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ABSTRACT: Leisure participation has been associated with happiness and well-being in children. Individuals born preterm are at greater risk for motor, cognitive and behavioral difficulties which may contribute to difficulties participating in leisure activities. This systematic review examined the current knowledge on participation in leisure activities in individuals born preterm throughout the lifespan as compared to term born controls. An electronic search of eight databases for articles published up to October 2011 was conducted. The quality of each study was assessed using a standardized checklist. Thirteen studies met the selection criteria. In school-age children, no significant differences were found in activity levels between children born prematurely and term born controls. In adolescents, leisure scores in social activities, hobbies and sports were statistically significantly lower compared to controls. In young adults, differences in frequency and intensity of physical activity were reported compared to term controls. Promoting participation in leisure activities should be encouraged at a young age and continued to adulthood by minimizing the gaps between capabilities and the demands of the tasks and the environment.
Research in developmental disabilities 07/2012; 33(4):1211-20. · 4.41 Impact Factor
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ABSTRACT: Children with musculoskeletal conditions experience muscle weakness, difficulty walking and limitations in physical activities. Standard treatment includes physiotherapy, casting, and surgery. The use of botulinum toxins appears as a promising treatment on its own, but usually as an adjunct to other treatment modalities and as an alternative to surgery. The objectives were to establish the evidence on the effectiveness, safety and functional outcome of BTX-A in children with musculoskeletal conditions. A literature search using five electronic databases identified 24 studies that met our inclusion criteria. Two randomized clinical trials were included; most studies were case studies with small sample sizes and no control group. Improvements in gait pattern, function, range of motion, reduction of co-contractions, and avoidance of surgical procedures were found following BTX-A injections. Adverse events were not reported in 10 studies, minor adverse events were reported in 13 children and there were no severe adverse events. Additional doses appear safe. BTX-A is a promising treatment adjunct in improving functional outcomes in children with musculoskeletal conditions. Future studies including larger samples, longer follow-up periods and a comparison group are required to provide evidence on the effectiveness and safety of this drug in children with musculoskeletal conditions.
International Journal of Pediatrics 01/2012; 2012:898924.
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ABSTRACT: To examine the functional outcomes of children with osteogenesis imperfecta (OI) following initial Fassier-Duval (FD) rodding to the femur at 1 year, and to determine which factors are associated with change in gross motor function, ambulation, and functional performance.
Approval from our Institutional Review Board was obtained. A retrospective chart review identified 60 children (28 males, 32 females) with OI who underwent initial FD femoral rodding (101 rods) and who were receiving bisphosphonates. The mean age of the children was 3 years, 11 months at the initial femoral FD rodding. Two had type I OI, 30 type III, 27 type IV, and one type VI. The maximum length of follow-up was 4 years. Telescoping FD rods were used for the femurs, with surgeries performed one leg at a time, with a 1-week interval. The active range of motion (AROM) of the hips and knees in flexion was measured 4-5 weeks post-initial rodding. Outcomes on the Gillette Functional Assessment Questionnaire (FAQ) Ambulation Scale, the Gross Motor Function Measure (GMFM), and the Pediatric Evaluation of Disability Inventory (PEDI) were compared pre-operatively and at 1 year post-surgery using t-tests and multivariate linear regression.
Pre-operatively, the mean FAQ score was 2.0, and this increased to 5.8 at 1 year post-surgery. Statistically significant improvements (P ≤ 0.05) were found on the FAQ, crawling, standing, walking and running, and total domains of the GMFM, and PEDI mobility and self-care from baseline to 1 year. The results from the multivariate linear regression indicate that older age (P = 0.0045) and higher weight (P = 0.0164) are significantly associated with lower scores in the self-care domain of the PEDI, and that OI type III compared to type IV is significantly associated (P = 0.0457) with greater improvement on the crawling domain of the GMFM. Higher weight was also associated (P = 0.0289) with lower scores in the standing domain of the GMFM, as well as with the total GMFM score (P = 0.0398).
Our findings indicate that initial FD femoral rodding resulted in benefits in ambulation, gross motor function, self-care, and mobility for children with OI beyond physiological expectations due to developmental growth. FD rodding is a procedure which can improve the overall mobility in children with OI with significant femoral deformities.
Journal of Children s Orthopaedics 06/2011; 5(3):217-24.
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ABSTRACT: Research on quality of life (QoL) of adolescents and young adults born preterm and those with congenital heart disease (CHD) was systematically reviewed, and factors associated with QoL were identified. Forty-five studies met the inclusion criteria for review. Although the majority of studies found that self-reported QoL of adolescents and young adults born preterm did not differ from term controls, several studies reported lower QoL among individuals born preterm, especially those who had additional impairments. Most studies on adolescents and young adults with CHD reported lower QoL compared with healthy peers, which may be in part due to real or perceived physical activity limitations of individuals with CHD. Overall, parents reported that their adolescents born at high risk had a less favorable QoL compared with those who served as controls. Encouraging age-appropriate, safe, and enjoyable physical activity and avoiding unnecessary restrictions and overprotection are considerations for optimizing QoL.
Physical & Occupational Therapy in Pediatrics 05/2011; 31(4):362-89. · 1.21 Impact Factor
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ABSTRACT: To describe the demographic and clinical characteristics of children who presented with open femur fractures.
A retrospective chart review of all children treated for open femur fractures at the McGill University Health Center between 1980 and 2009 was conducted. Thirty-seven patients (28 males and 9 females) were identified. Union was determined clinically by the absence of pain, tenderness to palpation and crepitus with motion. Complications were reported.
The mean age of the patients was 11.5 years (range 2.8-18.1 years). The mechanism of injury involved motor vehicle-related injuries in 70% of cases. There were 13 Grade I, 15 Grade II and 9 Grade III fractures. The treatment involved traction and hip spica in 11 patients, external fixator in nine patients, intramedullary nailing in seven patients, open reduction and internal fixation in six patients, and traction and an ischial weight bearing brace in four patients. Average time to union was 5.1 months (range 1.5-14.4 months). Infections occurred in ten patients, nine had delayed unions, two developed malunions, four had a refracture and four patients developed a limb length discrepancy >2 cm.
Open fractures of the femur are often accompanied by associated injuries, indicating the importance of early and comprehensive treatment. Treatment may include hip spica application in school-age children and solid intramedullary nails in adolescents. In children with multiple injuries, specifically those with higher fracture grades, treatment with an external fixator provides immediate stability of the fracture and allows early mobilization and ease of management of associated injuries.
Journal of Children s Orthopaedics 04/2011; 5(2):101-8.
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ABSTRACT: The objective of this cross-sectional study was to compare the activities and participation in the domains of mobility, self-care, domestic life and social functioning in young adults according to osteogenesis imperfecta (OI) type. Fifty-four former OI patients were invited to participate and were sent a structured questionnaire. Twenty-four patients (mean age: 25.0 years, SD: 2.6 years) with OI types I (n=7), III (n=7), IV (n =8) and V (n=2) completed the questionnaire. Participants with OI type I reported full independence, and only few respondents with OI types IV and V reported some limitations in mobility and domestic life activities. Young adults with OI type III had significantly lower activity scores in aspects of mobility and domestic life and lower levels of participation in employment, sporting activities and transportation. Participation in leisure and social interactions were not different across OI types. Young adults with more severe types of osteogenesis imperfecta have greater activity limitations and participation restrictions. Our findings indicate the importance of promoting and facilitating involvement in meaningful activities and roles in young adults with moderate to severe forms of OI.
Journal of pediatric rehabilitation medicine 01/2011; 4(1):13-22.
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ABSTRACT: Arthrogryposis multiplex congenita is a rare congenital disorder associated with multiple musculoskeletal contractures that causes substantial morbidity. Knee involvement is commonly seen among children with arthrogryposis, with flexion contracture of the knee being the most frequent knee deformity. Knee flexion contractures in the pediatric population are particularly debilitating as they affect ambulation. Treatment for knee flexion contractures requires numerous orthopaedic procedures and an extensive follow-up period. The purpose of this study was to assess the effectiveness of orthopaedic procedures, namely distal femoral supracondylar extension osteotomy and/or Ilizarov external fixator, on the ambulation status of children with knee flexion contracture and whether any functional gains are maintained at the latest follow-up.
All children with arthrogryposis followed at our institution who had surgical correction for knee flexion contractures were included in this study. Fourteen patients were identified and their medical records were reviewed. The etiology for all patients was amyoplasia. The mean age at first surgery was 7.0 years (range, 2 to 16 y). The mean length of follow-up was 59.3 months (range, 12 to 117 mo). Contractures were treated with femoral extension osteotomy (n=8), Ilizarov external fixator (n=1), or both (n=5). Three patients earlier had posterior soft tissue releases, including hamstrings lengthenings, proximal gastrocnemius release, and release of posterior capsule.
Preoperatively, 11 patients were nonambulatory, 2 patients were household ambulators, and 1 patient walked with orthoses in the community. There was an average of 1.8 knee surgeries done per patient, namely distal femoral extension osteotomy and/or Ilizarov external fixator. At the latest follow-up, 8 patients were ambulatory with technical aids (orthosis, walker, braces, or rollator walker), 2 patients were household ambulators, 1 patient used a wheelchair but was independent for transfers, and 3 patients remained nonambulatory. The mean flexion contracture before the first surgery was 63.7 ± 26.8 degrees. Postoperatively, the mean flexion contracture was 13.2 ± 16.7 degrees. At the latest follow-up, the mean flexion contracture was 34.0 ± 24.1 degrees. There were complications in 2 patients, including infected hardware which resolved with antibiotic treatment, and neurologic compromise which resolved on its own.
Surgical correction of knee flexion deformities by distal femoral extension osteotomy and/or Ilizarov external fixator was effective in improving the ambulation status of children with arthrogryposis. At latest follow-up, the gradual loss of total arc of motion and the recurrence of knee flexion contractures did not limit the ambulatory gains achieved.
IV, Case series.
Journal of pediatric orthopedics 12/2010; 30(8):863-9. · 1.23 Impact Factor
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ABSTRACT: This article presents a study that compared participation by elderly individuals living in the community according to primary transportation mode used, and estimated the association between transportation, personal factors, and environmental factors. Participants included 90 adults aged 65 and older (M=76.3 years; SD=7.7). They were classified according to their primary transportation mode: driver, passenger, public transport user, walk, or adapted transport/taxi user. Participation was measured with the Craig Handicap Assessment and Reporting Technique (CHART) and the Nottingham Leisure Questionnaire (NLQ). Overall, results indicated that drivers, public transport users, and walkers had higher participation levels compared to passengers and adapted transport/taxi users. This study suggests that clinicians should consider older adults' use of transportation in an attempt to encourage and maximize their participation.
Canadian journal on aging = La revue canadienne du vieillissement 12/2010; 29(4):491-502. · 0.92 Impact Factor
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ABSTRACT: External fixator treatment (EFT) of lower limb deformities is expected to optimize gait and physical appearance, which might improve the child's health-related quality of life (HRQOL). Although EFT can impose a significant psychologic burden on the children and their families, there is a lack of studies on the HRQOL of children undergoing EFT. The purpose of this paper is to determine the construct validity and the responsiveness of the Pediatric Quality of Life Inventory (PedsQL) generic module in children with lower limb deformities undergoing EFT and to describe the use of other outcome measures in this population.
Fifty-two children (mean age: 13.0 y, SD: 4.2) who enrolled in the pilot phase of a randomized controlled trial to examine the safety and efficacy of botulinum toxin type A injections in children undergoing EFT of the lower limb were included in this study. Pain and functional mobility were measured at baseline. HRQOL was assessed with the child self-report and parent proxy-report formats of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) at baseline, at mid-distraction, mid-consolidation, 1-week post-frame removal, and 3 months post-frame removal time points. The known groups method was used to measure the construct validity of the PedsQL; paired t tests, Cohen's d estimate of effect size (ES) and standardized response mean were used to calculate its responsiveness.
Children and parents reported significantly lower HRQOL scores on all PedsQL domains compared with norms. ES and standardized response mean calculations both show largest amounts of change in the Physical Health domain, with children and parents reporting worse HRQOL at mid-distraction than at baseline. The PedsQL shows statistically significant changes only in the emotional functioning score of the child self-report from 3 months post-frame removal compared with baseline.
The PedsQL is able to discriminate HRQOL between children with leg length discrepancy and the normal population. The responsiveness of the PedsQL in children with lower limb deformities was shown through patient change over time as a result of EFT. Our findings indicate the importance of assessing a wide range of domains including physical, psychosocial, and emotional components of health in children with leg length discrepancy undergoing EFT.
Level IV. Case series.
Journal of pediatric orthopedics 12/2009; 29(8):920-6. · 1.23 Impact Factor
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ABSTRACT: Numerous studies have described the use of osteogenic protein-1 (OP-1) in adults, but there are few reports in children. The objectives of this short-term followup cohort study were (1) to examine clinical and radiographic healing of persistent nonunions after OP-1 application in children; and (2) to determine the safety of OP-1 use in this sample. Clinical healing was defined by absence of pain and tenderness at the nonunion site and the ability to fully weight bear on the affected limb. Radiographic healing was determined by bony bridging of the nonunion site in at least one view. Safety was defined as the absence of major adverse events, including allergic reactions, infections, local inflammatory reactions, and heterotopic ossification. OP-1 was used in 19 patients who had an operative procedure for the bridging of persistent nonunions between 1999 and 2007. The mean age was 11.6 years (range, 4.8-20.3 years). Thirteen patients had persistent nonunion after one or more previous surgeries, prior to the initial OP-1 application. A single dose of 3.5 mg of OP-1 mixed with 1 g of Type I bovine collagen was applied to 23 sites of 19 patients. Three patients received additional OP-1 applications. Healing occurred clinically and radiographically in 17 of the 23 sites. Complications included four superficial pin site infections, one deep infection, and two fractures. No major local adverse event related to OP-1 application was noted in our sample. Our findings suggest OP-1 stimulates healing of persistent nonunions without major adverse events in our patient population. LEVEL OF EVIDENCE: Level IV, case series. See the guidelines online for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 08/2009; 467(12):3230-8. · 2.53 Impact Factor
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Reggie C Hamdy,
Kathleen Montpetit,
Ellen M Raney,
Michael D Aiona,
Ramona R Fillman,
William MacKenzie,
James McCarthy,
Ross S Chafetz,
Susan Sienko Thomas,
Cynthia M Tamayo,
Aaron G Littleton,
Joanne Ruck-Gibis,
Susan N Takahashi,
Mario Rinaldi,
G Allen Finley,
Robert W Platt, Noémi Dahan-Oliel
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ABSTRACT: The Ilizarov technique is commonly used for lengthening and deformity corrections of the lower limbs in children. Postoperative pain can be significant, affecting quality of life and functional mobility, and often requiring prolonged medication use. Several studies have investigated the antinociceptive actions of botulinum toxin type A (BtX-A), yet evidence for its use in this population is limited. The objectives were to (1) establish the feasibility of a randomized clinical trial in children undergoing limb lengthening or deformity correction and (2) provide preliminary evidence of the beneficial effects of BtX-A in this population.
Fifty-two patients with a mean age of 13.7 years (range, 5 to 21 y) were randomized to receive either BtX-A or an equivalent volume of sterile saline solution (placebo group), as a single dose during the surgical procedure. Pain, medication use, quality of life, and functional mobility outcomes were assessed in all patients. Adverse events were reported for all patients and classified as minor or major.
Differences between groups did not reach statistical significance; however, pain at mid-distraction was found to be slightly lower in the BtX-A group, as compared with the placebo group. Patients in the BtX-A group used less parenteral pain medication in the first 4 days after the surgery, had higher quality of life scores at 3 of the 5 time points assessed, and slightly higher functional mobility scores. All adverse events were expected complications of the lengthening process. No event was considered to be a serious adverse event related to the BtX-A injection itself. There was a trend toward fewer major adverse events in the BtX-A group.
This pilot study established the feasibility of a randomized controlled trial design for in this population. Its findings indicate that BtX-A injections appear to be safe and effective for reducing pain and improving the quality of life and functional mobility of children undergoing lengthening or deformity corrections of the lower limbs. A larger-scale study is currently underway to confirm these preliminary findings.
Journal of pediatric orthopedics 06/2009; 29(5):427-34. · 1.23 Impact Factor
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ABSTRACT: Introduction: Care Coordination is the health care delivery model that has been implemented in the prosthetic clinic at the Shriners Hospital for Children - Canada. In delivering comprehensive, family-centered services, it is important to evaluate the extent to which patients and families perceive coordinated care to occur. Aim: To evaluate the delivery of Care Coordination services to our patients and families in the prosthetic clinic, and to identify strengths and areas for improvement. The time required to provide coordinated care was also evaluated. Methods: The MPOC-20 was administered to the parents of 23 lower extremity deficiency or amputee patients seen in the prosthetic clinic over a 14-month period. Results: Providing coordinated and comprehensive care related to involving families as part of the team was the most frequently reported strength of the prosthetic clinic Care Coordination. Providing information to families about their child's progress and having information and resources available were areas identified as needing improvement by approximately 30% of respondents. Those with complex health needs required five times the amount of Care Coordination devoted time than the average patient. Conclusions: The MPOC-20 proved to be a useful tool to highlight areas for improvement in the prosthetic clinic and to validate aspects of care coordination that were appreciated by families.
Journal of pediatric rehabilitation medicine 01/2009; 2(3):209-15.
