Correction to: Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies.

The original article [1] contains a small mistake concerning the ARTIC Team members mentioned in the Acknowledgements. The team member, Rocco Salvatore Calabrò had their name presented incorrectly. This has now been corrected in the original article.

Health-related quality of life and functional outcome measures for children with cerebral palsy.

The aim of this study was to examine measures of health-related quality of life (HRQL) in children with cerebral palsy (CP) by comparing scores of a generic HRQL measure, the Child Health Questionnaire (CHQ); a disease-specific HRQL measure for children with CP, the Caregiver Questionnaire (CQ); and a pediatric functional measure, the Wee-Functional Independence Measure (WeeFIM). Participants included 30 caregivers of children with CP. The caregivers' children were a mean age of 8 years 6 months (17 females, 13 males). The ethnic origin of the children was 18 African-American, 8 white, 3 Hispanic, and 1 Middle Eastern. Significant correlations were found between the CQ and WeeFIM total and subscale scores (r=0.388 to 0.641). There was no correlation between the CHQ and CQ total summary scores, but significant correlations were found between the CHQ subscales related to parent time and family cohesion and the CQ total and subscale scores (r=0.386 to 0.481). The lack of correlation between the CHQ and WeeFIM indicates HRQL and function are different constructs that cannot be inferred from each other. The fair relationship found between the CQ and WeeFIM suggests that the constructs measured in these two assessments overlap. The lack of correlation between the total summary scores of the CHQ and CQ suggests the CQ may be a more specific measure of HRQL for this population that reflects the impact of the child's condition on the caregiver.

Improvement of sleep apnea in a patient with cerebral palsy.

Intrathecal baclofen (ITB) can reduce spasticity in adults and children with cerebral palsy. Benefits of ITB therapy include improved Ashworth scores, activities of daily living, and mobility. The impact of ITB therapy on sleep apnea in patients with cerebral palsy has not been reported. This case report describes a 29-yr-old female with mixed spastic athetoid quadriparetic cerebral palsy with dystonia, gross motor function IV, who had sleep apnea, requiring nightly continuous positive airway pressure. She received ITB with the goal to improve her wheelchair positioning and decrease her excessive movements. After the initiation of the ITB, reduction of her spasticity and dystonia was noted, as well as improvement of her sleep apnea. This case suggests that ITB therapy may improve respiratory function through reduction of respiratory muscle spasticity.

Use of botulinum toxin type A in pediatric patients with cerebral palsy: a three-center retrospective chart review.

Over the last several years, botulinum toxin type A has gained widespread use for the management of focal spasticity in children with cerebral palsy. To assess the current patterns of botulinum toxin type A use in the clinical setting, the dose, muscles injected, age at injection, and interval between injections of botulinum toxin type A treatments were examined in a retrospective chart review of children with cerebral palsy (N = 270) over a 2-year period at three major treatment centers. The average dose of botulinum toxin type A across the three centers ranged from 7.7 to 10.8 U/kg body weight, and the average total amount of botulinum toxin type A injected at a single visit ranged from 154 to 205 U. The majority of botulinum toxin type A injections were to the muscles to the lower limbs. The average age at first injection was 6.2 years, and the average interval between injections ranged from 134 to 199 days.

Recommendations for the use of botulinum toxin type A in the management of cerebral palsy.

Botulinum toxin type A (BTX-A) is increasingly being used for the treatment of childhood spasticity, particularly cerebral palsy. However, until very recently, all such use in this indication has been unapproved with no generally accepted treatment protocols, resulting in considerable uncertainty and variation in its use as a therapeutic agent. In view of the increasing awareness of, and interest in, this approach to the treatment of spasticity, and also the recent licensing in a number of countries of a BTX-A preparation for treating equinus deformity in children, it would seem timely to establish a framework of guidelines for the safe and efficacious use of BTX-A for treating spasticity in children. This paper represents an attempt, by a group of 15 experienced clinicians and scientists from a variety of disciplines, to arrive at a consensus and produce detailed recommendations as to appropriate patient selection and assessment, dosage, injection technique and outcome measurement. The importance of adjunctive physiotherapy, orthoses and casting is also stressed.

Selective posterior rhizotomy and soft-tissue procedures for the treatment of cerebral diplegia.

The results of selective posterior rhizotomy in fifty patients (group I) and of soft-tissue procedures in fifty patients (group II), all 100 of whom had cerebral diplegia and were seen in a private office, were reviewed retrospectively. No effort was made to randomize the treatment, as the selection criteria for the two procedures are different. We evaluated the range of motion and the ability and quality of walking preoperatively and postoperatively as well as the need for additional operative intervention in the two groups. The average age of the patients in both groups was five years (range, three to twelve years in group I and one to thirteen years in group II). The average duration of follow-up in both groups was four years (range, one to six years in group I and one to seven years in group II). Thirty-two patients (64 percent) in group I and forty-one patients (82 percent) in group II were able to walk independently at the latest follow-up examination. Both groups had an over-all improvement in the ranges of abduction of the hips and dorsiflexion of the ankles, a decrease in the flexion contractures of the hips, and more normal popliteal angles; however, with the numbers available, there were no significant differences in these measurements between the two groups at the 0.05 percent confidence level. Despite the overall improvement in range of motion, thirty-one patients in the rhizotomy group subsequently had soft-tissue releases, and twenty-two patients in the soft-tissue-release group had additional operative intervention.

Deep vein thrombosis in the disabled pediatric population.

The incidence of deep vein thrombosis (DVT) in the disabled pediatric population has rarely been studied. The purpose of our retrospective study was to define the incidence in patients younger than 18 years of age who were in a rehabilitation center. We reviewed the charts of 532 children admitted to the center from 1983 through 1987, and found a 2.2% overall incidence of DVT. The largest group of children under 18 of age with documented or suspected DVT was the group with spinal cord injuries (SCI). There were 87 SCI children, 67 of whom were between the ages of 15 and 18. Of the 67, 7 (10%) had DVT: 1 of the 20 SCI children under age 15 had DVT. There were single cases of DVT documented in children with: meningoencephalitis, arteriovenous malformation, closed head injuries, and Guillian-Barré syndrome. We studied the risk involved in treating DVT with heparin and formulated recommendations based on our findings.

Rehabilitation outcome in children after treatment of primary brain tumor.

Functional outcome studies after treatment of primary brain tumors in children are lacking. This study of 30 children, ages 3 to 20 years (x 10.8 yrs) was aimed at documenting the effects of rehabilitation on functional outcome after treatment of primary brain tumors. Functional measurements were documented by a modified functional independence measure for children (WeeFIM). The paired t-test, Wilcoxon test, chi 2 analysis, and Friedman test were used to assess significance of data. Statistically significant improvements were documented from admission to discharge, and discharge to follow-up in total WeeFIM scores (p = 0.001 and p = 0.0001) and specifically in the subgroups of self care, mobility, and locomotion. Though no significant improvement was noted in sphincter control from admission to discharge (p = 0.15), significant gains were seen at follow-up (p = 0.006). Borderline improvements at discharge in communication (p = 0.054) and social cognition (p = 0.051) became significant at follow-up (p = 0.01 and p = 0.004). At admission, 7 patients (23%) were independent in self care, 5 (17%) in mobility and 1 (3%) in locomotion compared with 18 (60%), 20 (67%), and 15 (50%) respectively at discharge. At follow-up there was further improvement with 95% independent in self care, 100% in mobility and 70% in locomotion. This study affirms the beneficial effect of comprehensive rehabilitation on functional outcome in children with residual disabilities after treatment of their primary brain tumors.

Superior mesenteric artery syndrome in acute traumatic quadriplegia: case reports and literature review.

Superior mesenteric artery syndrome is a condition in which the third portion of the duodenum is intermittently compressed by the overlying superior mesenteric artery, resulting in gastrointestinal obstruction. Predisposing factors include rapid weight loss, prolonged supine positioning, and using a spinal orthosis, all of which are common among acute traumatic quadriplegic patients. This paper presents three patients, aged 24, 16, and 20 years, with traumatic quadriplegia treated with supine positioning and cervical orthoses, who had postprandial nausea and emesis, bloating, and abdominal pain during rehabilitation. Upper gastrointestinal radiographic series demonstrated abrupt duodenal obstruction to barium flow in all three patients. Two of the patients had complete relief of symptoms with conservative management, and one required surgical duodenojejunostomy. Enhanced awareness of this condition may result in improved recognition of this disease as a cause of persistent, unexplained gastrointestinal disturbances in quadriplegic persons, thereby optimizing its treatment and reducing its potential morbidity.