Orthotic treatment of positional brachycephaly associated with osteogenesis imperfecta.

BACKGROUND: Osteogenesis imperfecta is an inherited disorder of the connective tissue characterized primarily by fractures with no or small causal antecedents and extremely variable clinical presentation. The disorder requires a global and, therefore, multidisciplinary therapeutic approach that should aim, among other aspects, at the prevention and treatment of deformities resulting from osteogenesis imperfecta. Due to limitations related to bony deformities, it can be difficult to place these infants in a variety of positions that would help remediate skull deformities, so a cranial orthosis becomes the therapy of choice. The aim of this study was to demonstrate the results obtained during treatment with a cranial remolding orthosis (helmet) in babies with osteogenesis imperfecta. Case Description and Methods: For the first time in the scientific literature, this study describes the use of a cranial orthosis for the treatment of infants with osteogenesis imperfecta. Both children had severe asymmetrical brachycephaly documented by laser digital scanning and were submitted to treatment with a cranial remolding orthosis. Outcomes and Conclusion: The study showed that there was a significant improvement in cranial proportion and symmetry, with a reduction in the cephalic index at reevaluation. It is concluded that the orthotic therapy is an effective therapeutic modality to improve the proportion and minimize the asymmetry in children with osteogenesis imperfecta. Clinical relevance The clinical relevance of such a description is that children with osteogenesis imperfecta may have numerous deformities and minimizing them can be an important factor. This report showed a beneficial result as the orthotic therapy modality improved the proportions and minimized the asymmetry. This treatment offers too high levels of satisfaction to parents and brings these children closer to normal indices.

Plagiocephaly and brachycephaly treatment with cranial orthosis: a case report.

The number of cranial deformities has increased considerably since international efforts of pediatricians to recommend parents putting their babies to sleep in the supine position as a strategy to reduce sudden death syndrome of the newborn. On the one hand, this program has demonstrated very efficient results at reducing deaths and, on the other hand, such recommendation has increased the incidence of cranial asymmetries. In addition, infants are kept too long in one position, much of this due to abusive use of strollers, baby carriers, car seats, swings and other devices. Among resulting asymmetries, the most frequently found are plagiocephaly (parallelogram shaped skull, with posterior unilateral flattening with the opposite frontal area also flattened) and brachycephaly (occipital bilateral flattening). The present study is a case report of a patient with brachycephaly associated with deformational plagiocephaly treated with cranial orthosis. The same physician clinically evaluated the patient before and after treatment using photographic recording and a laser scanning device, which allows the accurate measurement of variables determining asymmetries. It became clear during treatment that there was significant improvement in cranial symmetry documented by decrease in the cephalic index, diagonal difference and volume gain in the quadrant that was flattened. The authors conclude that orthotic therapy is a safe and effective therapeutic modality for position cranial asymmetries.

Tratamento de plagiocefalia e braquicefalia posicionais com órtese craniana: estudo de caso / Plagiocephaly and brachycephaly treatment with cranial orthosis: a case report

O número de deformidades cranianas tem aumentado desde que tiveram início os esforços internacionais dos pediatras, com a recomendação de se colocar os filhos para dormirem na posição supina, como estratégia para reduzir a morte súbita do recém-nascido. Se, por um lado, esse programa conseguiu demonstrar resultados muito eficientes nessa redução, por outro, tal recomendação fez com que os casos de assimetrias cranianas aumentassem em incidência. Isso porque os lactentes são mantidos por muito tempo em um só posicionamento, pois há também o uso abusivo de dispositivos como carrinho, bebê-conforto, cadeirinha de carro, balancinho, entre outros. Entre as assimetrias resultantes, as mais encontradas são a plagiocefalia (o crânio em forma de um paralelograma com achatamento occipital e anterior contralateral) e a braquicefalia (o achatamento occipital bilateral). Esse estudo relatou o caso de paciente com uma braquicefalia associada à plagiocefalia deformacionais tratado com órtese craniana. O paciente foi avaliado antes e após o tratamento clinicamente pelo mesmo médico, por meio de registro fotográfico e de um escaneamento a laser, que permite aferir variáveis determinantes das assimetrias. Foi possível, durante o período de tratamento, observar que houve importante melhora na simetria craniana documentada pela diminuição do índice cefálico, diminuição da diferença diagonal e ganho de volume no quadrante que se encontrava mais achatado. Conclui-se que a terapia ortótica constitui modalidade terapêutica segura e eficaz disponível para o tratamento das assimetrias cranianas posicionais.

The number of cranial deformities has increased considerably since international efforts of pediatricians to recommend parents putting their babies to sleep in the supine position as a strategy to reduce sudden death syndrome of the newborn. On the one hand, this program has demonstrated very efficient results at reducing deaths and, on the other hand, such recommendation has increased the incidence of cranial asymmetries. In addition, infants are kept too long in one position, much of this due to abusive use of strollers, baby carriers, car seats, swings and other devices. Among resulting asymmetries, the most frequently found are plagiocephaly (parallelogram shaped skull, with posterior unilateral flattening with the opposite frontal area also flattened) and brachycephaly (occipital bilateral flattening). The present study is a case report of a patient with brachycephaly associated with deformational plagiocephaly treated with cranial orthosis. The same physician clinically evaluated the patient before and after treatment using photographic recording and a laser scanning device, which allows the accurate measurement of variables determining asymmetries. It became clear during treatment that there was significant improvement in cranial symmetry documented by decrease in the cephalic index, diagonal difference and volume gain in the quadrant that was flattened. The authors conclude that orthotic therapy is a safe and effective therapeutic modality for position cranial asymmetries.

Free-running circadian rhythms of muscle strength, reaction time, and body temperature in totally blind people.

Light is the major synchronizer of circadian rhythms. In the absence of light, as for totally blind people, some variables, such as body temperature, have an endogenous period that is longer than 24 h and tend to be free running. However, the circadian rhythm of muscle strength and reaction time in totally blind people has not been defined in the literature. The objective of this study was to determine the period of the endogenous circadian rhythm of the isometric and isokinetic contraction strength and simple reaction time of totally blind people. The study included six totally blind people with free-running circadian rhythms and four sighted people (control group). Although the control group required only a single session to determine the circadian rhythm, the blind people required three sessions to determine the endogenous period. In each session, isometric strength, isokinetic strength, reaction time, and body temperature were collected six different times a day with an interval of at least 8 h. The control group had better performance for strength and reaction time in the afternoon. For the blind, this performance became delayed throughout the day. Therefore, we conclude that the circadian rhythms of strength and simple reaction time of totally blind people are within their free-running periods. For some professionals, like the blind paralympic athletes, activities that require large physiological capacities in which the maximum stimulus should match the ideal time of competition may result in the blind athletes falling short of their expected performance under this free-running condition.

Avaliação de resultados subjetivos de pacientes submetidos a artroplastia total de quadril pelo questionário WOMAC / Self-reported outcomes of patients undergoing total hip replacement surgery assessed by the WOMAC questionnaire

Objective: To assess pain, stiffness and physical function outcomes among patients undergoing total hip replacement using the Western Ontario and McMaster Universities Osteoarthritis Index. Methods: From January 2009 to July 2010, 64 male and female patients were assessed using the WOMAC questionnaire at baseline, hospital discharge, 3-month follow-up, and 6-month follow-up; one group of patients with primary hip osteoarthritis (n = 42) and another group with hip fracture (n = 22). Results: Changes in the total scores of the osteoarthritis group were statistically significant comparing baseline, hospital discharge, 3-month and 6-month assessments, demonstrating continued improvement over time up to 6-month follow-up. The total scores of the hip fracture group demonstrated a worsening from baseline to discharge, followed by improvement. The differences were statistically significant between baseline and discharge, as well as between discharge and the 6-month assessment. No statistically significant differences were found between baseline values and the 3-month assessment or baseline values and the 6-month assessment, demonstrating that the patients returned to their baseline health status after 3 months and maintained this status up to 6-month follow-up. Conclusion: The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire detected changes in outcome following hip replacement surgery among patients with primary diagnoses of hip osteoarthritis and hip fracture, with differences in the pattern of changes between the two groups.

Objetivo: Avaliar resultados referentes a dor, rigidez e função física de pacientes submetidos à artroplastia total de quadril utilizando o questionário Western Ontario and McMaster Universities Osteoarthritis Index. Métodos: De Janeiro de 2009 a Julho de 2010, 64 pacientes homens e mulheres foram avaliados utilizando o questionário WOMAC no momento pré-operatório, na alta hospitalar, com 3 meses e 6 meses de seguimento; um grupo de pacientes com osteoartrite primária de quadril (n = 42) e outro grupo com fratura de quadril (n = 22). Resultados: Mudanças nos escores totais do rupo de osteoartrite foram estatisticamente significantes comparando-se a avaliações de pré-operatório, alta hospitalar, com 3 meses e 6 meses, demonstrando melhora contínua com o decorrer do tempo até o seguimento de 6 meses. Os escores totais para o grupo com fratura de quadril demonstraram uma piora entre o momento pré-cirúrgico e a alta, seguida por uma melhora nos demais seguimentos. As diferenças foram estatisticamente significantes entre o pré-operatório e a alta, assim como entre a avaliação da alta e de 6 meses. Não houve diferença estatisticamente significante entre a avaliação pré-operatória e a de 3 meses ou entre a avaliação préoperatória e a de 6 meses, demonstrando que os pacientes retornaram ao seu estado de saúde pré-cirúrgico após 3 meses, mantendo esse estado até 6 meses de seguimento. Conclusão: O questionário Western Ontário and McMaster Universities Osteoarthritis Index detectou mudanças após a cirurgia entre os pacientes com diagnóstico primário de osteoartrite de quadril e fratura de quadril, com diferenças nos padrões de mudança entre os dois grupos.

Self-reported outcomes of patients undergoing total hip replacement surgery assessed by the WOMAC questionnaire.

OBJECTIVE: To assess pain, stiffness and physical function outcomes among patients undergoing total hip replacement using the Western Ontario and McMaster Universities Osteoarthritis Index. METHODS: From January 2009 to July 2010, 64 male and female patients were assessed using the WOMAC questionnaire at baseline, hospital discharge, 3-month follow-up, and 6-month follow-up; one group of patients with primary hip osteoarthritis (n = 42) and another group with hip fracture (n = 22). RESULTS: Changes in the total scores of the osteoarthritis group were statistically significant comparing baseline, hospital discharge, 3-month and 6-month assessments, demonstrating continued improvement over time up to 6-month follow-up. The total scores of the hip fracture group demonstrated a worsening from baseline to discharge, followed by improvement. The differences were statistically significant between baseline and discharge, as well as between discharge and the 6-month assessment. No statistically significant differences were found between baseline values and the 3-month assessment or baseline values and the 6-month assessment, demonstrating that the patients returned to their baseline health status after 3 months and maintained this status up to 6-month follow-up. CONCLUSION: The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire detected changes in outcome following hip replacement surgery among patients with primary diagnoses of hip osteoarthritis and hip fracture, with differences in the pattern of changes between the two groups.