (68 patients with myelomeningocele, 27 with pediatric onset spinal cord injury (SCI) and two with other diagnoses). Mean age was 12 years (range 1-27). Fifty-four percent of patients participated in their own CIC. Only two percent used sterile catheterization technique, whereas 98 percent used CIC. A sterile catheter was employed with clean technique by 22 percent. Catheters were reused by 76 percent. Subjects used a wide ranging number of catheters per month, with a median of 5.3. There was no correlation between the number of urinary tract infections (UTIs) per year and the type of catheter used or the use of prophylactic antibiotics. Compared with patients with myelomeningocele, subjects with SCI were significantly more likely to use sterile catheters (p = 0.04), > 10 catheters per month (p = 0.01) and gloves (p < 0.001). Subjects who used gloves or more catheters were more likely to experience UTI. These data suggest that clean reused supplies are not related to an increased likelihood of UTI and should be considered a way to lower costs in these populations.
Adolescent↗
Spondyloepiphyseal dysplasia congenita with ventilator dependence: two case reports.
Home mechanical ventilation has recently become feasible in a number of conditions. Several small series and case reports mention respiratory insufficiency or failure in a subset of patients with spondyloepiphyseal dysplasia congenita. Two cases of successful home mechanical ventilation in children, now 7 years of age, who have spondyloepiphyseal dysplasia congenita and respiratory insufficiency, are reported. Novel rehabilitation planning has facilitated the growth and development of these children.
Child↗
Incidence of maxillofacial involvement in arthrogryposis multiplex congenita.
PURPOSE: This study determined the incidence of maxillofacial involvement in patients diagnosed with arthrogryposis multiplex congenita (AMC). PATIENTS AND METHODS: Twenty-three patients were evaluated by the pediatric physical medicine and rehabilitation, orthopedic surgery, and pediatric oral and maxillofacial surgery departments. Any patient in whom the diagnosis of AMC was in doubt was excluded from the study. All patients with limited mandibular function underwent computed tomography (CT) examination of their temporomandibular joints (TMJ). The results of physical therapy were followed. RESULTS: Five of the 23 patients diagnosed with AMC were found to have maxillofacial involvement, eg, presence of cleft palate, Robin-like sequence, high-arched palate, open-bite deformity, facial muscle weakness, esophageal dysfunction, and limited mandibular opening. No TMJ abnormalities were found by CT scan. Physical therapy was used for treatment of the limited opening, but relapse occurred quicky after therapy was discontinued. CONCLUSION: The incidence of maxillofacial findings is similar to that of most other reports. Treatment involves surgical correction of abnormal anatomy when possible (ie, cleft repair), symptomatic management (ie, esophageal dysfunction), and physical therapy.
Adolescent↗
Home mechanical ventilation of children.
The medical records of 89 ventilator-assisted children followed at the University of Michigan Medical Center from 1978 to 1993 were reviewed. The status of these children was remarkably stable. Parameters of communication, nutrition, education, and mobility changed very little over time, and fewer than half had to be re-admitted. Children aged 9 to 12 years had the most nursing hours; in terms of diagnosis, those with spinal cord injury and bronchopulmonary dysplasia had the most. The younger children had the longest initial hospital stay and the most re-admissions. The authors conclude that appropriate rehabilitation during the initial hospitalization can minimize later changes, instability and rehospitalizations, and that careful follow-up and periodic evaluation can improve the patients' health and function.
Adolescent↗
Home mechanical ventilation in mitochondrial encephalomyopathy syndrome.
Long-term home mechanical ventilation of children has only recently become more practically feasible and ethically acceptable by the medical community. It has been particularly controversial in cases of degenerative myopathies in which quality of life has been questioned. There are no reports in the literature of long-term home mechanical ventilation of a child with mitochondrial encephalomyopathy (MELAS) syndrome despite the many descriptions of possible etiologies of the concomitant respiratory failure. The patient reported here has used home mechanical ventilation for 6 years with few medical complications, no hospitalizations in the past 3 years, and increased function in activities of daily living. Despite the ill-defined nature of the disease and uncertain prognosis, we believe that long-term home mechanical ventilation of children with early onset MELAS syndrome is a viable option for both patients and their families and results in overall improvement in quality of life for the patient.
Child↗
Rachitic syndrome after disodium etidronate therapy in an adolescent.
A 12-year-old patient with a severe traumatic brain injury developed heterotopic ossification (HO) with rapidly decreasing range of motion in multiple joints despite intensive passive range of motion exercises and the use of nonsteroidal antiinflammatory drugs (NSAIDs). His alkaline phosphatase was markedly elevated. Etidronate, 20mg/kg/d was used to control the ossification. After 7 months of continual etidronate use, the patient developed periarticular pain with widened growth plates, suggesting a rachitic syndrome. Serum laboratory panel including calcium, phosphorous, alkaline phosphatase, and vitamin D were normal. After 3 months off etidronate, radiological studies showed growth plate calcification, though not before development of bilateral slipped femoral capital epiphyses. Further improvement and resolution of all complications occurred 5 months after discontinuation of etidronate. Rachitic syndromes secondary to didronel use in a clinical setting has not been previously reported. Other possible causes for a rachitic syndromes were not present. Alternate treatments for children with or at risk for HO should be considered.
Brain Injuries↗
Hyperthermia associated with baclofen withdrawal and increased spasticity.
Rapid baclofen withdrawal is known to cause markedly increased spasticity, but high fever associated with this complication has not been reported. We describe a 13-year-old boy with sensory incomplete C1 quadriplegia two years after injury who was on 200mg of baclofen per day for spasticity. Concerns about adverse side effects prompted tapering of his baclofen. Severely increased spasticity was noted with associated hyperthermia to 107 degrees F after the dosage was gradually decreased. Sepsis work-up was negative, head computed tomography scan was unchanged, and electroencephalogram showed no epileptiform activity. Cooling blankets, intravenous diazepam, and return of baclofen to 160mg per day decreased spasticity and normalized body temperature without recurrence of hyperthermia. Possible fever etiology is the hypermetabolic state associated with the acute return of spasticity.
Adolescent↗
Risk factors for heterotopic ossification in children and adolescents with severe traumatic brain injury.
Previous reports on the incidence of heterotopic ossification (HO) in children and adolescents with traumatic brain injury (TBI) have ranged from 3% to 20%. These studies mention HO briefly or address patient cohorts with coma more than three months. We reviewed the medical records of 90 children younger than 19 years old, who were comatose more than 24 hours after TBI. Mean followup was 33.1 months (range = 2 to 128 months). Incidence of HO was 14.4% (n = 13). One to five sites were involved, with hip and knee most frequent, followed by shoulder, elbow, and nonjoint sites. Children with HO were older than 11 years (relative risk [RR] = 18.85, confidence interval [CI] = 3.7, 95.7), had a greater length of coma (RR = 7.22, CI = 1.4, 37.1), and had a greater associated risk for poor functional outcome (RR = 2.89, CI = 1.02, 7.9) compared to those without RO. Multiple limb fractures showed a trend toward association with increased incidence of HO. Other factors, including gender, history of skull fracture, brain CAT scan findings, and presence of spasticity, were not predictive of HO. Eleven children were treated with etidronate, four with nonsteroidal antiinflammatory drugs, and one with surgery. Only three children had residual functional impairments attributed to the presence of HO.
Adolescent↗
Characteristics of pediatric rehabilitation training offered by physical medicine and rehabilitation residencies.
Pediatric physiatry is a growing subspecialty. A survey was designed to determine the nature of pediatric rehabilitation training in physical medicine and rehabilitation residency programs in the United States. Sixty-five programs (93%) responded. More than three quarters of the programs required three months or more in pediatric rehabilitation, usually in the HO-III or HO-IV year. Forty-two percent of the programs had an even balance of inpatient and outpatient clinical opportunities. Approximately half offered exposure to a separate pediatric rehabilitation ward, and 82% placed residents in a general pediatric rehabilitation clinic. Advanced training has become more widespread in pediatric rehabilitation, with 46% of the residency programs having preceptors with board certification in pediatrics and physiatry or fellowship training, and 42% of the programs responding offering advanced training opportunities in pediatric rehabilitation.
Child↗
Prosthetics, orthotics, and assistive devices. 1. General concepts.
This self-directed learning module highlights the general concepts and new advances in the area of orthotics and prosthetics. This general overview is part of the chapter on prosthetics, orthotics, and assistive devices for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains essential information on spinal, lower and upper limb orthotics, lower and upper limb prosthetics, juvenile prosthetics, kinesiology, motion analysis, and assistive devices such as canes and crutches. This article establishes a foundation on which the second, third, and fourth articles of this chapter will build. The three articles to follow review newer developments in specialized seating and assistive devices, prosthetics, and the orthotic management of selected disorders.
Adult↗
Prosthetics, orthotics, and assistive devices. 2. Specialized seating and assistive devices.
This self-directed learning module discusses topics in specialized seating, mobility devices, augmented communication, and adaptive equipment. Development, perceptual-motor, and cognitive factors are addressed in regard to appropriate prescription, training, and follow-up. It is part of the chapter on prosthetics, orthotics, and assistive devices for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation.
Adult↗
Prosthetics, orthotics, and assistive devices. 3. Prosthetics.
This self-directed learning module highlights new advances in prosthetics. It is part of the chapter on prosthetics, orthotics, and assistive devices for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains information regarding conventional and myoelectric upper limb prosthetics, above-knee (AK) socket designs and materials, and foot and ankle systems. New advances that are covered in this section include the narrow medial-lateral AK socket, the flexible AK socket, and new prosthetic foot and ankle systems. Proper understanding and clinical application of this technology is essential for the optimal prosthetic rehabilitation of the amputee.
Artificial Limbs↗
Prosthetics, orthotics, and assistive devices. 4. Orthotic management of selected disorders.
This self-directed learning module presents core information and new advances in the orthotic management of problems of the runner and of patients with neurovascular foot ulcers or arthritis. Additional topics covered include a comprehensive approach to positioning and splinting for burns and tone-reducing orthoses for spasticity management. It is part of the chapter on prosthetics, orthotics, and assistive devices for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation.
Adult↗
Home mechanical ventilation.
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Home Care Services↗
Reduction mammaplasty in adolescents with myelodysplasia.
Macromastia may occur in patients with myelodysplasia and paraplegia. Breast enlargement complicates weight shifts, crutch walking, sitting balance, and personal hygiene. Three patients with macromastia and myelodysplasia who underwent reduction mammaplasty are presented. Their postoperative recoveries were uncomplicated and each was symptomatically improved.
Adolescent↗