Functional outcomes of children with sickle-cell disease affected by stroke.

The nature and degree of functional recovery after stroke in children with sickle-cell disease (SCD) has not been extensively investigated. The purpose of this study was to evaluate retrospectively the functional status of 14 SCD children who had had strokes and to compare them with age-matched and gender-matched SCD children who had not had strokes. By doing so, we would be able to quantify the eventual physical and cognitive functional outcomes of survivors of stroke secondary to SCD and assess the impact of stroke on these patients. These children (five boys and nine girls) with SCD and stroke(s) were 11.6 +/- 4.3 years of age (range five to 18 years). They experienced one to three strokes at a mean age of 6.1 +/- 5.2 years (range one to 17 years). A series of tests were administered to these subjects to evaluate physical and psychosocial functions. These tests were performed at least one year after the latest stroke. This study showed that all of the SCD-stroke children were physically independent. Only a few had impairments of hand functions and mild difficulties in self-care activities. However, most of these children demonstrated intellectual deficits ranging from borderline to moderate mental retardation, reduced language functions ranging from low normal to retarded range, and problems in adjustment. Intelligence quotient of the children with SCD-stroke(s) was significantly lower than those of age-matched and gender-matched nonstroke SCD children, suggesting that stroke caused an adverse effect on the cognitive functioning of these children. The results indicate that in the SCD-stroke children psychosocial deficits outweighed physical disabilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Rehabilitation of children with bone and soft tissue sarcomas: a physiatrist's viewpoint.

The physiatrist's chief concern for the child with an amputation secondary to tumor is that of comprehensive prosthetic rehabilitation. Problems unique to these children, factors which affect restoration favorably or unfavorably, principles of management, and measures of outcome are described and also illustrated by a case history. A multidisciplinary pediatric amputee clinic is recommended as the optimal setting for a prosthetic rehabilitation program.

Chronic neck and back pain: a reassessment of usual surgical treatment.

One hundred seventeen patients with chronic (noncancerous) back or neck pain had multidisciplinary evaluation in the Medical College of Virginia Pain Center and were followed up for one year. They ranged in age from 26 to 57 years. The 57 patients who had surgery had an average of 2.5 procedures (either laminectomies or back fusion) and only five of them returned to work. By contrast, 16 of 60 patients who had not had operation were able to secure employment after evaluation and treatment in the Pain Center.

Sexual function restoration in the physically disabled: use of a private hospital room.

For more than two years, a rehabilitation department in a large general hospital maintained a room adjacent to the ward as a site for evaluating and restoring sexual function of disabled patients. This report provides a description of the room, discusses its diverse purposes, and offers justifications of its feasibility in an acute hospital facility.

General anesthesia use in phenol intramuscular neurolysis in young children with spasticity.

This study reviews a nearly three-year experience of intramuscular neurolysis in children with spasticity. Thirteen children aged 3 to 11 years received general anesthesia during 16 procedures. Ten were cerebral palsy patients, one a congenital hydrocephalic, one a familial spastic paraplegic, and one a brain-injured child. Types of preoperative medications, induction and maintenance anesthetic agents are described, with indications for the particular choices of each type of drug. The principal and side effects of these agents during and after the 16 procedures are summarized. A combination of agents such as chloral hydrate; atropine if endotracheal intubation is necessary; pentothal, halothane, or cyclopropane for induction, and halothane-nitrous oxide for maintenance is our current choice of drugs to produce a light surgical plane of anesthesia. Advantages and disadvantages of the operating room method are considered. An overnight hospital stay was sufficient for all but two children, who required an additional evening of observation as the result of anesthetic side effects. No major complications were encountered in any of these elective procedures. The presence of a pediatric anesthesiologist during the procedure is perhaps to most reassuring aspect of the operating room-general anesthesia method.

Mobile velocity-controlled respirometer: description and performance capabilities.

An apparatus modeled after the Scram respirometer designed by Corcoran is described in terms of design, specifications and performance capabilities. The results with the use of this apparatus in a study of 14 able-bodied adults of five controlled walking speeds are compared to those of a similar study previously reported by Corcoran and Brengelmann. Oxygen consumption (ml O2/kg body wt/min) increases proportionately to the square of the velocity of walking. Results of the two investigations are parallel, although the present report demonstrates a greater male-female difference at all speeds. Uses and limitations of the apparatus are considered.

Clinical applications of a standardized mobility test.

Four patients with mobility problems were evaluated in relation to their performances on a standardized mobility test throughout the course of their rehabilitation programs. While each of the four cases demonstrates the value of an objective measurement of independent function, each also reflects individual points of merit. Clinical application demonstrated the test's ability to separate out areas of mobility deficit, evaluate forms of treatment, and indicate need for follow-up. Further, the sensitivity of the test in long-term follow-up of mobility problems was illustrated.

Sexual functioning in women with spinal cord injury.

The literature on women with spinal cord injury deals primarily with the factors of hormonal function, fertility and delivery. Unfortunately, information is limited concerning issues which are relevant to the total sexual functioning of these women. Little is known about potential hazards of contraceptives, the incidence of gynecological problems, the reactivity of vagina and external genitalia during sexual excitement, the nature of orgasmic experience, factors leading to orgasm and responsivity of nongenital erogenous zones. Sociocultural restrictions on vomen's sexual responsivity and willingness to discuss such issues are considered along with areas for future research, The authors emphasize the need to consider the totality of sexual functioning in future research and the need for women professionals to join research teams on this topic.