Benefits of Early Mobilization After Pediatric Liver Transplantation.

OBJECTIVE: To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU. DESIGN: A 70-month retrospective before-after study. SETTING: Medical and surgical PICU with 20 beds at a tertiary children's hospital. PATIENTS: Seventy-five patients 2-18 years old who underwent liver transplantation and could walk before surgery. INTERVENTION: We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach. MEASUREMENTS AND MAIN RESULTS: There was a significant increase in the proportion of patients who received physical therapy in the PICU (66% vs 100%; p < 0.001), especially within the first 48 hours after transplantation (9% vs 78%; p < 0.001). Furthermore, the time spent for physical therapy per eligible patient and per eligible PICU day increased (8.1 min [interquartile range, 0-10.6 min] vs 17.4 min [13.2-26.6 min]; p < 0.001). Compared with patients in the pre-early mobilization period, patients in the post-early mobilization period were able to walk again for more than 50 yards without a rolling walker earlier (28 [16-66] vs 23 [19-31] postoperative days; p = 0.015 by the Gray test), and the length of hospital stay of the post-early mobilization group was shorter than that of the pre-early mobilization group (55 [37-99] vs 40 [31-54] postoperative days; p = 0.012). CONCLUSIONS: Through implementation of early mobilization for pediatric patients who underwent liver transplantation, the duration from liver transplantation to regaining the ability to walk again without a rolling walker became shorter. Early mobilization intervention was beneficial for pediatric patients who underwent liver transplantation and could walk before surgery.

Early Mobilization after Pediatric Liver Transplantation.

Objective This study aims to evaluate the impact of early mobilization (EM) after pediatric liver transplantation in the pediatric intensive care unit (PICU). Design A 14-month prospective before and after study. Setting Multivalent PICU with 20 beds at a tertiary children's hospital. Patients A total of 57 patients aged younger than 16 years who received liver transplantation and were admitted to the PICU after surgery. Interventions EM project, a multifaceted framework for successful EM practice in the PICU focusing on a multidisciplinary team approach. Measurements and Main Results Compared with the period before the implementation of the EM project, there was a significant increase in the proportion of patients who received physical therapy in the PICU (43 vs. 97%, p < 0.001). Also, there were greater median numbers of physical therapy per eligible patient (0 vs. 3, p < 0.001). Moreover, patients achieved higher functional mobility level within a shorter time. Length of intubation, PICU stay, and hospital stay were not significantly different. There were no adverse events or deaths. Conclusion Using an EM project process, the proportion of patients who received physical therapy after liver transplantation increased. However, there was no difference in the length of PICU or hospital stay. Our findings indicated that EM for pediatric patients who received liver transplantation was well tolerated and safe.

[Summary of the Profiles of 22 Children with Traumatic Brain Injury Tacted with the Japanese Version of the WISC-IV].

The Japanese version of the Wechsler intelligence scale for children-fourth edition (WISC-IV) is often used to assess cognitive dysfunction in children with traumatic brain injury (TBI). To reveal the characteristics of cognitive impairment in pediatric TBI, we retrospectively analyzed the results of 22 children with TBI on the WISC-IV that was conducted at the Developmental Evaluation Center of the National Center for Child Health and Development over three years from July 2011 to July 2014. It has been hypothesized that the WISC-IV is limited for revealing neuropsychological dysfunction after traumatic brain injury.

[Case of long-term metamorphopsia caused by multiple cerebral infarction].

This report presents the case of a 79-year-old right-handed woman. One day on waking, she realized that the faces of her family members appeared distorted. She consulted an ophthalmologist at a nearby clinic in the vicinity and was diagnosed with left homonymous hemianopsia. Since a cerebrovascular disease was suspected, she was referred to clinic A. Brain MRI revealed a cerebral infarction in the right temporo-occipital area. Neurologically there was no other significant sign besides left homonymous hemianopsia and the visual disorder. Metamorphosia was the major visual disorder detected; in the patient's word "left half of the faces of people walking on the street in the opposite direction appeared distorted; they looked like monsters." With conservative medical treatment, the condition remitted; nevertheless, the right visual field metamorphopsia persisted for over 3 years. This unique case suggests that metamorphopsia occurs due to lesions in not only the contralateral parietooccipital lobe, as usually reported, but also in other resions, including the ipsilateral hemisphere.

[Lowered VIQ level following traumatic brain injury].

A patient with traumatic brain injury (TBI) is often associated with incidence of cognitive dysfunction as a sequela. We have conducted WAIS-R to 237 patients who were diagnosed as TBI at the Kanagawa Rehabilitation Hospital in order to assess their intellectual function. Twelve patients, whose VIQ being marked significantly lower than PIQ, were retrospectively analyzed in terms of their Functional Independence Measure (FIM), neuropsychological test results and lesions found in diagnostic images. In consequence, presence of a patient group whose VIQ level is significantly lowered due to the TBI sequela is recognized, in addition to a finding that trauma sites of cerebral contusion or other incidents are not necessarily corresponding to the results of neuropsychological test. Furthermore, based on an observation that those patients with lowered VIQ level are also associated with aggravation of PIQ 'digit symbol', Trail Making Test, or word fluency levels. This result was before similar with the result of "32 cases of DAI (diffuse axonal injury)" which authors reported, and it was guessed anew that the main factor of a cognitive dysfunction was damage on axon.

[Cognitive dysfunction in 32 diffuse axonal injury cases].

In acute stage of traumatic brain injury, it is not easy to diagnose diffuse axonal injury (DAI) by computer imaging. Even in chronic stage, DAIs occasionally show no remarkable abnormality by ordinal CT or MRI images. We retrospectively studied 32 DAI cases by the Functional Independence Measure (FIM), a battery of neuropsychological tests and CT or MRI films of acute and chronic phase. The result showed decrease of cognitive function in 32 DAI cases. The degree of enlargement of the ventricles in chronic stage did not correlate with cognitive dysfunction.

Dynamic postural control in patients with hemiparesis.

OBJECTIVE: Decreased postural stability is a common problem associated with hemiparesis secondary to stroke. The purpose of this study was to evaluate dynamic postural control in patients with hemiparesis and in normal subjects matched for age. DESIGN: Quantitative posturography (EquiTest System) was performed to assess the response of subjects to sudden perturbations. A total of 59 patients with hemiparesis and 98 healthy volunteers were evaluated. All the patients were able to walk inside their house without lower limb orthoses. Both the patients and the healthy volunteers were subjected to forward and backward perturbations while standing on a movable force platform. Balance responses were analyzed in terms of weight symmetry, latency, amplitude (relative response strength), and strength symmetry. They were also subjected to toes-up and toes-down perturbations to evaluate their response to a disruptive balance force. RESULTS: The response latency to perturbations was longer and the response strength was weaker on the paretic side of patients with hemiparesis. The dynamic postural control was impaired in patients with hemiparesis as compared with healthy subjects. CONCLUSION: The results suggest that patients with hemiparesis tend to fall easily and that the risk of falls toward the paretic side is high.

[A case of falcotentorial meningioma with visual allesthesia].

Visual allesthesia, in which visual images are transposed from one homonymous half-field of visual field to another, is a rare phenomenon. Palinopsia is the persistence or recurrence of visual images after the exciting stimulus object has been removed. Some authors have reported these phenomena, but these pathophysiology has not been understood. We report a right-handed 63-year-old woman, with a right falcotentorial meningioma. She paroxysmally experienced illusory transpositions of objects viewed in the right homonymous visual field into the left, and she recognized her face in it. The illusory images were palinoptic, persisting for up to a few minutes after the real objects were no longer in view. Administration of anticonvulsant medications resulted in the decrease of frequency of this phenomenon. Radiological and surgical findings revealed that the tumor was compressing the very localized visual cortex, especially the Brodmann's area 18 and 19. After resection of the tumor, visual allesthesia and palinopsia completely disappeared. These areas are associated with memory and recognition of visual images as visuopsychic area. This case provides some insight into the mechanisms of this phenomenon, and we consider that it could be caused by seizure activity in this lesion.