ABSTRACT
AIM: The aim of this investigation was to study the incidence of obstetric brachial plexus palsy (OBPP), to prospectively follow the recovery process, to assess the functional outcome at 18 months of age, and to find early prognostic indicators. METHOD: Of the 38 749 children born between 1999 and 2001 in western Sweden, 114 (70 males, 44 females) had an OBPP. Ninety-eight children were examined on six occasions at up to 18 months of age. Muscle strength, range of motion, hand preference, and functional abilities were noted, and the severity of the OBPP was classified. RESULTS: The incidence of OBPP was 2.9 per 1000 live births, and the incidence of persisting OBPP was 0.46 per 1000. At 3 months of age, the predictive value of regained elbow flexion for complete recovery was 100%, 99% of shoulder external rotation, and 96% of forearm supination. Most of the 18 children with persisting OBPP could perform functional activities but asymmetries were noted. Five children had a mild, 11 had a moderate, and two had a severe impairment. Three had undergone nerve surgery, one with a mild and two with a severe persisting impairment. INTERPRETATION: Most children with an OBPP recover completely. Muscle strength at 3 months of age can be used to predict outcome.
Subject(s)
Brachial Plexus Neuropathies/epidemiology , Brachial Plexus Neuropathies/therapy , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/therapy , Paralysis/epidemiology , Paralysis/therapy , Arm , Brachial Plexus Neuropathies/diagnosis , Child, Preschool , Disability Evaluation , Female , Follow-Up Studies , Functional Laterality , Humans , Incidence , Infant , Male , Movement , Muscle Strength , Obstetric Labor Complications/diagnosis , Paralysis/diagnosis , Pregnancy , Prognosis , Prospective Studies , Treatment OutcomeABSTRACT
Swedish Cystic Fibrosis (CF) care follows international guidelines in general. The only difference in our CF care package since 25 years is the physiotherapy regimen. Airway clearance therapy has since the early 1980s, from the day of diagnosis, been based upon daily physical exercise in conjunction with techniques for transporting and evacuating mucus. Postural Drainage+/-percussion and vibration has not been used in any age. The aim of this study was to evaluate our CF care package. Lung function data from the start of the study and with a 3-year interval were collected in the entire Swedish CF population > or =7 years old. Data were analysed for the age groups 7-17 and > or =18 years of age. Change of lung function over the study period was calculated. The impact of chronic Pseudomonas aeruginosa (Pa) colonisation and basal FEV(1)%p was also evaluated in a linear mixed model. Data from 99% of the country-wide CF population were available at inclusion. Mean FEV(1)%p was 90+/-21 vs 73+/-26 in the different age groups and mean VC%p was 94+/-18 vs 91+/-20. Forty percent of the adult group was > or =30 years old. Overall, 41% were chronically Pa colonised. Mean annual FEV(1)%p rate of decline was 0.77 and 0.64 in the different age groups. Lung function among Swedish CF patients is good and annual rate of decline low, even in an old cohort. The large proportion of adult patients emphasises future demands on CF care.
Subject(s)
Aging/physiology , Cystic Fibrosis/physiopathology , Adolescent , Adult , Child , Cystic Fibrosis/therapy , Drainage, Postural/methods , Female , Forced Expiratory Volume/physiology , Humans , Male , Middle Aged , Practice Guidelines as Topic/standards , Prognosis , Prospective Studies , Respiratory Function Tests , Sweden , Treatment Outcome , Young AdultABSTRACT
Recently it has been claimed that infants with congenital muscular torticollis (CMT) are at risk of a delay in early motor milestones. The aim of the present study was to investigate whether infants with CMT are indeed at risk in comparison with a control group of healthy infants. A second aim was to investigate whether the time spent in a prone position and plagiocephaly had any influence on motor development. Eighty-two infants with CMT (35 females and 47 males) were compared with 40 healthy infants (18 females and 22 males). Motor development was assessed with the Alberta Infant Motor scale (AIMS). Multiple regression showed that infants in the CMT group had a significantly lower AIMS score than the control group at 2 months (p=0.03) and 6 months of age (p=0.05). Infants who spent at least three occasions daily in a prone position when awake had significantly higher AIMS scores than infants who spent less time prone at 2 months (p=0.001), 6 months (p<0.001), and 10 months of age (p<0.001). The CMT group achieved early motor milestones significantly later than the control group until the age of 10 months, but the risk of delay seems to be more strongly associated with little or no time prone when awake than with CMT.
Subject(s)
Child Development/physiology , Developmental Disabilities/complications , Motor Skills/physiology , Plagiocephaly, Nonsynostotic/physiopathology , Torticollis/physiopathology , Analysis of Variance , Case-Control Studies , Developmental Disabilities/diagnosis , Female , Humans , Infant , Longitudinal Studies , Male , Plagiocephaly, Nonsynostotic/complications , Prone Position , Reference Values , Statistics, Nonparametric , Torticollis/complications , Torticollis/congenitalABSTRACT
The outcome of obstetric brachial plexus palsy depends on the severity of the lesion of the nerve fibers. The aim of the prospective study is to evaluate if differences in force used in downward traction on the fetal head correlate to the number of nerve roots affected. At final neurological examination at 18 months of age, complete neurological recovery occurred in 80 of 98 children (82%). Downward traction of the fetal head was applied more often and with greater force in the group with persistent damage. There was a significant correlation between the force used to the number of nerve roots affected. The risk of persistent obstetric brachial plexus palsy at age 18 months depended on obstetric management and increased significantly with increasing force used in downward traction of the fetal head.
Subject(s)
Brachial Plexus Neuropathies/etiology , Brachial Plexus/injuries , Delivery, Obstetric/adverse effects , Paralysis, Obstetric/etiology , Age Factors , Birth Weight , Case-Control Studies , Community Health Planning , Female , Humans , Infant , Infant, Newborn , Male , Pregnancy , Prospective Studies , Retrospective Studies , Time FactorsABSTRACT
OBJECTIVE: To assess and compare immediate effects of chest physiotherapy with positive expiratory pressure (PEP) versus oscillating PEP on transcutaneously measured blood-gas tensions in patients with cystic fibrosis. METHODS: Fifteen patients (mean age 12.5 y, range 6.9-21.5 y) participated. The treatments were randomized and performed on 2 separate occasions, 8 weeks apart. Spirometry was conducted before and after each treatment. We transcutaneously measured oxygen tension (P(tO2). RESULTS: There were no changes in spirometry values. During PEP, different trends in blood-gas tension were seen, and there were no consistent changes. During oscillating PEP, P(tO2) increased and P(tCO2) decreased. During oscillating PEP, P(tCO2) was lower and the intra-individual change in P(tCO2) was more pronounced than during PEP. The results obtained immediately after oscillating PEP showed a higher P(tO2) and a lower P(tCO2) than with PEP. CONCLUSION: PEP and oscillating PEP can both cause transitory effects on blood gases in patients with cystic fibrosis. However, oscillating PEP alters blood-gas tensions more than does PEP, and hyperventilation during oscillating PEP may reduce treatment time.
Subject(s)
Blood Gas Analysis , Cystic Fibrosis/therapy , Physical Therapy Modalities , Positive-Pressure Respiration/methods , Adolescent , Adult , Carbon Dioxide , Chest Wall Oscillation , Child , Female , Humans , Male , ThoraxABSTRACT
BACKGROUND: Children with multiple severe disabilities cannot be spontaneously physically active and therefore lack the ventilatory stimulation of physical activity. They often produce large quantities of airway mucus, which they have difficulty to evacuate on their own. The accumulation of mucus may lead to respiratory insufficiency. AIM: To investigate whether chest physiotherapy with positive expiratory pressure (PEP) could improve the blood oxygen tension (PO(2)) and/or decrease carbon dioxide tension (PCO(2)) in severely disabled children with airway mucus accumulation. METHODS: Eighteen disabled children (mean age 7.5 y, SD 4.3, range 1.7-17.8 y) participated in the study. Transcutaneous (tc) PO(2), tcPCO(2) and respiratory rate (RR) were recorded before and after PEP treatment. The reproducibility of the effect of the treatment was tested by repeating the recordings. RESULTS: The mean tcPO(2) increased 1.0 kPa (range -0.2 to 3.4 kPa) immediately after PEP treatment (p=0.0001). No significant changes in tcPCO(2) or RR were noted. The reproducibility of the effect of PEP treatment was good, with a significant increase in tcPO(2) at all retests. All children accepted the treatment well. CONCLUSION: PEP increases blood oxygen tension immediately after treatment in severely disabled children with airway mucus accumulation. Long-term effects remain to be proven.
Subject(s)
Blood Gas Monitoring, Transcutaneous , Disabled Children/rehabilitation , Physical Therapy Modalities , Positive-Pressure Respiration , Adolescent , Child , Child, Preschool , Comorbidity , Female , Humans , Infant , Male , Severity of Illness IndexABSTRACT
The aim of the study was to establish transcutaneous oxygen tension (tcPO(2)), carbon dioxide tension (tcPCO(2)), and oxygen saturation (tcSO(2)) values and to investigate the intra- and interindividual variation in these values in healthy children and adolescents. Forty-one healthy children/adolescents (21 girls; mean age, 12.1 years; SD, 3.5; range, 5.0-19.0 years) participated. Continuous recordings of tcPO(2), tcPCO(2), tcSO(2), and heart rate (HR) were made for 30 min on two occasions, with a mean interval of 10.3 days, with the child/adolescent in a sitting position. The respiratory rate (RR) was counted manually during the last 5 min of each recording. The mean values of tcPO(2), tcPCO(2), tcSO(2), HR, and RR during the last 5 min of the recordings were reported. At the first recording, the mean value for tcPO(2) was 10.8 kPa (SD 1.0), for tcPCO(2) 5.1 kPa (0.4), for tcSO(2) 97.4% (1.1), for HR 82.2 min(-1) (9.9), and for RR 19.0 min(-1) (2.8). The coefficient of variation for tcPO(2) was 9.3%, for tcPCO(2) 7.8%, for tcSO(2) 1.1%, for HR 12.0%, and for RR 14.7%. The mean intraindividual variation in tcPO(2) was 0.3 kPa (SD 1.0), tcPCO(2) 0.0 kPa (0.5), tcSO(2) 0.1% (1.3), HR 0.1 min(-1) (7.7), and RR 0.5 min(-1) (2.7). No significant differences were observed in tcPO(2), tcPCO(2), tcSO(2), HR, or RR between the two recordings. In conclusion, the reproducibility of tcPO(2), tcPCO(2), and tcSO(2) monitoring during 30 min in healthy children and adolescents was good. This indicates that transcutaneous blood gas monitoring may be used to document significant changes in blood gas tensions and oxygen saturation over time.
