Lower Extremities In Children Research Articles

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.

Comparison of PNF Stretching and Static Stretching to Reduce Spasticity of Lower Extremity in Spastic Cerebral Palsy Children

Background: Cerebral palsy (CP) presents a significant burden on childhood health, with the spastic type being the most prevalent manifestation. This neurological disorder, affecting 2-3 per 1000 births, stems from various prenatal, perinatal, or postnatal brain injuries. Commonly impacted outcome measures include muscle tone, pain, and range of motion, assessed by the Modified Ashworth Scale, Wong-Baker Face Pain Rating Scale, and popliteal angle measurement, respectively. While conservative static stretching is a widely used treatment option for spasticity, its efficacy remains inconclusive due to temporary effects. Conversely, proprioceptive neuromuscular facilitation (PNF) stretching, introduced by Harman Kabat and Margaret Knott in the 1940s, has shown promise in improving functional outcomes and reducing spasticity in neurological conditions like stroke and CP. However, limited evidence exists regarding its comparative efficacy with conventional static stretching in reducing spasticity among children with spastic cerebral palsy. Therefore, this study aims to compare the effectiveness of PNF stretching and static stretching in reducing lower extremity spasticity in children with spastic cerebral palsy, with pain and popliteal angle as secondary objectives. Objective: The primary objective of this study is to assess the comparative effectiveness of PNF stretching and static stretching in reducing spasticity in the lower extremities of children with spastic cerebral palsy. Additionally, pain intensity and popliteal angle will be evaluated as secondary objectives. Methods: A sample size of 60 children was determined using Epitool Google calculator and selected through non-probability purposive sampling. Participants were randomly assigned to either the experimental group, receiving PNF stretching, or the control group, receiving static stretching, with both groups undergoing identical baseline treatment. Pre- and post-intervention assessments were conducted for spasticity, pain intensity, and popliteal angle measurement using appropriate scales and instruments. Data were analyzed using SPSS 20.0, employing independent sample t-tests and paired sample t-tests for intergroup and intragroup comparisons, respectively. Results: Inter-group analysis revealed significant improvements in both groups concerning pre- and post-treatment outcomes across all variables. However, intra-group analysis demonstrated statistically significant improvements in the PNF stretching group compared to the static stretching group across all measured variables. Conclusion: The study concludes that proprioceptive neuromuscular facilitation stretching is more effective than static stretching in reducing spasticity in children with cerebral palsy. Nevertheless, both techniques exhibit efficacy in their respective capacities.

Study of height, sitting height, lower extremity length, and the prevalence of short stature among elementary school students in the Tianyuan District of Zhuzhou City.

In this study, the height, sitting height, lower extremity length, growth status, and body proportions of elementary school students aged 6 to 12 years in Tianyuan District of Zhuzhou City, China, were analyzed. A total of 41,156 children from 38 elementary schools in the Tianyuan District of Zhuzhou City were selected for height measurement, employing the cluster sampling method. After the cluster data were obtained, the height and sitting height information were extracted, and calculations were performed for lower extremity length, sitting height-to-lower extremity length ratio, and sitting height-to-height ratio. Statistical analysis was conducted using SPSS 23.0 software. The height and sitting height measurements of boys and girls aged 6 to 12 years in Tianyuan District surpassed the 2005 national standard set for 9 cities, while the lower extremities of children within the 7 to 9 age range fell below the national standard. In alignment with the national average, the fitted curve representing height for both boys and girls aged 6 to 12 years in Tianyuan District exhibited an intersection point around 10 to 10.5 years. No discernible distinction was observed in the incidence of short stature, as analyzed through the P3 standard, between the fitted curve for Tianyuan District and the national standard. Moreover, tall children exhibited a significantly lower sitting height-to-height ratio compared to their shorter counterparts. The fitted height curve in Tianyuan District, Zhuzhou City, proves effective in discerning shorter-statured children within the region. Nevertheless, further research is warranted to elucidate the factors contributing to the comparatively shorter lower extremities observed in children from Tianyuan District, Zhuzhou City, in contrast to the national average.

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.

Endocrine and metabolic monitoring for anesthesia care in orthopedic trauma surgery on the lower extremities of children: prospective comparative study

BACKGROUND: Standard anesthesia monitoring during surgery only indirectly allows us to estimate achieving an effective level of analgesia sufficient to protect the patient from surgical trauma. Recently, studies have analyzed cortisol, glucose, and lactate levels during surgery in children and adults; however, data presented remain inconsistent.&#x0D; OBJECTIVE: This study aimed to conduct a prospective comparative analysis of endocrine metabolic dynamic rates in orthopedic trauma surgery on the lower extremities of children.&#x0D; MATERIALS AND METHODS: The study included 39 children who underwent orthopedic trauma surgery. They were divided into two groups: group 1 (n=17) underwent multicomponent balanced general anesthesia, and group 2 (n=22) received combined anesthesia (multicomponent balanced general anesthesia combined with regional blockade of the sciatic and femoral nerves). The dynamics of cortisol, glucose, and lactate indicators at three stages of the perioperative period, total amount of fentanyl, and need for an inhalation anesthetic were examined.&#x0D; RESULTS: Indicators of cortisol, glucose, and lactate in mixed venous blood during surgery did not exceed the age norm in both groups. In group 1, cortisol, glucose, and lactate levels did not statistically differ at all stages of the study. In group 2, cortisol and lactate levels increased at the fifth stage (traumatic stage) of surgery, and lactate levels increased in the sixth stage (end of surgery). In intergroup comparison, the lactate level at the traumatic stage of surgery was higher in group 1 than in group 2 (p=0.048). Cortisol and glucose levels at the stages of the study did not differ significantly. The total amount of fentanyl for pain relief in group 1 was 4.1 [3.3; 5.0] g/kg, which was 8.2 times higher than that in group 2, with 0.5 [0.4; 0.53] g/kg (p 0.0001).&#x0D; CONCLUSION: Both anesthesia methods ensure stable levels of cortisol, glucose, and lactate, and adequate level of analgesia at all stages of surgery; however, the use of a conduction blockade as a component of combined anesthesia provides more pronounced antinociceptive protection and reduces surgical stress in children.

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?

Free flaps to replace extensive and deep limb defects in children

BACKGROUND: Extensive and deep limb defects remain a difficult problem of reconstructive surgery in children. Free microsurgical flaps are used to resolve this problem. Free flaps can be complex in composition and include muscles and bone parts, which allow replacing large and multicomponent limb defects. The technique is used in patients with posttraumatic deformities, burns, acquired limb deformities, and congenital deformities of the extremities.&#x0D; AIM: To retrospectively analyze free flaps in children for the replacement of limb defects.&#x0D; MATERIALS AND METHODS: This single-center retrospective study analyzed 120 cases of microsurgical autotransplantation of free flaps to replace defects of the upper and lower extremities in children. The patients were children aged 117 years who had injuries and burns, acquired limb deformities, and congenital limb deformities.&#x0D; RESULTS: The average age of the patients was 9.5 years, and 72% of the patients were boys. Moreover, 95% of the children had posttraumatic deformities, burns, and acquired pathologies. Free latissimus dorsi flaps were used in 70% of the patients. The recipient area was the upper limb in 53% of the cases. The survival rate of free flaps was 96%. The general surgical complications were inflammation, pneumothorax, deformities, and specific vascular thrombosis.&#x0D; CONCLUSIONS: Replacement of extensive limb defects with free flaps remains a practical method in children.

Effectiveness of Vojta Therapy on Gross Motor Function in Children with Cerebral Palsy at GMFCS Levels 4 and 5: A Randomized Controlled Trial

Objective: To study the effectiveness of the Vojta therapy on gross motor function in children with cerebral palsy at the Gross Motor Function Classification System (GMFCS) levels 4 and 5. Materials and Methods: The present study was a randomized controlled trial, assessor-blinded, in 24 children with cerebral palsy, GMFCS 4 and 5 at Thai Red Cross Rehabilitation Center. Participants were randomly allocated to the Vojta therapy as the intervention group or conventional therapy as the control group and were trained by physical therapists. All participants in both groups received a home program for eight weeks. Outcomes were motor function assessment by the Gross Motor Function Measure (GMFM)-88, range of motion of lower extremities and parent’s satisfaction. Results: Twenty-four participants were randomly assigned with twelve participants each in the intervention and the control group. The mean age of participants in the intervention group was 7.08±3.17 years. The Vojta therapy significantly improved the GMFM-88 Dimension A- lying and rolling (p=0.001) and the improvement was greater than that of the control group (p=0.001). Both groups had significant increase in range of motion, including bilateral hip flexion, bilateral hip extension, bilateral knee flexion, and bilateral ankle dorsiflexion. Parent’s satisfaction in both groups were very satisfied and had no adverse effects. Conclusion: The Vojta therapy significantly improved gross motor function and range motion of the lower extremities in children with cerebral palsy at GMFCS levels 4 and 5. The Vojta therapy was superior to conventional therapy in the GMFM-88 Dimension A- lying and rolling. Keywords: Cerebral palsy; Vojta therapy; Gross motor function; GMFM-88; GMFCS

Effects of tension band plating on coronal plane alignment of lower extremities in children treated for idiopathic limb length discrepancy.

One of the most common treatment methods for moderate limb length discrepancy in children is growth modulation using tension band plating. Coronal plane deformities after tension band plating for limb length discrepancy have been documented as an important complication in articles involving heterogeneous groups consisted of both idiopathic cases and patients with pathological physes. The aim of the study was to determine the rate of coronal plane deformities after treatment of a homogeneous group of idiopathic limb length discrepancy cases with tension band plating and to compare screw constructs of medial and lateral plates. Patient files were retrospectively reviewed for amount of limb length discrepancy, anatomical femorotibial angle, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and inter-screw angles of each plate on both sides of the tibiae and femora. Measurements at each follow-up period were compared to each other. A total of 26 patient files (37 bones) were included to the study. The mean age was 10.5 years. The mean limb length discrepancy was 27.5 mm. Implants were removed after mean 34.5 months. The mean follow-up period was 58.5 months. There was no significant difference in inter-screw angle on each side of the bones at the time of implantation and in lower limb alignments during follow-up. Treatment of mild-to-moderate idiopathic limb length discrepancy with tension band plating in children was found to be safe against any coronal plane deformity during follow-up until skeletal maturity. Level IV.

Ultra-low-dose computed tomography for torsion measurements of the lower extremities in children and adolescents

BackgroundQuantifying femoral and tibial torsion is crucial in the preoperative planning for derotation surgery in children and adolescents. The use of an ultra-low-dose computed tomography (CT) protocol might be possible for modern CT scanners and suitable for reliable torsion measurements even though the bones are not completely ossified.MethodsThis is a retrospective review of 77 children/adolescents (mean age 12.7 years) who underwent a lower extremity CT for torsion measurements on a 64-slice scanner. A stepwise dose reduction (70%, 50%, 30% of the original dose) was simulated. Torsion measurements were performed on all image datasets, and image noise, interrater agreement and subjective image quality were evaluated. Effective radiation dose of each original scan was estimated. As proof of concept, 24 children were scanned with an ultra-low-dose protocol, adapted from the 30% dose simulation, and the intra-class correlation coefficient (ICC) was determined. Ethics approval and informed consent were given.ResultsTorsion measurements at the simulated 30% dose level had equivalent interrater agreement compared to the 100% dose level (ICC ≥ 0.99 for all locations and dose levels). Image quality of almost all datasets was rated excellent, regardless of dose. The mean sum of the effective dose of the total torsion measurement was reduced by simulation from 0.460/0.490 mSv (boys/girls) at 100% dose to 0.138/0.147 mSv at 30%. The ICC of the proof-of-concept group was as good as that of the simulated 30% dose level.ConclusionPediatric torsion measurements of the lower extremities can be performed using an ultra-low-dose protocol without compromising diagnostic confidence.

Effects of Acupuncture Combined with Biofeedback Therapy on Limb Motor Rehabilitation in Patients with Acute Stroke: Systematic Review and Meta-Analysis.

Objective The purpose of the systematic review is to verify the effect of biofeedback therapy on limb motor rehabilitation in patients with acute stroke and to provide evidence-based medicine for the promotion and use of biofeedback therapy. Methods The randomized controlled trials (RCT) of biofeedback therapy in the treatment of cerebral palsy were searched in PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang Database, and Chinese Biomedical Literature Database (CBM). The starting time and ending time of this study are from the time of building the database of the number of pieces to October 31, 2018. The data included in this study were extracted by two independent researchers and evaluated the bias risk of all the literature included in the study according to the Cochrane manual 5.1.0 criteria. RevMan5.4 statistical software was used to analyze the collected data by meta. Results This systematic review included 9 RCT studies with a total of 1410 patients. The results of meta-analysis showed that there were significant differences in the improvement of lower limb muscle tension, comprehensive spasm scale score, EMG score, and passive range of motion of ankle joint between biofeedback therapy and routine rehabilitation therapy. Conclusion Biofeedback therapy can improve lower limb muscle tension, spasticity, EMG integral value, and passive range of motion of ankle joint in children with cerebral palsy and provide better conditions for improving the motor ability of lower extremities in children with cerebral palsy. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.

Pathogenetic substantiation of methods for correcting disorders of the neuromuscular apparatus of the lower extremity in children with congenital clubfoot

Ensuring effective and stable correction of congenital clubfoot remains an urgent task of modern pediatric orthopedics (1, 4, 6, 9). The high frequency of unsatisfactory treatment results for this deformity, according to many researchers [1, 2, 4 - 6, 9], is due to neuromuscular disorders that persist in the outcome of traditional lower limb correction. Insufficient effectiveness of traditional rehabilitation of the neuromuscular apparatus in congenital clubfoot is associated with insufficient pathogenetic substantiation of treatment [1, 6].

More than 25 years after selective dorsal rhizotomy: physical status, quality of life, and levels of anxiety and depression in adults with cerebral palsy.

The primary purpose of selective dorsal rhizotomy (SDR) is to ameliorate spasticity in the lower extremities of children with cerebral palsy (CP). In correctly selected patients, this neurosurgical procedure has been shown to have a beneficial effect on many aspects of the child's life. However, given the challenges faced by adults with CP, it would be valuable to document the status of this population compared to their peers later in adulthood. Therefore, the aim of this study was to determine the physical status, mental health, and health-related quality of life (HRQoL) of adults with CP who underwent SDR at least 25 years ago, compared to matched typically developing (TD) individuals. The second aim was to investigate relationships between physical status and the other outcome measures. Adults with CP were recruited from a database of children who had undergone SDR performed using the technique introduced by Professor Warwick Peacock at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between 1981 and 1991. These individuals were matched for age, sex, body mass index, and socioeconomic status to a TD adult cohort from a similar background. The parameters assessed were lower-extremity muscle tone, passive range of motion, muscle strength, selectivity, functional mobility and dynamic balance (Timed Up and Go [TUG] test), HRQoL (SF-36), and anxiety and depression levels. Twenty-six adults with CP who had a median age of 35.8 years (interquartile range 34.2-41.4 years) (female/male: n = 10/16; Gross Motor Function Classification System level I/II/III: n = 13/10/3), were compared to 26 TD adults. Muscle tone was similar, whereas passive range of motion, muscle strength, selectivity, TUG, and SF-36 physical functioning (concept and summary) scores differed between the cohorts. Other SF-36 parameters, anxiety levels, and depression levels were not different. Strong correlations were found between the muscle strength and TUG scores. Normalized lower-extremity muscle tone was sustained 25-35 years after SDR. Whereas the lower scores for physical assessments are in line with findings in other CP populations, remarkably, relatively good mental health and HRQoL scores were reported in this CP group despite their physical limitations. The strong correlation between muscle strength and TUG suggests that strength training after SDR may have value in improving functional mobility and balance.