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Boarini M, Tremosini M, Di Cecco A, Gnoli M, Brizola E, Mordenti M, Pedrini E, Locatelli M, Lanza M, Antonioli D, Gallone G, Rocca G, Staals EL, Trisolino G, Sangiorgi L. Health-related quality of life and associated risk factors in patients with Multiple Osteochondromas: a cross-sectional study. Qual Life Res 2024; 33:1323-1334. [PMID: 38457053 PMCID: PMC11045590 DOI: 10.1007/s11136-024-03604-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To evaluate the health-related quality of life and associated risk factors for Multiple Osteochondromas patients. METHODS A cross-sectional, observational study was conducted from May to December 2022 during the routine visit to the referral center for rare skeletal disorders. All patients with Multiple Osteochondromas aged ≥ 3 years were included. EuroQol 5-dimension questionnaires, and demographic, clinical, and surgical history data were collected. Descriptive statistics, Fisher's exact test, One-sample t-test, Spearman's correlation, and multiple linear and logistic regression were performed to analyze the data. Results are reported following STROBE guidelines. RESULTS A total of 128 patients were included in the study, with a mean age of 14 [SD, 10] years. The mean EQ-5D Index Value was 0.863 [SD, 0.200] and the EQ-VAS was 84 [SD, 19] with a positive correlation between two scores [r = 0.541, p < 0.001]. Patients frequently referred problems in pain/discomfort [78.8%], anxiety/depression [50%], and usual activities [38.8%] dimensions. Increasing age was the common risk factor for health-related quality of life [p < 0.000], as well as Index Value and VAS scores were significantly lower in surgical patients [p = 0.001 and p < 0.001, respectively]. CONCLUSION Increasing age and surgical procedures were found highly associated with reduced health-related quality of life in Multiple Osteochondromas patients. Our findings provide relevant information to support the establishment of patient-centered healthcare pathways and pave the way for further research into medical and non-medical therapeutic strategies for these patients.
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Affiliation(s)
- Manila Boarini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Morena Tremosini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Alessia Di Cecco
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Maria Gnoli
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Evelise Brizola
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Marina Mordenti
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Elena Pedrini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Manuela Locatelli
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Marcella Lanza
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Diego Antonioli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Gallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L Staals
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
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Bailly R, Pons C, Haes AC, Nguyen L, Thepaut M, Houx L, Lempereur M, Brochard S. Bone Deformities through the Prism of the International Classification of Functioning, Disability and Health in Ambulant Children with Cerebral Palsy: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:257. [PMID: 38397369 PMCID: PMC10888000 DOI: 10.3390/children11020257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
(1) Aim: The aim of this study was to determine the relationship between lower limb bone deformities and body functions, activity, and participation in ambulant children with CP and whether changing bone morphology affects outcomes in these domains. (2) Methods: A systematic literature search (PROSPERO CRD42020208416) of studies reporting correlations between measures of lower limb bone deformities and measures of body function, activity or participation, or post-surgical outcomes in these domains was conducted from 1990 to 2023 in Medline, Scopus, and Cochrane Library. We assessed study quality with the Checklist for Case Series (CCS) and a quality assessment developed by Quebec University Hospital. Meta-analysis was not possible; therefore, descriptive synthesis was performed. (3) Results: A total of 12 of 3373 screened articles were included. No studies evaluated the relationships between bone deformities and activity or participation, or the effect of isolated bone surgery on these domains. Correlations between bone deformities and body functions were poor-to-moderate. Internal hip rotation during gait improved after femoral derotation osteotomy. (4) Conclusions: A shift in paradigm is urgently required for the research and management of bone deformities in children with CP to include the activity and participation domains of the ICF, as well as consider more psychological aspects such as self-image.
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Affiliation(s)
- Rodolphe Bailly
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
| | - Christelle Pons
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
- Faculty of Medicine, Western Britany University, 29238 Brest, France
| | - Anne-Charlotte Haes
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- School of Physiotherapy (IFMK), CHRU Morvan, 29200 Brest, France
| | - Lisa Nguyen
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- School of Physiotherapy (IFMK), CHRU Morvan, 29200 Brest, France
| | - Matthias Thepaut
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Faculty of Medicine, Western Britany University, 29238 Brest, France
- Pediatric Surgery Department, University Hospital of Brest, 29200 Brest, France
| | - Laëtitia Houx
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
| | - Mathieu Lempereur
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
| | - Sylvain Brochard
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
- Faculty of Medicine, Western Britany University, 29238 Brest, France
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Skoutelis VC, Kanellopoulos AD, Vrettos S, Dimitriadis Z, Dinopoulos A, Papagelopoulos PJ, Kontogeorgakos VA. Improving health-related quality of life in middle-age children with cerebral palsy following selective percutaneous myofascial lengthening and functional physiotherapy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T57-T63. [PMID: 37995817 DOI: 10.1016/j.recot.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. MATERIAL AND METHODS A single-group pre-posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5-7 years, with Gross Motor Function Classification System levels II-IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. RESULTS After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06 ± 9.05; 95% confidence interval [CI], 7.40-14.71; p < 0.001). CONCLUSIONS This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).
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Affiliation(s)
- V C Skoutelis
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Departamento de Fisioterapia, Laboratorio de Estudio Neuromuscular y Cardiovascular del Movimiento, Facultad de Ciencias de la Salud y el Cuidado, Universidad de West Attica, Egaleo, Grecia; Departamento de Fisioterapia, Hospital General Universitario Attikon, Chaidari, Grecia.
| | | | - S Vrettos
- Centro de Fisioterapia Pediátrica ENA, Chalandri, Grecia
| | - Z Dimitriadis
- Departamento de Fisioterapia, Laboratorio de Investigación sobre Salud y Calidad de Vida, Facultad de Ciencias de la Salud, Universidad de Tesalia, Lamia, Grecia
| | - A Dinopoulos
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Tercer Departamento de Pediatría, Hospital General Universitario Attikon, Chaidari, Greece
| | - P J Papagelopoulos
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Primer Departamento de Cirugía Ortopédica, Hospital General Universitario Attikon, Chaidari, Grecia
| | - V A Kontogeorgakos
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Primer Departamento de Cirugía Ortopédica, Hospital General Universitario Attikon, Chaidari, Grecia
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4
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Chen JX, Shi XL, Liang CS, Ma XG, Xu L. Anesthesia management in a pediatric patient with complicatedly difficult airway: A case report. World J Clin Cases 2023; 11:2482-2488. [PMID: 37123316 PMCID: PMC10130984 DOI: 10.12998/wjcc.v11.i11.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/31/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Reports on perioperative anesthesia management in pediatric patients with difficult airways are scarce. In addition to relatively more difficulties in the technique of endotracheal intubation, the time for manipulation is restricted compared to adults. Securing the airways safely and avoiding the occurrence of hypoxemia in these patients are of significance.
CASE SUMMARY A 9-year-old boy with spastic cerebral palsy, severe malnutrition, thoracic scoliosis, thoracic and airway malformation, laryngomalacia, pneumonia, and epilepsy faced the risk of anesthesia during palliative surgery. After a thorough preoperative evaluation, a detailed scheme for anesthesia and a series of intubation tools were prepared by a team of anesthesiologists. Awake fiberoptic intubation is the widely accepted strategy for patients with anticipated difficult airways. Given the age and medical condition of the patient, we kept him sedated with spontaneous breathing during endotracheal intubation. The endotracheal intubation was completed on the second attempt after the failure of the first effort. Fortunately, the surgery was successful without postoperative complications.
CONCLUSION Dealing with difficult airways in the pediatric population, proper sedation allows time to intubate without interrupting spontaneous breathing. The appropriate endotracheal intubation method based on the patient’s unique characteristics is the key factor in successful management of these rare cases.
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Affiliation(s)
- Jia-Xiang Chen
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
- Department of Anesthesiology, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518038, Guangdong Province, China
| | - Xiao-Li Shi
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
| | - Chang-Sheng Liang
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
| | - Xing-Gang Ma
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
| | - Liang Xu
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
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Liu KB, Guan J, Zang JC, Hua QK, Qin SH. The epidemiological characteristics of neurogenic limb deformity disorder in China: a national-based study from Qin Sihe orthopedic center. BMC Public Health 2023; 23:567. [PMID: 36973707 PMCID: PMC10041791 DOI: 10.1186/s12889-023-15470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Neurogenic limb deformity disorder (NLDD) refers to limb deformity disorders caused by various neurogenic disorders. However, there are no studies to systematically summarize and analyze these diseases in China, and we first proposed the concept of NLDD. We describe the epidemiological characteristics of NLDD in China based on the largest case database of limb orthopedics in China. METHODS This study analyzed parameters from the Qin Sihe Orthopedic Surgery Case Data (QSHOSCD). The database is based on the Rehabilitation Hospital affiliated to National Research Center for Rehabilitation, which has collected nearly 37,000 patients to date and includes a wide variety of limb deformities. The types of diseases are summarized and classified for all patients studied. Statistical analysis was based on the type of etiology, age, regional distribution, and historical surgical volume. Partial outcomes were statistically analyzed separately by common diseases (polio and cerebral palsy) and rare diseases (37 other diseases). RESULTS From 1979 to 2019, 30,194 patients with NLDD were treated surgically for 39 neurogenic disorders. The male to female ratio was 1.48:1, the mean age was 19.65 years, and most patients (82.38%) were aged between 6 and 30 years. Patients included from 32 provinces and cities across China, mainly concentrated in populous central provinces and Heilongjiang Province. The peak of annual surgical procedures was from 1988 to 1994, and the number of annual surgical procedures for common diseases gradually decreased from 1994 onwards, but the trending is opposite for rare diseases. CONCLUSIONS This study is the first to demonstrate the disease types, population characteristics and incidence trends of NLDD in China. It suggests that the prevention and treatment of NLDD should focus on the adolescent population and enhance the treatment of neurogenic diseases that cause limb deformities. The growth and adaption of the Ilizarov technique and its practice in Chinese orthopedic benefits the treatment of neurogenic limb deformity disorders.
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Affiliation(s)
- Kai-Bing Liu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jack Guan
- Bay Area Foot and Ankle Medical Clinic, San Jose, USA
| | - Jian-Cheng Zang
- Department of Orthopaedics, Rehabilitation hospital, National Research Center For Rehabilitation, Beijing, China
- Key Laboratory of Intelligent Control and Rehabilitation Technology, Ministry of Civil Affairs, Beijing, China
| | - Qi-Kai Hua
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Si-He Qin
- Department of Orthopaedics, Rehabilitation hospital, National Research Center For Rehabilitation, Beijing, China.
- Key Laboratory of Intelligent Control and Rehabilitation Technology, Ministry of Civil Affairs, Beijing, China.
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Barth CA, Wladis A, Roy N, Blake C, Kolo SM, O'Sullivan C. Ways to improve surgical outcomes in low- and middle-income countries. Bull World Health Organ 2022; 100:726-732. [PMID: 36324551 PMCID: PMC9589388 DOI: 10.2471/blt.22.287950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022] Open
Abstract
Global surgery initiatives such as the Lancet Commission on Global Surgery have highlighted the need for increased investment to enhance surgical capacity in low- and middle-income countries. A neglected issue, however, is surgery-related rehabilitation, which is known to optimize functional outcomes after surgery. Increased investment to enhance surgical capacity therefore needs to be complemented by promotion of rehabilitation interventions. We make the case for strengthening surgery-related rehabilitation in lower-resource countries, outlining the challenges but also potential solutions and policy directions. Proposed solutions include greater leadership and awareness, augmented by recent global efforts around the World Health Organization’s Rehabilitation 2030 initiative, and professionalization of the rehabilitation workforce. More research on rehabilitation is needed in low- and middle-income countries, along with support for system approaches, notably on strengthening and integrating rehabilitation within the health systems. Finally, we outline a set of policy implications and recommendations, aligned to the components of the national surgical plan proposed by the Lancet Commission: infrastructure, workforce, service delivery, financing, and information management. Collaboration and sustained efforts to embed rehabilitation within national surgical plans is key to optimize health outcomes for patients with surgical conditions and ensure progress towards sustainable development goal 3: health and well-being for all.
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Affiliation(s)
- Cornelia Anne Barth
- Cochrane Switzerland, Unisanté, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Andreas Wladis
- Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nobhojit Roy
- The George Institute of Global Health, New Delhi, India
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Cliona O'Sullivan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Wang XK, Gao C, Zhong HQ, Kong XY, Qiao R, Zhang HC, Chen BY, Gao Y, Li B. TNAP—a potential cytokine in the cerebral inflammation in spastic cerebral palsy. Front Mol Neurosci 2022; 15:926791. [PMID: 36187348 PMCID: PMC9515907 DOI: 10.3389/fnmol.2022.926791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: Several studies have shown the significance of neuroinflammation in the pathological progress of cerebral palsy (CP). However, the etiology of CP remains poorly understood. Spastic CP is the most common form of CP, comprising 80% of all cases. Therefore, identifying the specific factors may serve to understand the etiology of spastic CP. Our research aimed to find some relevant factors through protein profiling, screening, and validation to help understand the pathogenesis of cerebral palsy. Materials and methods: In the current study, related clinical parameters were assessed in 18 children with spastic CP along with 20 healthy individuals of the same age. Blood samples of the spastic CP children and controls were analyzed with proteomics profiling to detect differentially expressed proteins. On the other hand, after hypoxic-ischemic encephalopathy (HIE) was induced in the postnatal day 7 rat pups, behavioral tests were performed followed by detection of the differentially expressed markers and inflammatory cytokines in the peripheral blood and cerebral cortex of the CP model rats by Elisa and Western blot. Independent sample t-tests, one-way analysis of variance, and the Pearson correlation were used for statistical analysis. Results: Through proteomic analysis, differentially expressed proteins were identified. Among them, tissue-nonspecific alkaline phosphatase (TNAP), the gene expression product of alkaline phosphatase (ALPL), was downregulated in spastic CP. In addition, significantly lower TNAP levels were found in the children with CP and model rats. In contrast, compared with the sham rats, the model rats demonstrated a significant increase in osteopontin and proinflammatory biomarkers in both the plasma and cerebral cortex on the ischemic side whereas serum 25 hydroxyvitamin D and IL-10 were significantly decreased. Moreover, serum TNAP level was positively correlated with serum CRP and IL-10 in model rats. Conclusion: These results suggest that TNAP is the potential molecule playing a specific and critical role in the neuroinflammation in spastic CP, which may provide a promising target for the diagnosis and treatment of spastic CP.
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Affiliation(s)
- Xiao-Kun Wang
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
| | - Chao Gao
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
- Henan Key Laboratory of Children’s Genetics and Metabolic Diseases, Zhengzhou, China
| | - He-Quan Zhong
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
| | - Xiang-Yu Kong
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
| | - Rui Qiao
- College of Acupuncture-Massage and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Yunnan, China
| | - Hui-Chun Zhang
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Bai-Yun Chen
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Yang Gao
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Bing Li
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
- *Correspondence: Bing Li https://orcid.org/0000-0001-5709-9396
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Skoutelis VC, Kanellopoulos AD, Vrettos SG, Dimitriadis Z, Kalamvoki E, Dinopoulos A, Papagelopoulos PJ, Vrettos SS, Kontogeorgakos VA. Effects of minimally invasive surgery and functional physiotherapy on motor function of children with cerebral palsy: A non-randomised controlled trial. J Orthop 2021; 27:122-129. [PMID: 34616116 DOI: 10.1016/j.jor.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose This non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP). Methods Fifty-two children with spastic CP aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS. Results There was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 ± 10.46; control mean difference = 2.40 ± 4.62) and E (experimental mean difference = 19.33 ± 11.82; control mean difference = 4.20 ± 6.26) between experimental and control group (p < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group (p < 0.001), but not for the control group (p > 0.05). Conclusion SPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence.
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Affiliation(s)
- Vasileios C Skoutelis
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,Laboratory of Neuromuscular & Cardiovascular Study of Motion, Department of Physiotherapy, School of Health and Caring Sciences, University of West Attica, Egaleo, Attica, Greece.,Department of Physiotherapy, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | | | | | - Zacharias Dimitriadis
- Health and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Efstratia Kalamvoki
- 'Paidokinisi' Pediatric Physiotherapy Practice, Argyroupolis, Attica, Greece
| | - Argirios Dinopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,Third Department of Paediatrics, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Panayiotis J Papagelopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Stefanos S Vrettos
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vasileios A Kontogeorgakos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
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Danzig JA, Katz EB. Musculoskeletal and skin considerations in children with medical complexity: Common themes and approaches to management. Curr Probl Pediatr Adolesc Health Care 2021; 51:101074. [PMID: 34656455 DOI: 10.1016/j.cppeds.2021.101074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The term "children with medical complexity" (CMC) describes a population of heterogeneous genetic and metabolic disorders with multi-system involvement, with shared common abnormalities within the musculoskeletal system. Disorders that affect the central nervous system (CNS) result in abnormal muscular tone, ranging from dystonia and spasticity, to hypotonia, to combinations of both (axial hypotonia with appendicular hypertonia). Abnormal tone can impair movement and function and contribute to development of contractures, progressive scoliosis and hip dislocation. Impaired mobility, chronic illness and polypharmacy can result in fragile bones and increased risk of fracture, which can be difficult to diagnose and associated with pain. Additionally, CMC with impaired ability to communicate, total dependence on caregivers and frequent use of support devices can develop unintended skin injuries. There are a variety of treatments available for CMC with musculoskeletal disorders ranging from physical supports to pharmacologic treatments to surgeries. Medical and surgical treatments can promote changes in tone and support bone health to improve comfort, hygiene and proper positioning. These therapies may also carry significant risk in medically fragile patients. It is important for CMC to have a care team with a good understanding of the patient's overall health and goals of care and that can advocate for the patient to balance optimization of function and reduction of pain while also minimizing risk.
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Affiliation(s)
- Jennifer A Danzig
- Division of General Pediatrics, The Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Elana B Katz
- Center for Rehabilitation, The Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
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