Vojta therapy and neurodevelopmental treatment in children with infantile postural asymmetry: a randomised controlled trial.

[Purpose] Physical therapy is an acknowledged and frequently applied method for infantile postural asymmetry. However, there is not yet sufficient evidence for its effectiveness. [Subjects and Methods] In a randomised controlled trial, the effect of Vojta therapy versus Neurodevelopmental treatment is assessed in infants with postural asymmetry. 65 infants with postural asymmetry were recruited. 37 infants aged six to eight weeks (mean 7.38) were found to be eligible and randomly assigned to two groups, with 19 receiving Vojta and 18 Neurodevelopmental treatment. Using a standardised and blinded video-based assessment, we documented restriction in head rotation and convexity of the spine in prone and supine position before and after therapy. A reduction of at least four points (range of scale 20 points) in postural asymmetry was regarded as a clinically relevant change. [Results] On average a four-point reduction was achieved in both groups within eight weeks. A mean difference (pre-post) between the groups of -2.96 points in favour of Vojta therapy was observed. [Conclusion] While both Neurodevelopmental treatment and Vojta are effective in the treatment of infantile postural asymmetry and comparably well applied by the parents, therapeutic effectiveness is significant greater within the Vojta group.

Disease-specific risk for an osteonecrosis of the jaw under bisphosphonate therapy.

PURPOSE: Osteonecrosis of the jaw (ONJ) presents a severe side-effect of intravenous bisphosphonate (i.v. BP) treatment; yet, the pathoethiological influence of the underlying disease which indicated that treatment remains unclear. METHODS: We studied a large register of subjects who suffered an ONJ (n = 356) under i.v. BP therapy and characterized them according to underlying diseases and BP intake. By using claims data, we analysed indications in the general public in a cohort of new users of i.v. BPs (n = 1,075) in ambulatory care. For the years 2004-2006, both data sources were compared to indirectly assess the disease-specific risk for the development of an ONJ. We further assessed disease-specific survival after treatment initiation. RESULTS: Patients with multiple myeloma were found more often, in the ONJ register, than were treated in real life (males: 36.4% vs. 16.2%; females: 27.8% vs. 6.5%) while the proportions of patients with prostate or breast cancer were as expected, and malignancies with low survival rates were strongly underrepresented. No patients with osteoporosis were reported to the ONJ register despite accounting for 18.8% of all the treated females in the general public. CONCLUSIONS: The pattern of diagnoses that indicated i.v. BP treatment in patients who suffered an ONJ is different from what would be expected when looking at indications in the general public. Each underlying disease may, hence, have its own inherent risk to develop an ONJ due to varying life-expectancies and overall oncological treatment regimes including the interval and type of i.v. BP application.

Pattern of intravenous bisphosphonate use in outpatient care in Germany.

PURPOSE: Intravenous bisphosphonate therapy has recently been associated with the development of an osteonecrosis of the jaws (ONJ). If new adverse events have been linked to drugs, basic information on drug exposure in routine care is essential. The aim of this study was to investigate prevalence as well as duration and cumulative doses of intravenous bisphosphonate treatment. METHODS: We analysed data of the statutory health insurance company Gmünder ErsatzKasse (GEK) over the years 2000-2006. We first estimated treatment prevalence in 2006. We further studied a cohort of new users of intravenous bisphosphonates who initiated treatment between 1 January 2001 and 31 December 2005. We used the Kaplan-Meier method to estimate the time to end of treatment (composite of discontinuation and death). RESULTS: A total of 1024 patients received at least one dose of intravenous bisphosphonates in 2006. The most commonly prescribed agent was zoledronate (53.7%). After standardizing for sex and age, an estimated 0.1% of the German population would have been treated in 2006. Of 1259 new users in 2001-2005, an estimated 40% of men and 22% of women died within 12 months. The median treatment duration was 3.5 months in men and 5.7 months in women. This difference disappears when studying only survivors. CONCLUSIONS: Although our study suggests that intravenous bisphosphonates were prescribed mainly for short durations, this result is strongly influenced by the fact that new users had a poor prognosis with a short life expectancy.

Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial.

The aim of this study was to assess the therapeutic efficacy of osteopathic treatment in infants with postural asymmetry. A randomized clinical trial of efficacy with blinded videoscoring was performed. Sixty-one infants with postural asymmetry aged 6 to 12 weeks (mean 9wks) were recruited. Thirty-two infants (18 males, 14 females) with a gestational age of at least 36 weeks were found to be eligible and randomly assigned to the intervention groups, 16 receiving osteopathic treatment and 16 sham therapy. After a treatment period of 4 weeks the outcome was measured using a standardized scale (4-24 points). With sham therapy, five infants improved (at least 3 points), eight infants were unchanged (within 3 points), and three infants deteriorated (not more than -3 points); the mean improvement was 1.2 points (SD 3.5). In the osteopathic group, 13 infants improved and three remained unchanged; the mean improvement was 5.9 points (SD 3.8). The difference was significant (p=0.001). We conclude that osteopathic treatment in the first months of life improves the degree of asymmetry in infants with postural asymmetry.

Patterns of postural asymmetry in infants: a standardized video-based analysis.

Cervical rotation deficit (CRD) and trunk convexity (TC) constitute the diagnosis of infantile postural asymmetry (IPA), which is often associated with further asymmetric features. However, very little data on the entire symptom complex are currently available. The aim of this study was to analyse the entire clinical spectrum of IPA based on a standardized video documentation. Forty-five infants (27 male) with an asymmetry score of > or = 12 points (scale: 4-24) at a median post-term age of 10 weeks (range: 6-16) were selected from two previously studies using predefined criteria. CRD and TC as reactive movements to an orienting head turn in the prone and supine position were assessed from video recordings by three independent observers. Plagiocephaly, oblique body position and asymmetric foot position were descriptively assessed by consent of the same observers. Hip dysplasia data were derived from sonography charts. The assessment of the reactive movements showed a "scoliosis" pattern in sox infants, a "torticollis" pattern in nine infants, a "mixed prone" pattern in 13 infants and a "mixed" pattern in 26 infants. Side agreement in the prone and supine position of TC and CRD was seen in 27 infants, with a left-sided convexity and left-sided head rotation deficit in two-thirds of the infants. Plagiocephaly was present in 27 infants, oblique body position in 13 infants, hip dysplasia in 4 infants and calcaneus foot in 11 infants. In conclusion, infantile asymmetry pattern analysis showed that morphological and functional anomalies are intricately linked and that infants with only a single apparent sign of asymmetry have actually a much more generalized disturbance.

Idiopathic infantile asymmetry, proposal of a measurement scale.

UNLABELLED: To evaluate the development of idiopathic infantile asymmetry and the efficacy of therapeutic interventions, spinal scoliosis can be quantified on the basis of radiographs. For obvious reasons, use of this technique is limited. Here we present a clinical method to describe and quantify infantile asymmetry. For item selection, spontaneous movements (SMs), reactive movements (RMs) and length differences were video recorded in 30 infants (median age 10 weeks, range 6-16) with variable degrees of asymmetry. Within these three categories, reactive movements elicited by head turns to the right and left side in the prone and supine position emerged as reliable parameters reflecting trunk convexity and cervical rotation deficits. Six-point scales were developed for both measurements and added to form final scales. Consistency and interobserver reliability were evaluated in another 20 infants (median age 9 weeks, range 6-15) with variable degrees of asymmetry. Statistical analysis indicated good reliability and consistency of the testing method with an intraclass correlation coefficient of 91.5% (Cronbach alpha 0.84). CONCLUSION: During the first months of life, idiopathic infantile asymmetry can be clinically assessed using a highly consistent and reliable measurement scale describing degrees of trunk convexity and cervical rotations deficit.