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Objective To explore the physical activity and exercise rehabilitation for children with cerebral palsy using International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). Methods Based on the theoretical framework of ICF-CY and the theories of children's development, the paper discussed the physical activities and exercise rehabilitation strategies for chil-dren with cerebral palsy. Results There were important roles of physical activity and exercise rehabilitation to improve the motor function and cognitive function, and enhance cognition, mobility, self-care, and communication function, and promote the overall development for children with cerebral palsy. The individualized physical activity and exercise rehabilitation program for children with cerebral palsy could be developed with the analysis of functioning and disability with ICF-CY. Conclusion Children with cerebral palsy could improve their functioning and get overall development with individualized physical activity and exercise rehabilitation program based on ICF-CY.
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Objective To explore the functioning and disability and individualized rehabilitation strategies for children with cerebral pal-sy using ICF-CY. Methods ICF-CY core set for children with cerebral palsy was used, and literatures of functioning and disability (motor function) and physical activity and exercise rehabilitation for children with cerebral palsy were reviewed systematically. Based on the theo-retical framework of ICF-CY and the theories of children's development, the rehabilitation strategies for children with cerebral palsy were discussed. Results The main functioning and disability for children with cerebral palsy were impairment of brain structure and nerve system-and motor function at body level;activity limitation and participation restriction in cognition, mobility and self-care, and restriction in partic-ipation in games, leisure and educational activities at individual level and related environmental factors. The rehabilitation strategies of chil-dren with cerebral palsy should be based on the physical structure and function, activities and participation, as well as environmental factors, to develop programs that met the characteristics of the individual. Conclusion The characteristics of functioning and disability for children with cerebral palsy were analyzed using ICF-CY. Individualized rehabilitation strategies should be developed to promote the overall develop-ments for children with cerebral palsy.
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Objective To analyze the characteristics of functioning in children with autism spectrum disorder (ASD) based on the ICF-CY, to discuss the approaches of physical activity and exercise rehabilitation for them. Methods The typical disabilities in children with ASD were analyze based on ICF-CY and literature review. The approaches of physical activity and exercise rehabilitation were discussed. Results There were two kinds of behaviors including repetitive behavior and communication impairments. The main functioning of children with ASD included special mental function and motor function in body function and body structure;interpersonal interactions, hand and arm flexibly use, walking and moving in activity and participation. Individualized physical activity plan for children with ASD should promote the development of motor skills, improve relevant functions and promote all-round developments. Conclusion It is useful to analyze the functioning and disability, to develop individualized plans of physical activity and sport rehabilitation, to improve total functioning and to promote all-round developments.
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Objective To explore the physical activity and exercise rehabilitation for children with cerebral palsy using International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). Methods Based on the theoretical framework of ICF-CY and the theories of children's development, the paper discussed the physical activities and exercise rehabilitation strategies for chil-dren with cerebral palsy. Results There were important roles of physical activity and exercise rehabilitation to improve the motor function and cognitive function, and enhance cognition, mobility, self-care, and communication function, and promote the overall development for children with cerebral palsy. The individualized physical activity and exercise rehabilitation program for children with cerebral palsy could be developed with the analysis of functioning and disability with ICF-CY. Conclusion Children with cerebral palsy could improve their functioning and get overall development with individualized physical activity and exercise rehabilitation program based on ICF-CY.
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Objective To explore the functioning and disability and individualized rehabilitation strategies for children with cerebral pal-sy using ICF-CY. Methods ICF-CY core set for children with cerebral palsy was used, and literatures of functioning and disability (motor function) and physical activity and exercise rehabilitation for children with cerebral palsy were reviewed systematically. Based on the theo-retical framework of ICF-CY and the theories of children's development, the rehabilitation strategies for children with cerebral palsy were discussed. Results The main functioning and disability for children with cerebral palsy were impairment of brain structure and nerve system-and motor function at body level;activity limitation and participation restriction in cognition, mobility and self-care, and restriction in partic-ipation in games, leisure and educational activities at individual level and related environmental factors. The rehabilitation strategies of chil-dren with cerebral palsy should be based on the physical structure and function, activities and participation, as well as environmental factors, to develop programs that met the characteristics of the individual. Conclusion The characteristics of functioning and disability for children with cerebral palsy were analyzed using ICF-CY. Individualized rehabilitation strategies should be developed to promote the overall develop-ments for children with cerebral palsy.
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Objective To analyze the characteristics of functioning in children with autism spectrum disorder (ASD) based on the ICF-CY, to discuss the approaches of physical activity and exercise rehabilitation for them. Methods The typical disabilities in children with ASD were analyze based on ICF-CY and literature review. The approaches of physical activity and exercise rehabilitation were discussed. Results There were two kinds of behaviors including repetitive behavior and communication impairments. The main functioning of children with ASD included special mental function and motor function in body function and body structure;interpersonal interactions, hand and arm flexibly use, walking and moving in activity and participation. Individualized physical activity plan for children with ASD should promote the development of motor skills, improve relevant functions and promote all-round developments. Conclusion It is useful to analyze the functioning and disability, to develop individualized plans of physical activity and sport rehabilitation, to improve total functioning and to promote all-round developments.
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<p><b>OBJECTIVE</b>To study whether the range of knee flexion (ROF) is affected by geometrical mismatch of the femoral component and the resultant change in the posterior condylar offset (PCO) after high-flexion posterior-stabilized total knee arthroplasty (TKA).</p><p><b>METHODS</b>One hundred osteoarthritic patients (50 males and 50 females) underwent femoral osteotomy by the anterior referencing technique. The PCO for each patient was measured from lateral radiographs before, during and 2 years after TKA. The thickness of the joint cartilage was measured by magnetic resonance imaging before TKA and added onto the radiographic measurement. The relationship between changes in the PCO and improvements in the ROF before, during and 2 years after TKA were statistically analyzed.</p><p><b>RESULTS</b>Compared with the preoperative value, the PCO was reduced by (3.45+/-3.28) mm after TKA, with a significantly larger reduction observed in female patients than male patients (P less than 0.05). When examining the subject population as a whole, there was a significant positive correlation between PCO and ROF improvement during TKA (P less than 0.05), but this improvement was not maintained 2 years after TKA (P larger than 0.05). However, when male and female patients were analyzed separately, there was a significant positive correlation between PCO change and ROF improvement for both sexes at both time points (all P less than 0.05).</p><p><b>CONCLUSIONS</b>Restoration of PCO plays an important role in the optimization of knee flexion even after posterior-stabilized TKA. Femoral components based on Caucasian anatomic characteristics could not match the native anatomy of distal femurs in Chinese population especially female Chinese. Rotated resection of distal femur with anterior re-ferencing technique usually leads to a decreased PCO and therefore reduces maximal obtainable flexion.</p>
Subject(s)
Humans , Arthroplasty, Replacement, Knee , Femur , General Surgery , Knee Joint , Osteotomy , Range of Motion, ArticularABSTRACT
<p><b>OBJECTIVE</b>To detail our early experience and technique of a modified two-stage reimplantation protocol using antibiotic-loaded articulating cement spacers (ALACSs) for treatment of late periprosthetic infection after total knee arthroplasty (TKA).</p><p><b>METHODS</b>From January 2006 to February 2009, a series of 21 patients (21 knees) with late infected TKAs were treated by radical debridement and removal of all components and cement, and then articulating spacers were implanted using antibiotic-impregnated bone cement. For this purpose, 4 g vancomycin powder was mixed with per 40 g cement. Graduated knee motion and partial weight bearing activity were encouraged in the interval period. Each patient received an individual systemic organism-sensitive antimicrobial therapy for 4.9 (range, 2-8) weeks followed by a second-stage TKA revision. All the patients were regularly followed up using the American Knee Society Scoring System.</p><p><b>RESULTS</b>Each case underwent a successful two-stage exchange and had infection eradicated, none had recurrent infection after an average of 32.2 (range, 17-54) months of follow-up. Preoperatively, the mean knee score was 53.5 points, function score was 27.3 points, pain score was 25.7 points, range of motion (ROM) was 82.0 degree extensor lag was 2 degree Between stages, the mean knee score was increased to 61.3 points, function score to 45 points, pain score to 35 points, ROM to 88.2 degree and extensor lag to 3.4 degree At final follow-up, the mean knee score was further increased to 82.1 points, function score to 74.5 points, pain score to 42.1 points, ROM to 94.3 degree and knee extension lag to 1.9 degree The interval period was 11.5 (range, 6-32) weeks. The amount of bone loss was unchanged between stages. No patient developed noticeable dysfunction of the liver or kidney or other complications such as impaired wound healing, deep venous thrombosis, pulmonary embolism, cerebrovascular accidents, etc.</p><p><b>CONCLUSIONS</b>Treating infected TKA with ALACS avoids spacer-related bone loss, preserves knee function between stages, and eradicates infection effectively without significant complications. The early clinical results are inspiring. The authors believe that radical and repeated (if needed) debridement, individual application of systemic antibiotics, and reasonable timing judgement upon the secondary revision are all key factors related to a successful outcome with two-stage reimplantation procedure for infected TKA.</p>
Subject(s)
Humans , Anti-Bacterial Agents , Arthroplasty, Replacement, Knee , Knee Joint , Knee Prosthesis , Prosthesis-Related InfectionsABSTRACT
<p><b>OBJECTIVE</b>To evaluate causes and clinical management of postoperative pain after total knee arthroplasty (TKA).</p><p><b>METHODS</b>From January 2004 to June 2009, 41 patients (44 knees) with knee pain post TKA were treated. There were 9 male and 32 female patients aging from 51 to 84 years with a mean of 63.5 years. The diagnosis followed to Brown diagnostic system. One case of extraarticular pain was complex regional pain syndrome type 1 (CRPS-1) and underwent conservative treatment, the remaining 5 cases were treated by surgery. Three cases of joint instability, 1 case of patellar baja, 2 cases of soft tissue impingement caused by overhang of the prosthesis, 1 case of popliteal tendon impact underwent conservative treatment, the other 27 cases underwent surgical intervention. The patients were followed up and the Knee Society Score (KSS) knee score, pain visual analog scale (VAS) score were recorded.</p><p><b>RESULTS</b>Forty-one cases were followed up for 1 to 6 years. At the last time of follow-up, the 5 cases received surgical treatment to extra-articular pain showed VAS score as 2.5 ± 0.2, KSS clinical and functional score as 92.8 ± 2.6 and 89.0 ± 3.4. There was significantly difference compared with preoperative (P < 0.05). One case of CRPS-1 performed conservative treatment, the therapy was effective. In the infected 12 cases of intra-articular pain, 1 case received amputation, 3 cases received antibiotic bone cement insert, 8 cases received two stage revision. All infections were cured, and VAS score was 3.8 ± 0.2, KSS clinical score was 88.3 ± 4.6, function score was 85.0 ± 4.6 postoperatively, with significantly difference compared with preoperative (P < 0.05). In the 8 cases received conservative treatment in non-infected group, at the last time of follow-up, VAS score was 4.5 ± 0.4, KSS clinical and functional score was 85.4 ± 4.2 and 84.2 ± 2.3, with significantly difference compared with preoperative (P < 0.05). Fifteen cases underwent surgical treatment, at the last time of follow-up, VAS score was 3.4 ± 0.1, KSS clinical and functional score was 86.6 ± 5.4 and 87.1 ± 2.4, with significantly difference compared with preoperative (P < 0.05).</p><p><b>CONCLUSIONS</b>Patients with knee pain post TKA need systematic assessment to identify the causes. Appropriate treatment due to the positive diagnosis generally lead to satisfactory results, surgical intervention with indefinite causes is strictly prohibited.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Knee , Follow-Up Studies , Pain, Postoperative , Therapeutics , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To determine the effect of the posterior condylar offset (PCO) on intra- and post-operative knee flexion after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis and to discuss it's importance in femoral prosthesis design.</p><p><b>METHODS</b>The clinical and radiographic materials of 100 consecutive patients (100 knees) were prospectively studied, including 50 men and 50 women, who had undergone primary NexGen LPS-Flex TKAs for end-stage osteoarthritis. All operations were performed by a single surgeon using the same operative technique between March 2005 and October 2006. Pearson's regression analysis was used to assess the relationship between the difference in the pre- and post-operative PCO on true lateral radiographs and the change in knee range of flexion (ROF) under non-weight-bearing conditions.</p><p><b>RESULTS</b>The decrease of the corrected PCO was (3.4 ± 3.3) mm compared with the preoperative value, the restoration of PCO was better in male than female [female (-5.4 ± 3.1) mm vs. male (-1.5 ± 2.0) mm, P < 0.05]. The difference in the corrected PCO after PS TKA demonstrated significantly correlated with the change in 2 years postoperative ROF in male and female, respectively (P < 0.05). While no statistically correlation was observed in the overall group (P > 0.05). Intraoperatively, the difference in the corrected PCO was significantly correlated with the change in ROF in male, female, and the overall group, respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>Restoration of PCO plays an important role in the optimization of knee flexion after high-flex PS TKA. Femoral components based on Caucasian anatomic characteristics could not match the native anatomy of distal femurs of Chinese population especially female Chinese. Rotated resection of distal femur with anterior referencing technique usually leads to a decreased PCO and therefore reduces maximal obtainable flexion. Sexual dimorphism in humans and anatomic variations in various ethnic groups should be seriously considered in total knee prosthesis design.</p>