Immediate effects of a novel hand rehabilitation board on fine motor skills in children with cerebral palsy: A pilot study.

BACKGROUND: In children with cerebral palsy (CP), fine motor skills limit forearm supination and active extension of the elbow, wrist, or fingers. Therapeutic interventions focusing on improving the ranges at these joints while facilitating active movements are the key to augmenting fine motor skills. OBJECTIVE: This pilot study examines if children with CP (with UE involvement) exposed to the Novel Hand Rehabilitation (NHR) Board will demonstrate 1) changes in spasticity and passive ROM of forearm and wrist/finger muscles, and 2) improvement in fine motor abilities. METHODS: The forearm and wrist/fingers of children with spastic CP (N = 15; M = 7, F = 8) aged 49-72 months (65.33±6.355 months) were positioned on the NHR board till their tolerance limit or a minimum duration of 30 minutes. The outcome measures, i.e., spasticity (Modified Ashworth Scale), passive range of motion (PROM) of wrist and fingers, and fine motor skills (PDMS-2 - Fine motor scale), were recorded. RESULTS: The spasticity of forearm pronators (0.001) and wrist flexors (0.008) reduced significantly, but not in wrist extensors. Post-intervention improvements in wrist extension (p = 0.005) and ulnar deviation ROM (p = 0.007) were significant. In thumb, changes were non-significant for the CMC flexion, but extension (0.003) and abduction (0.001) as well as MCP extension (0.004) were significant. The post-intervention MCP extension ROM for the 2nd (0.001), 3rd (0.007), and 4th fingers (0.014) were also substantial, but not for PIP and DIP joints. The post-intervention percentage change in the Grasping and Visual-motor integration subtests of PDMS-2 was 11.03% (p = 0.002) and 5.09% (p = 0.001) respectively. CONCLUSION: The immediate effects on fine motor skills in children with CP after the NHR board application were positive and encouraging. Hence, the NHR board can be recommended as an intervention to improve the fine motor abilities of children with CP.

Effect of hip abductors and lateral rotators' muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis.

BACKGROUND: Even though literature indicates presence of weak hip abductors and lateral rotators' in Patellofemoral Pain (PFP), studies evaluating the effect of hip abductors and lateral rotators strengthening to improve knee function and quality of life in PFP are limited. OBJECTIVE: This study systematically reviews and meta-analyzes the best evidence on the therapeutic value of strengthening hip abductors and lateral rotators muscles for treating PFP with a presumptive hypothesis that strengthening hip muscles stabilizes the patellofemoral joint, relieves pain, and enhances knee functions. METHOD: Medline, EMBASE, CINAHL, PEDro and PubMed Central databases were searched between January 1994 and September 2019 using the PICOS tool. The methodological quality of the selected studies were appraised individually using the 20-item McMaster Critical Review Form for Quantitative Studies. Supplemental quality appraisal of randomized controlled clinical trials performed using the Cochrane Collaboration's 'Risk of bias' quality criteria. Data on patient population demographics, interventions, duration of intervention, and outcome measures were extracted and summarized in evidence tables and descriptive analysis. Meta-analyses under both fixed and random-effects models determined pooled effects size from appropriate RCTs. RESULTS: All fourteen studies demonstrated that hip muscle strengthening improved pain and knee function. All RCTs, except one, demonstrated that hip muscle strengthening is superior to quadriceps strengthening. Of the five RCTs assessing the additional effect of hip-quad versus quadriceps strengthening, four suggested that hip-quad strengthening is superior to standard quadriceps strengthening alone to improve PFP and knee function. CONCLUSION: In adult patients with PFP, strengthening hip abductors and lateral rotators' have beneficial therapeutic effects than the conventional quadriceps exercises in improving knee pain and function both in the short- and long term. However, the present review data can be used to develop a standardized hip-quad protocol in the future.

Percutaneous versus open epiphysiodesis.

OBJECTIVE: Epiphysiodesis is used for the treatment of leg-length discrepancy in skeletally immature patients. Phemister described an open technique that requires surgical dissection with potential morbidity. Recently, minimally invasive approaches that utilize intraoperative fluoroscopy have been introduced. The aim of this study is to compare our experience using the open and the minimally invasive percutaneous techniques. METHODS: A prospective follow-up of 87 consecutive patients undergoing epiphysiodesis for correction of post traumatic leg-length discrepancy using either the open or the percutaneous technique at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1993 and December 2000. RESULTS: Out of the 87 patients, 52 were carried out using the open technique and 35 were utilized by this percutaneous technique. There was no statistically significant difference between the 2 groups in terms of demographic date, operative time, perioperative complications or time required to achieve the growth arrest. However, there was a significant difference in the hospital stay and postoperative need for physiotherapy. The percutaneous group had a shorter hospitalization (average 2.5 days) compared to the open technique group (average 4 days). CONCLUSION: Our experience is similar to what is reported in the literature and confirms that the percutaneous technique has an advantage over the open technique with shorter hospitalization and less duration of physiotherapy.

Removal of internal fixation in pediatric patients.

OBJECTIVE: Internal fixation devices are commonly used in the surgical treatment of many orthopedic conditions. Their prolonged presence, however, has been associated with potential complications. Many surgeons advocate the routine removal of internal fixation in the pediatric age group. In this report we present our experience with removal of internal fixation in pediatric patients and evaluate the benefits and difficulties of doing so. METHODS: A retrospective analysis of 304 pediatric patients who underwent removal of internal fixation implants for various indications at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1985 and December 1999, was carried out. RESULTS: A total of 176 males and 128 females were included. Their mean age at time of removal of internal fixation was 11 years (range 2-18). The fixation device was removed at an average of 16.3 months (range 10-40) after implantation. One hundred and twenty (39.5%) patients had the initial fixation for the treatment of fractures. For all 304 patients, late removal of the implant was found to be more difficult than early removal. Implants around the hip and pelvis were more difficult to remove than other locations. CONCLUSION: Our experience supports the indication for timely removal of internal fixation devices in the pediatric population. When carried out on a routine basis it can avoid the difficulties associated with the late removal of implants.