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Chaudhry S. Upper Extremity Care for Children: Unique Medical and Psychosocial Aspects. J Hand Surg Am 2019; 44:606-609. [PMID: 30551917 DOI: 10.1016/j.jhsa.2018.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
Hand surgeons encountering pediatric patients should be attuned to both technical and practical facets of caring for congenital and traumatic pathologies. Psychosocial aspects include engaging children in conversation and factoring in both self and external perception of deformity. Medical considerations are also unique, from including child abuse in the differential to having techniques to assess active motion and sensation in the nonverbal child. Certain universal principles, such as minimizing radiation exposure and limiting needle sticks, have higher emphasis in pediatric patients than in adults. With these aspects in mind, treating children and their families can be a mutually rewarding experience.
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Affiliation(s)
- Sonia Chaudhry
- Department of Pediatric Orthopaedic and Hand Surgery, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT.
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Beste C, Ocklenburg S, von der Hagen M, Di Donato N. Mammalian cadherins DCHS1-FAT4 affect functional cerebral architecture. Brain Struct Funct 2015; 221:2487-91. [PMID: 25930014 DOI: 10.1007/s00429-015-1051-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/22/2015] [Indexed: 11/25/2022]
Abstract
Cortical development is a complex process where a multitude of factors, including cadherins, plays an important role and where disruptions are known to have far reaching effects in neural development and cortical patterning. Cadherins play a central role in structural left-right differentiation during brain and body development, but their effect on a functional level remains elusive. We addressed this question by examining functional cerebral asymmetries in a patient with Van Maldergem Syndrome (VMS) (MIM#601390), which is caused by mutations in DCHS1-FAT4 cadherins, using a dichotic listening task. Using neurophysiological (EEG) data, we show that when key regulators during mammalian cerebral cortical development are disrupted due to DCHS1-FAT4 mutations, functional cerebral asymmetries are stronger. Basic perceptual processing of biaurally presented auditory stimuli was unaffected. This suggests that the strength and emergence of functional cerebral asymmetries is a direct function of proliferation and differentiation of neuronal stem cells. Moreover, these results support the recent assumption that the molecular mechanisms establishing early left-right differentiation are an important factor in the ontogenesis of functional lateralization.
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MESH Headings
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/physiopathology
- Abnormalities, Multiple/psychology
- Acoustic Stimulation
- Adolescent
- Cadherin Related Proteins
- Cadherins/genetics
- Cadherins/physiology
- Cerebral Cortex/physiopathology
- Child
- Craniofacial Abnormalities/genetics
- Craniofacial Abnormalities/physiopathology
- Craniofacial Abnormalities/psychology
- Dichotic Listening Tests
- Electroencephalography
- Evoked Potentials, Auditory
- Foot Deformities, Congenital/genetics
- Foot Deformities, Congenital/physiopathology
- Foot Deformities, Congenital/psychology
- Functional Laterality
- Hand Deformities, Congenital/genetics
- Hand Deformities, Congenital/physiopathology
- Hand Deformities, Congenital/psychology
- Humans
- Intellectual Disability/genetics
- Intellectual Disability/physiopathology
- Intellectual Disability/psychology
- Joint Instability/genetics
- Joint Instability/physiopathology
- Joint Instability/psychology
- Male
- Mutation
- Tumor Suppressor Proteins/genetics
- Tumor Suppressor Proteins/physiology
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Affiliation(s)
- Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Schubertstrasse 42, 01309, Dresden, Germany.
| | - Sebastian Ocklenburg
- Institute for Cognitive Neuroscience, Biopsychology, Ruhr Universität Bochum, Bochum, Germany
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Nataliya Di Donato
- Faculty of Medicine, Institute for Clinical Genetics, TU Dresden, Dresden, Germany
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Verhoeven WMA, Egger JIM, Hoogeboom AJM. X-linked Aarskog syndrome: report on a novel FGD1 gene mutation. Executive dysfunction as part of the behavioural phenotype. Genet Couns 2012; 23:157-167. [PMID: 22876573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aarskog-Scott syndrome [OMIM 100050] is a predominantly X-linked disorder that is phenotypically characterized by short stature, craniofacial dysmorphisms, brachydactyly and urogenital abnormalities. The level of intelligence shows a great variability and no specific behavioural phenotype has been described so far. In about 20 percent ofAarskog families, a mutation in the FGD1 gene located in Xp11.21 can be identified. In the present study, four affected males from the fourth generation of a large Dutch family (published in 1983 by Van de Vooren et al. (41)) are described. A novel FGD1 missense mutation (R402W) at position 1204 (1204C>T) was demonstrated. In the patients, the level of intelligence varied between normal and severely disabled. Their behavioural profile showed, among others, elements of attention deficit hyperactivity disorder, primarily reflected by impaired executive attentional processes that may be sensitive to systematic training.
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MESH Headings
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/psychology
- Adolescent
- Adult
- Attention Deficit Disorder with Hyperactivity/diagnosis
- Attention Deficit Disorder with Hyperactivity/genetics
- Attention Deficit Disorder with Hyperactivity/psychology
- Chromosomes, Human, X/genetics
- Cognition Disorders/diagnosis
- Cognition Disorders/genetics
- Cognition Disorders/psychology
- Dwarfism/diagnosis
- Dwarfism/genetics
- Dwarfism/psychology
- Face/abnormalities
- Genetic Diseases, X-Linked/diagnosis
- Genetic Diseases, X-Linked/genetics
- Genetic Diseases, X-Linked/psychology
- Genitalia, Male/abnormalities
- Guanine Nucleotide Exchange Factors/genetics
- Hand Deformities, Congenital/diagnosis
- Hand Deformities, Congenital/genetics
- Hand Deformities, Congenital/psychology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/psychology
- Humans
- Intellectual Disability/genetics
- Intellectual Disability/psychology
- Male
- Mutation, Missense/genetics
- Neuropsychological Tests/statistics & numerical data
- Polymorphism, Single-Stranded Conformational/genetics
- Young Adult
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Affiliation(s)
- W M A Verhoeven
- Vincent van Gogh Institute for Psychiatry, Centre of Excellence for Neuropsychiatry, Venray, The Netherlands.
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Krekel NMA, Smeulders MJC, Klaij F, Margry R, Kreulen M. [Effect of surgical treatment on patients with cerebral palsy: improvement of manual dexterity but not of perceived competence]. Ned Tijdschr Geneeskd 2010; 154:A1527. [PMID: 20719005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To examine the relationship between impaired manual dexterity and perceived competence in children with cerebral palsy and the effect of surgical intervention, with the question whether the perceived competence is applicable as an outcome measure for surgical reconstruction of hand function. METHOD The Dutch version of the Michigan Hand Outcomes Questionnaire (MHQ-DLV) for perceived manual dexterity and the Dutch version of the Harter Scales for perceived competence were used in a sample of 25 children and adolescents with hemiplegic cerebral palsy of the spastic type. 10 patients underwent surgical treatment to improve hand function. In this 'surgical group' both questionnaires were repeated at least one year postoperatively. RESULTS Perceived manual dexterity was low (mean MHQ-DLV-score: 63.2; SD: 18.9), as were the scores of perceived overall competence (2.92; SD: 0.84), social competences (2.66; SD: 0.92) and athletic competences (2.29; SD: 0.79). There was no correlation between the degree of perceived impairment in manual dexterity and the perceived competence (r = -0.16; p = 0.43). After surgical reconstruction manual dexterity improved (mean increase in score: 24; SD: 10.4; p < 0.01), but perceived competence did not improve (p = 0.39). CONCLUSION Children with cerebral palsy and impaired manual dexterity did have a lower perceived competence than children without this disorder. The extent to which manual dexterity was impaired did not correlate with the extent to which perceived competence was lowered. Surgical intervention substantially improved perceived manual dexterity, but perceived competence did not improve. Perceived competence does not seem to be applicable as an outcome measure for surgical reconstruction of manual dexterity.
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Affiliation(s)
- Nicole M A Krekel
- Academisch Medisch Centrum, afd. Plastische -, reconstructieve- en handchirurgie, Amsterdam, the Netherlands
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Baker S. Beating disability, embracing motherhood. Pract Midwife 2003; 6:16-7. [PMID: 12886835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Abstract
The psychological approach to congenital malformation is determined by the stares of the others and the individual's needs. The relationship of the body of the person afflicted with a congenital malformation is a question of aesthetic suffering and not of functional use. Caught up in a network of a priori and anxiety-based projections, it is difficult for patients, children, adolescents or adults, to express themselves and make themselves heard. This multi-faced issue poses a basic problem for a society, which penalizes physical deformity. Beyond the medical techniques, the subject's ethic has to be considered.
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Abstract
AIM To test the hypothesis that overall intelligence quotient (IQ) is decreased in patients with Aarskog syndrome. METHODS 21 boys under 17 years of age with a confirmed clinical diagnosis of Aarskog syndrome were assessed using the Griffiths mental development scales and the British ability scales. RESULTS IQ ranged from 68 to 128 and followed a normal distribution. CONCLUSION This study does not support the hypothesis that Aarskog syndrome is associated with a lowering of mean IQ.
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Affiliation(s)
- L J Logie
- Human Genetics Unit, University of Edinburgh, Molecular Medicine Centre, Western General Hospital, UK
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Abstract
We report on 3 sibs (2 boys and a girl) with a previously apparently unrecognized combination of anonychia congenita and microcephaly with normal intelligence. The shape of the head is normal. Other anomalies include clinodactyly of the fifth fingers and bilateral single transverse palmar creases. Skeletal survey was normal in the 2 older children. These children and their first-cousin Iranian parents have widely spaced teeth. The children's first cousin also has total anonychia congenita and apparently small head. We review anonychia congenita, and conclude that the presently reported family with a "new autosomal-recessive disorder" provides further evidence of the heterogeneity of this condition.
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Affiliation(s)
- A S Teebi
- F. Clarke Fraser Unit of Clinical Genetics, Montreal Children's Hospital, Quebec, Canada
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Abstract
Forty children with congenital (85%) or acquired hand disorders underwent transfer of one or two toes to one hand. The children were reviewed with their parents and assessed for functional and psychosocial performance. There was some evidence that the older the child at the time of transfer, the better the range of motion. The passive range of motion was on average 60 degrees more than the active range of motion despite subsequent procedures such as tenolysis. All transfers recovered protective sensibility and the majority recovered good levels of two point discrimination and light touch perception. Almost all transfers were naturally incorporated into the use pattern of the limb for some or most of the time. Most parents and patients reported a very positive effect of this surgery on the child's psychosocial functioning.
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Affiliation(s)
- S P Kay
- Department of Plastic Surgery, St James's University Hospital, Leeds, UK
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Bucher P, Monsivais DB. Gaining commitment to rehabilitation: importance of preoperative assessment. Plast Surg Nurs 1996; 16:234-239. [PMID: 9060768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Assessment and psychological concerns in caring for the child and parents contemplating pediatric microsurgery to repair hand defects are issues nurses will face. Assessing the patient's perception of self, assessing the perception of expected postoperative results, and assessing the parents' adjustment to the disability will be discussed in this article.
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Affiliation(s)
- P Bucher
- Denton Regional Medical Center, TX, USA
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Abstract
This paper is based on a prospective study of microvascular toe transfers which examined psychosocial, functional and aesthetic outcome for children with congenital hand anomalies and their parents. 14 families were assessed both pre-operatively and 2 years post-operatively. There were five boys and nine girls. Their ages ranged from 6 months to 13 years (mean age = 5.08 years). The parents were assessed on the basis of a parental adjustment measure, a detailed semi-structured interview and a measure of anxiety and depression. The children were assessed on the basis of behaviour and social competence, social experience, self-consciousness about the hand and the perceptions of their own functional competence. Both parents and children were asked to rate their satisfaction with the hand. In addition, function and appearance was assessed using an independent professional panel. It was found that parental adjustment to the hand was an important independent variable in determining psychosocial outcome. The children of poorly-adjusted parents had more social and psychological problems prior to surgery, and showed an increase in behavioural problems after surgery. Their parents were less anxious and happier after surgery and it was of particular benefit to them. The children of well-adjusted parents had fewer pre-operative problems and showed a general slight improvement after surgery. For all the children, there was a significant improvement in both function and appearance of the hands after surgery.
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Abstract
When a baby is born with a visible disfigurement, then parents need to adjust to the loss of the anticipated 'perfect' child and thus accept their baby. The impact of the birth on the parents is described in the context of a measure which identifies areas of potential difficulty. The two groups studied were parents of children with cleft palates and parents of children with congenital hand deficit. A wide range of adjustment was found. There was no significant difference between the two groups in terms of their overall adjustment, but there were individual differences in adjustment which did not relate to the severity or type of anomaly. The only significant variable found to relate to parental adjustment was perceived family support.
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Abstract
The task of decision-making about microvascular toe-transfer surgery is a complex one for parents and their children. The process involves balancing risks and benefits within the context of the emotional responses of the parents and the future needs of their children. This paper describes a model of clinical practice which incorporates that process through a multi-disciplinary approach. The factors which influenced parents in their decision are examined, and the issue of the competence of the child to participate is discussed. 34 families were assessed, of whom 7 did not proceed with surgery. It was found that parents were more influenced by factors within the process, such as communication, than by concerns about technical outcome. Specialised psychological counselling played an integral role in the making of stable decisions.
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Affiliation(s)
- E T Bradbury
- Department of Plastic Surgery, St James's University Hospital, Leeds, UK
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André M. [The first 20 years of a handicapped person. Report of his mother]. Dtsch Krankenpflegez 1989; 42:171-4. [PMID: 2518124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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