Extremities In Children Research Articles

Safety and efficacy of non-invasive brain stimulation for the upper extremities in children with cerebral palsy: A systematic review.

Safety and efficacy of non-invasive brain stimulation for the upper extremities in children with cerebral palsy: A systematic review.

CAUSES OF PAIN IN THE MUSCLES OF THE LOWER EXTREMITIES IN CHILDREN WITH CEREBRAL PALSY

A high level of muscle spasticity in children with cerebral palsy is one of the causes of degenerative and dystrophic changes in tissues. Against the background of high spasticity, there is a violation of blood flow in the vessels of the lower extremities, which leads to changes in subfascial pressure and the formation of primary pain syndromes. The analysis of the literature shows the need to study the issues related to the mechanism of formation of changes in the muscles and determine the primary causes of pain. Objective. Тo study the mechanism of changes in the muscles of the lower extremities, as well as the primary causes of pain syndrome. Methods. The analysed indicators were obtained during the treatment of 40 patients with cerebral palsy, who were divided into 3 groups depending on the muscle tone disorder. Clinical and instrumental methods were used to examine patients. The data obtained were statistically processed with the determination of M ± m, the coefficient of reliability according to Student’s criteria. Results. According to the results of the study, high spasticity leads to impaired blood flow and increased subfascial pressure in the musculofascial sheaths. There is an inverse correlation between the increase in subfascial pressure, the diameter of the vessel lumen and blood flow velocity. This is one of the causes of degenerative and denervation changes in muscles and fascia. It was proved that the occurrence of primary pain in the lower extremities is caused by various etiological causes: tissue ischemia; increased subfascial pressure; narrowing of pathologically significant anatomical areas in which nerves lie; degenerative and dystrophic changes in the joints. Conclusions. The study found that the cause of changes in the muscles and fascia is a violation of blood flow, a change in subfascial pressure in the musculofascial cases of the lower extremities. The occurrence of pain in the lower extremities in children with cerebral palsy is multifactorial in nature and consists of myofascial, articular, and tunnel syndromes.

Reliability and validity of the Chinese version of the selective control assessment of the lower extremity in children with spastic cerebral palsy.

To assess the reliability and validity of the Chinese version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy (CP). Forty-five children with spastic CP (mean age 7.29 years, SD 2.87 years, rang 4-16 years) were recruited. Internal consistency was measured using Cronbach's α, while test-retest and inter-rater reliability were evaluated using intra-class correlation coefficients (ICC). Construct validity was established through correlation and confirmatory factor analyses. Discriminative validity was assessed by comparing SCALE scores across varying GMFCS levels. The Chinese version of SCALE demonstrates high internal consistency (Cronbach's α = 0.91) and good reliability with ICCs exceeding 0.76 for test-retest and inter-rater assessments. It shows significant correlations with GMFCS (r = -0.76, p < 0.001) and Fugl-Meyer scales (r = 0.79, p < 0.001), confirming its validity. Confirmatory factor analysis supports a well-fitting model (χ 2/df = 1.58, RMSEA = 0.08, SRMR <0.001, GFI = 0.98, AGFI = 0.90, CFI = 0.99, TLI = 0.98), with the latent variable's AVE at 0.59 and CR at 0.88. Discriminative validity is evident in significant differences across GMFCS levels (p < 0.001), notably between levels I and II, I and III, and I and IV (p < 0.05). The Chinese version of SCALE shows good reliability and validity for assessing lower limb selective movement control in children with spastic cerebral palsy in China. https://www.chictr.org.cn/showproj.html?proj=205380, identifier ChiCTR2400083880.

DERMATOSCOPIC PATTERN OF ANGIOMATOID SPITZ NEVUS: A CASE REPORT

Angiomatoid Spitz nevus is a rare histopathological variant of Spitz nevus, most commonly observed on the extremities of children and young adults. Dermatoscopic features of this variant have seldom been reported. We presented a 14-year-old female diagnosed with angiomatoid Spitz nevus based on clinical, dermatoscopic, and histopathological findings.Polarized-light dermatoscopic examination revealed a red structureless background, reticular white lines, lacunae, and surface scaling.

Effects of Whole-Body Vibration Therapy in Weight-Bearing and Non-Weight Bearing Positions for Upper and Lower Extremities on Balance and Cervical Joint Position Sense in Children With Cerebral Palsy.

Cerebral palsy (CP) is a complex pathological entitythat affects muscular control, coordination, proprioception, fine andgross motor abilities, position, stability, and, in some cases, cognition. This study aimed to compare the effects of whole-body vibration therapy (WBVT) in weight bearing and non-weight bearing positions for the upper and lower extremities on balance and cervical joint position sense in children with spastic CP. A randomized controlled trial was carried out on 60 hemiplegic children with spastic CP aged 5-15 years. Following randomization, all participants were allocated into six equal-sized groups based on the application ofWBVT for upper extremities, lower extremities, or both simultaneously in either weight-bearing or non-weight-bearingpositions. Pediatric balance scale (PBS) and laser tracker system were used to assess functional balance and cervical joint position sense. One-way analysis of variancefor Inter-group analysis showed a statistically significant difference among all groups in PBS and cervical joint position sense (p<0.05). WBVT was found to be beneficial in improving balance and cervical joint position sense in both weight-bearing and non-weight-bearing positions for the upper and lower extremities in children with cerebral palsy. However, the simultaneous application of WBVT in weight-bearing positions for both upper and lower extremities showed the most significant improvements in improving both balance and cervical joint position sense, indicating the most efficacious position of this treatment approach in children with cerebral palsy.

Primary intraosseous papillary intralymphatic angioendothelioma of the distal femoral epiphysis: a case report with literature review.

Papillary intralymphatic angioendothelioma (PILA) is an exceptionally rare metastasizing soft tissue tumor. It tends to arise in the subcutaneous tissues of distal extremities in children. Only four intraosseous PILA cases have been reported until now in English language literature. We present a case of PILA arising in the distal femoral epiphysis of a 50-year-old female patient. It started as a relentless pain in her left knee. A plain radiography revealed a radiolucent area in the left internal femoral condyle. Computerized tomography revealed a 1-cm lytic lesion with a sclerotic rim. Magnetic resonance images showed a significant bone marrow edema signal focused on a 1-cm subchondral lesion suggestive of an intraarticular osteoid osteoma. Histologically, the tumor contained vascular channels covered by a single endothelial layer with intraluminal papillary endothelial structures lined with hobnail cells. Immunohistochemically, the cells were positive for ERG, CD31, and D2-40. The tumor underwent cryoablation and 6months later, after local recurrence or tumor persistence, a wide tumor resection was referred. After 7years of follow-up, the patient displayed neither local recurrence nor distant metastases. Primary intraosseous PILAs are exceedingly rare tumors that should be considered in the differential diagnosis of vascular bone tumors.

Comparative assessment of hemodynamic parameters during anesthesia in orthopedic and traumatological operations on the lower extremities in children

Objective. To conduct a comparative analysis of hemodynamic parameters during orthopedic and traumatological operations on the lower extremities in children performed under conditions of multicomponent balanced general and combined anesthesia. Materials and methods. A single-center prospective study. The present study included 60 children aged 6 to 17 years who underwent planned orthopedic and trauma surgery interventions on the lower extremities. Patients were divided into two groups depending on the method of anesthesia: Group 1 (n = 25) - multicomponent balanced general anesthesia, Group 2 (n = 35) - combined anesthesia (multicomponent balanced general anesthesia in combination with regional blocks of the sciatic and femoral nerves). To solve these problems, a comparative analysis of heart rate, systolic, diastolic and mean arterial blood pressure was carried out at seven stages of the study: 1st stage - initial, child on the operating table; 2nd stage - induction of anesthesia; 3rd stage - placement of the laryngeal mask; 4th stage - start of the operation; 5th stage - traumatic stage of the operation; 6th stage - completion of the operation; 7th stage - after removal of the laryngeal mask. Results. In all cases, the surgical interventions were successful. The study found that in the group of children who underwent multicomponent general anesthesia at the 4th (start of surgery), 5th (traumatic stage of surgery) and 6th (end of surgery) stages, heart rate (HR) was higher compared to the group of combined anesthesia. Systolic and mean arterial blood pressure during the traumatic phase of surgery were also higher in children undergoing multicomponent general anesthesia. The values of diastolic blood pressure did not differ between groups throughout the study with the exception of the 3rd stage (laryngeal mask placement) where lower values were observed in patients of the Group 1. Diastolic blood pressure values did not differ between groups throughout the study, with the exception of 3th stage (laryngeal mask placement), where lower values were noted in Group 1 patients. Conclusion. Combined methods of anesthesia based on the combination of multicomponent general anesthesia and conductive peripheral nerve blocks provide the greatest hemodynamic stability during orthopedic and traumatologic surgeries on the lower extremities in children.

A preliminary study on the spasticity reduction of quadriceps after selective dorsal rhizotomy in pediatric cases of spastic cerebral palsy.

This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR). A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2. Muscle tone and motor function were assessed before the operation, at short-term follow-up and at the last follow-up after SDR. Additionally, intraoperative neurophysiological monitoring data were reviewed. The study comprised 20 eligible cases, where, prior to surgery, 35 quadriceps muscles exhibited spasticity exceeding modified Ashworth Scale grade 2. Following short-term and mid-term follow-up, specifically an average duration of 11 ± 2 days and 1511 ± 210 days after SDR, it was observed that muscle tension in adductors, hamstrings, gastrocnemius, and soleus decreased significantly. This reduction was accompanied by a decrease in quadriceps muscle tone in 24 out of 35 muscles (68.6%). Furthermore, the study found that intraoperative electrophysiological parameters can predict postoperative spasticity relief in the quadriceps. The triggered electromyographic (EMG) output of the transected sensory root/rootlets after single-pulse stimulation revealed that the higher the EMG amplitudes in quadriceps, the greater the likelihood of postoperative decrease in quadriceps muscle tension. SDR demonstrates the potential to reduce muscle spasticity in lower extremities in children diagnosed with CP, including a notable impact on quadriceps spasticity even they are not targeted in SDR. The utilization of intraoperative neurophysiological monitoring data enhances the predictability of quadriceps spasticity reduction following SDR.

Effect of Solitary Osteochondroma on Alignment and Length in the Lower Extremities.

There is a lack of information about the effects of untreated solitary osteochondroma (SO) on longitudinal growth of the lower extremities in children and adolescents. This study aimed to assess the coronal alignment and length of the lower extremity in patients with SO around the knee and to identify the factors related to the development of deformities. We retrospectively reviewed 111 patients diagnosed with SO around the knee. The patients were classified into 2 groups depending on the location of the SO: 51 in the distal femur and 60 in the proximal tibia. Characteristics of the lesions, such as type, location, size, and distance from the joint line, were determined. Radiographic analysis of the lower limbs included mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, whole-leg length, femoral length, and tibial length. The mean age at the time of diagnosis was 12.3±3.4 years. No statistically significant differences were found between the affected and contralateral sides for mechanical lateral distal femoral angle and mechanical medial proximal tibial angle in either the distal femur or the proximal tibia groups. In patients with femoral lesions, the femoral and whole-leg lengths were significantly shorter on the affected side than on the unaffected side ( P <0.001 and 0.002, respectively), and the mean differences were 2.1±3.6 and 2.1±4.4mm, respectively. Univariate logistic regression analysis did not reveal any factors associated with limb length discrepancy (LLD). In patients with tibial lesions, no statistically significant differences were found in LLD. SOs around the knee did not cause clinically significant deformity of the lower extremity. However, in contrast to proximal tibia lesions, SO in the distal femur was associated with the shortening of the affected limb. Consideration should be given to the development of LLD in skeletally immature children with SO in the distal femur. Level III-retrospective comparative study.

Mechanotransduction and Biomechanical Properties of Bone Tissue as a Basis for the Use of Intraosseous Osteopathic Techniques

The development and maintenance of bone mass is critical to movement, health, and quality of life. Bone mass is regulated by various factors, activation of biologically active substances, enzymes, including changes in mechanical load. The osteocyte network provides a wide-ranging load monitoring "network" that penetrates every cubic millimeter of bone tissue. Deformities or trauma create a limitation that can cause asymmetric bone growth, such as plagiocephaly. A deep understanding of the cellular mechanisms responsible for bone remodeling as well as bone mechanotransduction is essential for the development of effective exercise, osteopathic techniques, and pharmaceutical strategies to increase and/or prevent bone loss. This review summarizes current data on the main molecular mechanisms involved in bone mechanotransduction, which provides insight into bone tissue, methods of working with it, and points of application for correcting various dysfunctions to promote bone growth in length. This process is carried out by increasing the proliferation of chondrocytes and the activity of growth plates. This contributes to the correction of such consequences of intraosseous dysfunctions as the development of anatomical differences in the size of the lower extremities in children.

Https://universepg.com/journal-details/ejmhs/outcome-of-early-versus-delay-hip-spica-casting-for-children-with-femoral-shaft-fractures

Femoral shaft fractures are among the most prevalent fractures of the lower extremities in children. Although many approaches and options are available for their treatment, the most appropriate treatment option for school going children is still debatable. In this study 34 children with femoral fractures were recruited between Jan. 2018 and Jan 2019 at the Nangarhar university and public health Hospital. which is divided into two groups: (Group-A) immediate reduction with hip Spica consists 22 children and (Group -B) treatment consist of skin traction for 2-3 weeks precede with hip Spica casting consists 12 children and we studied gender distribution, fracture side, site and type of the fracture, also we note complications include; initial shortening, axial, sagittal and rotational alignment and hospital stay. All patients were under observation for a period of 3 months after removal of Spica cast. The study found that boys were more affected than girls, which the middle third of the femoral shaft was the most common site fracture (58.92%), that the spiral fracture was the most common type of femoral shaft fracture (43.18%), as well as that side way alignment was observed more than other kinds of complications in both treatment modalities; for immediate Spica, four children (18.18%) and three cases (25%).Conclusions: There was minimal difference between early and delayed Spica in terms of treatment complications and functional result. However, early Spica greatly reduced hospitalization time and treatment costs while producing equivalent results as delayed Spica use.

A cruel invasion of Ewing's sarcoma of the skull: A rare case report

Ewing's sarcoma, a highly malignant bone tumor, typically affects the pelvis and long bones of the lower extremities in children and young adults; primary involvement of the skull is rare. Primary Ewing's sarcoma arising from the skull is very rare. In most cases, this disease is fatal, although the prognosis of Ewing sarcoma improves with radiation and chemotherapy after surgery. This case is about 25-year-old woman who was referred to Omid Hospital in Urmia because of frequent headaches, where a tumor mass was found according to the results of CT scan. Biopsy confirmed small round cell sarcoma as the diagnosis. Chemotherapy was ineffective and tumor growth was unstoppable, causing the patient to die after 3 months. Ewing's sarcoma can affect various parts of the human body, including bone and soft tissue, but rarely the skull. Ewing's sarcoma typically grows extradural and often reaches a very large size before invading the skull or being detected clinically. In most cases, Ewing's sarcoma is fatal, although the prognosis of this disease improves with radiation and chemotherapy after surgery.

Comparison of the Effectiveness of Conventional Physiotherapy Methods and Robot-Assisted Gait Training after Botulinum Toxin Injection of Lower Extremities in Children with Cerebral Palsy: Prospective Randomized Controlled Study

AbstractThere are increasing numbers of studies regarding robot-assisted gait training thanks to technological developments and whether it is superior to conventional physiotherapy methods draws attention. This study aimed to compare the effectiveness of conventional physiotherapy methods and robot-assisted gait training in children with cerebral palsy receiving botulinum toxin injection of lower extremities. A total of 28 patients who were followed up in our clinic and had received botulinum toxin injection of lower extremities in the last month were randomized into two groups in the study. First group received conventional physiotherapy (range of joint motion [ROM], stretching, gait training, etc.), and the other group received robot-assisted gait training. The study population was evaluated pre- and posttreatment regarding their ROM, spasticity, gross motor function, balance, functional independence, and gait analyses. When we look at the responses of the patients before and after treatment, a statistically significant change was observed in all fields when comparing before treatment with after treatment (p &lt; 0.05), but there was no statistically significant difference between the groups. We find that both conventional physiotherapy methods and robot-assisted treatments after botulinum toxin injection of lower extremities in children with cerebral palsy were efficient; however, one of both methods was not superior to the other. In addition, further large-scale studies with long-term follow-ups on the comparison of treatment methods are needed.

Association of activities of daily living and cognitive function with thickness of the upper extremity muscles in children and adults with cerebral palsy

We examined the association of activities of daily living (ADL) and cognitive function with the upper extremity muscle thickness and upper extremity range of motion (ROM) and spasticity in children and adults with cerebral palsy (CP). The subjects were 20 children and adults with CP. The ADL performed using the upper extremities and cognitive function were assessed using the self-care domain of the Pediatric Evaluation of Disability Inventory (PEDI) and the full-scale intelligence quotient (FSIQ) of the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV), respectively. The WISC-IV was assessed in only seven of 20 subjects able to undergo evaluation. The thickness of the upper extremity muscles was measured using an ultrasound imaging device. Moreover, ROM and spasticity of the upper extremities were assessed using the Modified Ashworth Scale (MAS). Manual manipulation ability was also assessed using the Manual Ability Classification System (MACS). Stepwise regression analysis revealed that the extensor digitorum muscle thickness and MACS level were significant and independent factors of self-care in the PEDI. Partial correlation analysis with MACS level and age as control variables showed that the FSIQ of the WISC-IV was significantly associated with the thickness of the anterior fibers of the deltoid and flexor digitorum superficialis muscles. Reduced ADL performed using the upper extremities is associated with decreased extensor digitorum muscle thickness rather than ROM and spasticity of the upper extremities in children and adults with CP.

Evaluation of the strength of the upper extremity in children with hemiplegia after stroke: a case series study

The brain is a system with multidimensional organization and architecture and requires a continuous supply of blood in order to normally function. If blood flow is interrupted for more than a few seconds, the brain is deprived of blood and oxygen, causing death in nerve cells in the affected area. Stroke in children after birth appears even more rarely than in adults. For the study, 10 children with hemiplegic cerebral palsy (7 boys and 3 girls) participated (mean age 10, 9 years), from the “General Hospital Hippocratio” of Thessaloniki, according to the inclusion criteria. The strength of the upper extremity was measured using the Jamar dynamometer and for the assessment of the balance the pediatric balance scale (PBS) affected and contralateral hands, results were analyzed and compared with norms for age and sex and related to the affected balance. It was found that the strength of the non-affected upper extremities was also reduced according to the data of the normal children and the balance was also affected because of the stroke. Physiotherapy programs may include exercises that give emphasis on the non-affected upper extremities, more similar research must be done on a bigger population.

Exploration of the relationship between functional motor and communication performance levels and amount of use of the more affected upper extremity based on the caregivers’ perceptions in children with hemiplegic cerebral palsy: A cross-sectional study

ObjectiveTo investigate relationships between amount of use of the more affected upper extremity and functional motor and communication performance classification systems. Material and methodsThe study comprised 95 children with congenital hemiplegic cerebral palsy (CP) aged 6–15 years (52 males, 43 females; mean age 9.53, SD 3.1) and their parents/caregivers. The amount of use of the more affected upper extremity was assessed using Pediatric Motor Activity Log-Revised-How Often subscale (PMAL-R HO). Functional levels of the enrolled children were defined by the parents/caregivers using Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), and Communication Function Classification System (CFCS). ResultsA strong and negative correlation was found between PMAL-R HO subscale score and MACS (r=−0.819), suggesting that children with lower MACS levels are more likely to use their more affected upper extremity spontaneously. Additionally, negative and moderate associations between PMAL-R HO subscale score and GMFCS and CFCS were revealed (r1=−0.549 and r2=−0.567). ConclusionThe amount of use of the more affected upper extremity is more sensitive to MACS than GMFCS-E&R and CFCS. Children with a given MACS level had a wide range of PMAL-R HO subscale score. In addition to MACS, a score on the PMAL-R HO subscale related to the more affected upper extremity should be included as an inclusion criterion in clinical trials to avoid misleading effects of intervention approaches aimed at improving the amount of use of the more affected upper extremity in children with congenital hemiplegic CP.

Efekat robotski potpomognutog hoda i tradicionalnog treninga na motorička oštećenja kod dece sa cerebralnom paralizom

Aims. The aim of the study was to assess the effectiveness of robotic-assisted gait treadmill training (Lokomat) as an adjunct to traditional physiotherapy in improving the range of motion, muscle strength and decreasing spasticity in lower extremities in children with cerebral palsy. Materials and Methods. Twenty-six participants, with mean 7.69 ± 2.90 years, levels I-IV on Gross Motor Classification System (38.5% level I-II and 61.5% level III-IV) with a bilateral and unilateral form of cerebral palsy underwent intensive 20 Lokomat and 20 traditional physiotherapy sessions, each training session lasting 40 minutes. Preand post-testing was done using goniometer measure, manual muscle testing and modified Ashworth scale. Results. Positive effects were seen in participant who underwent a combination of Lokomat training and traditional therapy. An increase in the range of motion was minimal (2 - 4 degrees) in hip flexion, extension, and abduction. A significant improvement was achieved in ankle dorsiflexion on the right (p = 0.003) and left side (p = 0.006), while the values of knee extension for the left and right extremity were p = 0.062 left and p = 0.075, respectively. An increase in muscle strength of the lower limb was seen in 30.8% - 80% of participants. Reduction of spasticity in adductors, hamstrings and gastrocnemius were seen in 26.9% of participants. Conclusion. Lokomat training is an adjunct to conventional physiotherapy treatment. It has a negligible effect on the increase in the range of motion and muscle strength of the lower limb and reduction of spasticity in children with cerebral palsy.

Day I: Thursday, March 23, 2023; 1.30 PM Plumeria 3: Physiotherapy in Pediatric Physiotherapy: AB No: 3 3-D instrumented gait analysis of the lower extremity in children with flexible pes planus: what the eyes cannot see?

Day I: Thursday, March 23, 2023; 1.30 PM Plumeria 3: Physiotherapy in Pediatric Physiotherapy: AB No: 3 3-D instrumented gait analysis of the lower extremity in children with flexible pes planus: what the eyes cannot see?

Day I: Thursday, March 23, 2023; 1.30 PM Plumeria 3: Physiotherapy in Pediatric Physiotherapy: AB No: 3 3-D instrumented gait analysis of the lower extremity in children with flexible pes planus: what the eyes cannot see?

Day I: Thursday, March 23, 2023; 1.30 PM Plumeria 3: Physiotherapy in Pediatric Physiotherapy: AB No: 3 3-D instrumented gait analysis of the lower extremity in children with flexible pes planus: what the eyes cannot see?

To the Question of Reparative Regeneration in Children

The commentary touches upon the interpretation of the term refracture and discusses the hemodynamic features in the area of the emerging fusion in primary and repeated fractures in children. In particular, not only the role of methods for studying blood circulation in the diagnosis of disorders of reparative processes is considered, but attention is also focused on the risk of complications in the conservative and surgical treatment of fractures of the long bones of the extremities in children. It is emphasized that in order to minimize the risks of refractory development, it is necessary to take into account the individual characteristics of a pediatric patient, the method of fixing a fracture, rehabilitation and dispensary observation. The commentary provides a brief overview of publications by domestic and foreign authors on this problem.