The measurement of three dimensional scapulohumeral kinematics--a study of reliability.

OBJECTIVE: To validate a system, using electromagnetic movement sensors, for the simultaneous measurement of scapular and humeral positions. DESIGN: The study was designed to analyse the repeatability and to quantify the inherent measurement errors, using two observers to measure the movements of five normal subjects. BACKGROUND: Following an earlier study of a system to measure three dimensional scapula motion, the method has been developed to incorporate simultaneous measurement of humeral and scapular position using a new design of scapula locator and a two-channel measurement system. METHODS: The system was used to measure the scapula movements accompanying abduction of the shoulder. The scapula locator was applied at 10 degrees intervals of abduction. This was measured initially using a fluid filled goniometer, but, in a second part of the study, using an additional motion sensor. RESULTS: In the single channel study, the 95% confidence intervals were less than 4 degrees and 10 mm. When simultaneous measurement of arm position was performed the confidence intervals were little changed. CONCLUSIONS: A new system for the measurement of scapulohumeral relationships has been shown to have good inter-and intraobserver reliability. This study opens the way for a full investigation of the scapula motion accompanying three dimensional shoulder motion in both normal subjects and in patients having shoulder pathology.

Primary amoebic meningoencephalitis with Naegleria fowleri: clinical review.

Two children with primary amoebic meningoencephalitis secondary to Naegleria fowleri are reported. Both children died, and the causative agent was identified at autopsy. Presentation and outcome conformed to the usual course of primary amoebic meningoencephalitis and reaffirm the gravity and rapid progression of this infection. The epidemiology, microbiology, diagnostic considerations, and treatment are discussed. Primary amoebic meningoencephalitis should be considered in the differential diagnosis of children with meningitis or encephalitis.

Hemolytic uremic syndrome with particular involvement of basal ganglia and favorable outcome.

Two children with hemolytic uremic syndrome and extrapyramidal complications are presented. Neuroimaging studies demonstrated bilateral basal ganglia (striatal) involvement with favorable recovery in both patients. The pathophysiology of the neurologic complications in hemolytic uremic syndrome are probably multifactorial. Our patients suggest a reversible process because both patients recovered clinically and radiographically. Neurologic complications do not always portend a poor prognosis and, in general, involvement of the basal ganglia is associated with favorable outcome.

Winging of the scapula: the underlying biomechanics and an orthotic solution.

Winging of the scapula occurring in muscular disorders (muscular dystrophy and spinal muscular atrophy) or nerve injury has been investigated, resulting in a thorough understanding and presentation of the underlying biomechanics causing this occurrence. This includes a biomechanical explanation of the characteristic prominence of the medial border of the scapula upon attempted elevation, together with the biomechanical reasons for the rotation of the scapula in a direction contrary to the normal scapulohumeral rhythm. Based on these findings, a non-invasive alternative to the surgical technique for scapular stabilization has been devised, using an inflatable orthosis, placed between the scapula and an external restraint (such as a spinal jacket). The device has been tested on one subject using a 3SPACE Isotrak electromagnetic source and sensor system, and gave encouraging results. Elevation increased by up to 35 degrees (37 per cent), and functional improvement in the use of the hand around the head and face has been achieved. The technique needs no aftercare or physiotherapy and is therefore both economical and functionally effective.