Análisis electromiográfico de los músculos del tobillo en adultos jóvenes con síndrome de Down antes y después de la implementación de un programa de actividad física basado en la danza / Electromyographic analysis of ankle muscles in young adults with Down syndrome before and after the implementation of a physical activity programme based on dance

Introducción: Las personas con síndrome de Down tienen dificultades de control postural, y muestran diferencias en cuanto a desplazamiento de su centro de presión y a su actividad muscular, en comparación con la población general. La investigación previa ha reflejado que el centro de la presión de desplazamiento es menos dependiente de las condiciones visuales en las personas con síndrome de Down, aunque se ha observado una mejora del equilibrio tras la realización de actividades físicas basadas en la danza. El objetivo del proyecto fue valorar el efecto de un programa de actividad física basado en la danza sobre la actividad muscular en adultos jóvenes con síndrome de Down. Material y métodos: Once participantes con síndrome de Down y 11 participantes sin síndrome de Down, como grupo control, siguieron un programa de danza de 18 semanas de duración. Se utilizó electromiografía de superficie para valorar la actividad del músculo del tobillo antes y después de la finalización del programa, con los ojos abiertos y cerrados. Resultados: Observamos un nivel superior de activación muscular en el grupo de síndrome de Down, que reflejó unas diferencias menores entre las diferentes condiciones visuales que el grupo control. No se observaron diferencias significativas previas y posteriores al entrenamiento en el grupo síndrome de Down. Sin embargo se observaron menores diferencias entre ambos grupos tras el entrenamiento, en relación a la situación previa al mismo. Conclusiones: Aunque no se observaron diferencias significativas en el grupo síndrome de Down tras el entrenamiento, sí se observó un descenso de las diferencias entre los grupos. Estas podrían guardar relación con ciertas adaptaciones posturales. En el futuro, sería interesante incrementar la muestra, y analizar también la posición del centro de presión en relación a los pies

Introduction: People with Down syndrome have difficulties in postural control and exhibit differences in the displacement of their centre of pressure and in muscle activity compared with the general population. Previous research has shown that centre of pressure displacement is less depending on visual conditions in people with Down syndrome, although improved balance has been observed following specific physical activities based on dance. The aim of the project was to assess the effect of a dance-based physical activity programme on muscle activity in young adults with Down syndrome. Material and methods: Eleven participants with Down syndrome and eleven participants without Down syndrome as the control group followed an 18-week dance programme. Surface electromyography was used to assess ankle muscle activity before and after completion of the programme in open and closed eyes conditions. Results: We observed a higher level of muscle activation in Down syndrome group. They showed minor differences between different visual conditions than control group. No significant differences were seen in pre- and post-training in Down syndrome group. Nevertheless, less differences were observed between both groups after training than before. Conclusions: Although no significant differences were observed in Down syndrome group after training, differences between groups were decreased. These could be related to some postural adaptations. In the future, it will be interesting to increase the sample and also analyze the position of centre of pressure in relation to feet

HUSP: A Smart Haptic Probe for Reliable Training in Musculoskeletal Evaluation Using Motion Sensors.

As a consequence of the huge development of IMU (Inertial Measurement Unit) sensors based on MEMS (Micro-Electromechanical Systems), innovative applications related to the analysis of human motion are now possible. In this paper, we present one of these applications: a portable platform for training in Ultrasound Imaging-based musculoskeletal (MSK) exploration in rehabilitation settings. Ultrasound Imaging (USI) in the diagnostic and treatment of MSK pathologies offers various advantages, but it is a strongly operator-dependent technique, so training and experience become of fundamental relevance for rehabilitation specialists. The key element of our platform is a replica of a real transducer (HUSP-Haptic US Probe), equipped with MEMS based IMU sensors, an embedded computing board to calculate its 3D orientation and a mouse board to obtain its relative position in the 2D plane. The sensor fusion algorithm used to resolve in real-time the 3D orientation (roll, pitch and yaw angles) of the probe from accelerometer, gyroscope and magnetometer data will be presented. Thanks to the results obtained, the integration of the probe into the learning platform allows a haptic sensation to be recreated in the rehabilitation trainee, with an attractive performance/cost ratio.

Repairability of skeletal alterations induced by sodium valproate in rats.

The present study aimed at examining postnatal repairability of sodium valproate-induced skeletal alterations in rats. Sodium valproate (400 mg/kg) or the vehicle (distilled water) was orally administrated to pregnant Sprague-Dawley rats from gestation days 9 to 11. Fetuses and pups were obtained on gestation day 21 and postnatal day 11, respectively, and their skeletons were stained with Alizarin red S and Alcian blue and examined. Sodium valproate-induced costal and vertebral alterations in the fetuses included discontinued rib cartilage, fused rib, full or short supernumerary rib, bipart ossification of thoracic centrum, supernumerary lumbar vertebrae, and lumbarization. In pups, however, discontinued rib cartilage was not observed, and the incidence of a short supernumerary rib was significantly lower than that in the fetuses, suggesting that these alterations are postnatally repairable.

Adaptive behaviour and motor skills in children with upper limb deficiency.

BACKGROUND: The dysfunction of individuals with upper limb deficiencies affects their daily lives and social participation. OBJECTIVES: To clarify the adaptive behaviours and motor skills of children with upper limb deficiencies. STUDY DESIGN: Cross-sectional survey. METHODS: The subjects were 10 children ranging from 1 to 6 years of age with unilateral upper limb deficiencies at the level distal to the elbow who were using only cosmetic or passive prostheses or none at all. To measure their adaptive behaviour and motor skills, the Vineland Adaptive Behavior Scales, Second Edition was used. They were evaluated on the domains of communication, daily living skills, socialization and motor skills. We also examined the relationship of the scores with age. RESULTS: There were no statistically significant scores for domains or subdomains. The domain standard score of motor skills was significantly lower than the median scores of the domains and was negatively correlated with age. CONCLUSION: Children with upper limb deficiencies have individual weaknesses in motor skill behaviours, and these weaknesses increase with age. It may be helpful in considering approaches to rehabilitation and the prescription of prostheses to consider the characteristics and course of children's motor skill behaviours. Clinical relevance Even if children with unilateral upper limb deficiencies seem to compensate well for their affected limb function, they have or will experience individual weaknesses in motor skills. We should take this into consideration to develop better strategies for rehabilitation and prostheses prescriptions.

Congenital agenesis of the superficial posterior compartment calf muscles in a 13-month-old infant.

Muscle agenesis may induce cosmetic and functional deficits, particularly if the muscle is an axial limb or a large muscle. Limb muscle agenesis is a rare condition. Here, the authors report the case of a 13-mo-old girl with unilateral atrophic calf and gait abnormality. Magnetic resonance imaging confirmed agenesis of the posterior superficial compartment of the calf. The patient showed an out-toeing calcaneal gait and fibular length discrepancy secondarily during growth. Normal embryology and the differential diagnostic point of foot deformity as well as the clinical implications of calf agenesis are described.

Prevalence and factors associated with thoracic alterations in infants born prematurely.

OBJECTIVE: To determine the prevalence of thoracic musculoskeletal alterations and associated factors in infants born prematurely. METHODS: This was a cross sectional study with infants in the first year of age, born prematurely with birth weight < 2,000 g, who were followed up at the Premature Clinic from February, 2007 to December, 2008. Exclusion criteria were: major congenital malformations as defined by the Centers for Disease Control and Prevention (CDC), grade III/IV intraventricular hemorrhage, or periventricular leucomalacia. Physical examinations performed independently by two physiotherapists were used to assess shoulder elevation and thoracic retractions. Comparisons between groups were performed using the chi-squared test or Fisher's exact test for categorical variables, and Mann-Whitney's test or Student's t-test were used for continuous variables. Interobserver reliability between the two physiotherapists was assessed by the kappa coefficient. Variables associated with these thoracic musculoskeletal alterations were studied by univariate and multiple logistic analyses. Statistical differences were considered significant when p < 0.05. This study was approved by the ethical committee of the institution, and parents/guardians signed an informed consent. RESULTS: 121 infants with a gestational age of 31.1 ± 2.8 weeks and birth weight of 1,400 ± 338 g were included. Thoracic alterations were detected by Physiotherapist 1 in 81 (66.9%) infants, and in 83 (68.6%) by Physiotherapist 2 (kappa coefficient = 0.77). By multivariate logistic regression analysis, factors associated with thoracic musculoskeletal alterations were: respiratory distress syndrome (odds ratio [OR] = 3.246, 95% confidence interval [CI]: 1.237-8.732), bronchopulmonary dysplasia (OR = 11.138, 95% CI: 1.339-92.621), and low length/age ratio (OR = 4.571, 95% CI: 1.371-15.242). CONCLUSION: The prevalence of thoracic alterations was high in infants born prematurely, and was associated with pulmonary disease and low length/age ratio.

Prevalence and factors associated with thoracic alterations in infants born prematurely / Prevalência e fatores associados às alterações torácicas em lactentes nascidos prematuros

OBJECTIVE: To determine the prevalence of thoracic musculoskeletal alterations and associated factors in infants born prematurely. METHODS: This was a cross sectional study with infants in the first year of age, born prematurely with birth weight < 2,000 g, who were followed up at the Premature Clinic from February, 2007 to December, 2008. Exclusion criteria were: maj or congenital malformations as defined by the Centers for Disease Control and Prevention (CDC), grade III/IV intraventricular hemorrhage, or periventricular leucomalacia. Physical examinations performed independently by two physiotherapists were used to assess shoulder elevation and thoracic retractions. Comparisons between groups were performed using the chi-squared test or Fisher's exact test for categorical variables, and Mann-Whitney's test or Student's t-test were used for continuous variables. Interobserver reliability between the two physiotherapists was assessed by the kappa coefficient. Variables associated with these thoracic musculoskeletal alterations were studied by univariate and multiple logistic analyses. Statistical differences were considered significant when p < 0.05. This study was approved by the ethical committee of the institution, and parents/guardians signed an informed consent. RESULTS: 121 infants with a gestational age of 31.1 ± 2.8 weeks and birth weight of 1,400 ± 338 g were included. Thoracic alterations were detected by Physiotherapist 1 in 81 (66.9%) infants, and in 83 (68.6%) by Physiotherapist 2 (kappa coefficient = 0.77). By multivariate logistic regression analysis, factors associated with thoracic musculoskeletal alterations were: respiratory distress syndrome (odds ratio [OR] = 3.246, 95% confidence interval [CI]: 1.237-8.732), bronchopulmonary dysplasia (OR = 11.138, 95% CI: 1.339-92.621), and low length/age ratio (OR = 4.571, 95% CI: 1.371-15.242). CONCLUSION: The prevalence of thoracic alterations was high in infants born prematurely, and was associated with pulmonary disease and low length/age ratio.

OBJETIVO: Determinar a prevalência e os fatores associados às alterações torácicas musculoesqueléticas em lactentes nascidos prematuros. MÉTODOS: Estudo transversal com lactentes no primeiro ano de vida, nascidos prematuros com peso < 2000 g e acompanhados em um ambulatório de seguimento de prematuros, de fevereiro/2007 a dezembro/2008. Foram excluídas crianças com malformações maiores definidas pelo CDC ou com hemorragia peri-intraventricular grau III/IV ou leucomalácia periventricular. Duas fisioterapeutas realizaram o exame físico, avaliando, de modo independente, a elevação de ombros e as retracões da caixa torácica. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição, sendo solicitada assinatura do Termo de Consentimento pelos pais. As variáveis numéricas foram comparadas pelo teste t ou Mann-Whitney. O grau de concordância entre as avaliações das fisioterapeutas foi obtido pelo coeficiente kappa e as variáveis associadas às alterações torácicas foram estudadas por regressão logística univariada e múltipla. Considerou-se significante p < 0,05. RESULTADOS: Foram estudados 121 lactentes com idade gestacional de 31,1 ± 2,8 semanas e peso ao nascer de 1400 ± 338 g. A fisioterapeuta 1 detectou alterações torácicas em 81 (66,9%) lactentes e a fisioterapeuta 2 em 83 (68,6%) (coeficiente kappa = 0,77). Os fatores associados às alterações musculoesqueléticas foram: síndrome do desconforto respiratório no período neonatal (OR=3,246; IC 95%: 1,237-8,732), ter apresentado displasia broncopulmonar (OR=11,138; IC 95%: 1,339-92,621) e relação comprimento para a idade alterada (OR=4,571; IC 95%: 1,371-15,242). CONCLUSÃO: A prevalência de alterações torácicas foi alta em lactentes nascidos prematuros e associou-se a doença pulmonar no período neonatal e baixa relação comprimento/idade.

Tortícolis muscular congénita en fase de adulto / Congenital muscular torticollis in adults

La tortícolis muscular congénita (TMC) es una enfermedad frecuente, que debido a su fácil reconocimiento y exitoso tratamiento en los primeros meses de vida no suelen mostrar alteraciones clínicas en edades infantiles tardías o adultos. El escaso número de casos que prevalecen por encima de los primeros años de vida hace que exista una menor información sobre las decisiones terapéuticas a seguir. Básicamente se relegan, tras fracasar la fisioterapia, al uso de toxina botulínica o de una cirugía específica. Presentamos el caso clínico de una paciente diagnosticada finalmente, ya en edad adulta de TMC, y que fue tratada mediante sección unipolar de la porción clavicular del esternocleidomastoideo seguida de una rehabilitación específica, intensa y precoz, con muy buenos resultados estéticos y funcionales (AU)

Congenital muscular torticollis is a common condition. Because it is easy to recognize and its successful treatment during the first months of life, clinical changes are not usually found in the late childhood or adult age. As few cases prevail after the first years of life, there is less information about treatment decisions to follow. When physical therapy fails, these treatments are basically relegated to botulinum toxin or specific surgery. We report the case of a patient who was finally diagnosed in adulthood of congenital muscular torticollis. This patient was treated by unipolar sectioning of the clavicular portion of the sternocleidomastoid muscle. This was followed by specific, early and intense rehabilitation, with very good esthetic and functional results (AU)

Photogrammetry: an accurate and reliable tool to detect thoracic musculoskeletal abnormalities in preterm infants.

OBJECTIVE: To analyse the accuracy and reproducibility of photogrammetry in detecting thoracic abnormalities in infants born prematurely. DESIGN: Cross-sectional study. SETTING: The Premature Clinic at the Federal University of São Paolo. PARTICIPANTS: Fifty-eight infants born prematurely in their first year of life. OUTCOME MEASURES: Measurement of the manubrium/acromion/trapezius angle (degrees) and the deepest thoracic retraction (cm). Digitised photographs were analysed by two blinded physiotherapists using a computer program (SAPO; http://SAPO.incubadora.fapesp.br) to detect shoulder elevation and thoracic retraction. Physical examinations performed independently by two physiotherapists were used to assess the accuracy of the new tool. RESULTS: Thoracic alterations were detected in 39 (67%) and in 40 (69%) infants by Physiotherapists 1 and 2, respectively (kappa coefficient=0.80). Using a receiver operating characteristic curve, measurement of the manubrium/acromion/trapezius angle and the deepest thoracic retraction indicated accuracy of 0.79 and 0.91, respectively. For measurement of the manubrium/acromion/trapezius angle, the Bland and Altman limits of agreement were -6.22 to 7.22° [mean difference (d)=0.5] for repeated measures by one physiotherapist, and -5.29 to 5.79° (d=0.75) between two physiotherapists. For thoracic retraction, the intra-rater limits of agreement were -0.14 to 0.18cm (d=0.02) and the inter-rater limits of agreement were -0.20 to -0.17cm (d=0.02). CONCLUSION: SAPO provided an accurate and reliable tool for the detection of thoracic abnormalities in preterm infants.

Control postural y manejo de deformidades de cadera en la parálisis cerebral: revisión / Postural control and managements of hip deformities in cerebral palsy: a review

Resumen El objetivo de la presente revisión es determinar la efectividad de los sistemas de control postural en el manejo de las deformidades de caderas en sujetos con parálisis cerebral. Para ello, se ha realizado una búsqueda bibliográfica en Medline, Ovid y Pedro. Se han incluido artículos que con una antigüedad máxima de 15 años, donde la población de estudio fuesen sujetos menores de 18 años con diagnóstico de parálisis cerebral. Las intervenciones incluían sistemas para el control postural cuyo objetivo fuese controlar y/o disminuir la deformidad a nivel de la cadera, evaluado a través del porcentaje de migración de la cabeza femoral. De los 22 artículos potencialmente válidos se incluyeron un total de 6. Aunque existe una falta de homogeneidad en los estudios, sí parece claro que el empleo de estos sistemas permite controlar la deformidad de cadera. Para ello, es necesario un empleo prolongado del mismo en el tiempo, por encima de los 2 o 3 años, exigiéndose, además, una utilización mínima de 5 a 6h diarias. También destaca la necesidad de que las intervenciones sean lo más precoces posibles, ya que las posibilidades de éxito son mayores cuando el grado de deformidad es menor. Sin embargo, se hace necesario aumentar el número y la calidad de publicaciones (AU)

Abstract The aim of the present review is to determine the efficiency of postural control systems in management of hip deformities in subjects with cerebral palsy. A review of the bibliography was made using Medline, Ovid and PEDro databases. Those article having a maximum antiquity of 15 years and in which the study population consisted of subjects under 18-years with a diagnosis of cerebral palsy were included. The interventions included systems for postural control whose purpose was to control and/or diminish the deformity on the hip level, this being evaluated according to the percentage of femoral head migration. Six out of 22 potentially valid articles were included. Although the studies lack homogeneity, it seems to be clear that the use of these systems makes it possible to control hip deformities. To do so, extended use of a period greater than two or three years as well as minimal usage of 5 to 6hours daily is necessary. The need for the interventions to begin as early as possible also stands out since the possibilities of success are greater when the degree of deformity is minor. Nevertheless, the number and the quality of the publications needs to be increased (AU)

Systemic review on upper limb treatment in infantile hemiplegic cerebral palsy

Objetivos El objetivo de esta revisión consiste en la búsqueda y la revisión sistemática, utilizando el método científico, de los ensayos clínicos, revisiones sistemáticas y metaanálisis publicados en los últimos 10 años sobre los tratamientos, y su efectividad, del miembro superior en la parálisis cerebral hemipléjica para conocer qué tipo de tratamiento es el más adecuado. Estrategia de búsquedaSe buscó en Medline, LILACS, Embase, PEDro, IME, CINAHL, Cochrane plus de 2000 a 2010.Selección de estudios Veintidós estudios cumplieron los criterios de inclusión y fueron revisados con la escala PEDro y AMSTAR. Síntesis de resultados Los tratamientos aplicados de forma mayoritaria son la toxina botulínica A, la terapia de movimiento inducido por restricción, la terapia de movimiento inducido por restricción modificada, el uso forzado, la cirugía, la electroestimulación y el braceo dinámico. Los estudios encontrados varían en cuanto a muestra, control de variables, existencia de ciegos e interpretación de los resultados. Conclusiones Existe una gran variedad de terapias, y las más utilizadas son la TMIR y la TB-A. Los estudios varían tanto en la metodología como en el rigor del diseño y en la medida de los resultados clínicos. Se observa un mayor efecto beneficioso cuando se combinan varias terapias (AU)

Background This systematic review has been made to make a search and systemic review using the scientific method of clinical trials, systematic reviews and meta-analysis published over the last ten years on the treatment of upper limb hemiplegic cerebral palsy as well as their effectiveness to know which treatment is the most adequate. Search strategy A search was made in the databases of Medline, LILACS, Embase, PEDro, IME, CINAHL and Cochrane plus databases including studies from 2000 to 2010.Study selection A total of 22 studies fulfilled the inclusion criteria and were rated with the PEDro scale and AMSTAR scale. Result synthesis The treatments most used are botulinum-A toxin injections, constraint-induced movement therapy, modified constraint-induced movement therapy, forced use, surgery, neuromuscular electrical stimulation and dynamic bracing. The studies found vary in sample, control of variables, bias control and interpretation of the results. Conclusions There was great variety in the therapies, those used most being TMIR and TB-A. The studies varied in methodology and design rigor as well in the outcome measures. A greater beneficial effect was observed when several treatments were combined (AU)

Measures of self-care independence for children with osteochondrodysplasia: a clinimetric review.

This systematic review evaluates the validity, reliability, and clinical utility of outcome measures used to assess self-care skills among children with congenital musculoskeletal conditions and assesses the applicability of these measures for children with osteochondrodysplasia aged 0-12 years. Electronic databases were searched to identify self-care assessments that addressed the self-care domain as defined by of the International Classification of Function Disability and included children with osteochondrodysplasia. Ten measures were identified and three met the inclusion criteria: the Functional Independence Measure for Children (WeeFIM), the Activities Scale for Kids (ASK), and the Pediatric Evaluation of Disability Inventory (PEDI). Although psychometric data specific to children with osteochondrodysplasia are limited, adequate to excellent reliability and evidence of validity were reported for all three instruments for children with physical disabilities. Further evaluation of psychometric properties of self-care instruments specifically for children with osteochondrodysplasia would be beneficial to help identify instruments that will assist with improved assessment and management.

El desarrollo psicomotor en los niños con síndrome de Down y la intervención de fisioterapia desde la atención temprana / Psychomotor development in children with Down

El niño con síndrome de Down (SD) tiene unas características propias que lo definen y que hacen que su desarrollo psicomotor sea específico. Los aspectos cerebrales, las alteraciones musculo esqueléticas y los problemas médicos asociados son los factores que intervienen de forma más significativa en su desarrollo psicomotor, tanto en lo relativo a la temporalización de la adquisición de los ítems como en lo relacionado con la calidad de movimiento. El principal objetivo de la Atención Temprana es optimizar y acompañar el curso del desarrollo del niño potenciando sus capacidades y teniendo en cuenta su individualidad. La atención fisioterapéutica que se ofrece tiene un carácter básicamente preventivo. Se da la posibilidad al niño de que experimente el movimiento de forma adecuada, facilitándole patrones óptimos, procurando que no aparezcan patrones en mala alineación y asesorando a los padres y a las demás personas de su entorno (AU)

Children with Down syndrome have uniquedefining traits with a specific bearing on their psychomotor development. Brain characteristics, musculoskeletal abnormalities and associated medical conditions are the most significant factors that affect their psychomotor development, both in terms of milestone timing and in the quality of movements. The main aim of Early Intervention is to optimise and support the child’s development, fostering their capabilities and taking on board their individuality. Physiotherapy is offered primarily as a preventive service. Children are given the chance to experience appropriate movement, by setting optimum patterns and preventing mis alignedones. Parents and significant others in the child’s environment are also given advice (AU)

[The psycho-social impact of the locomotor deformations in school-aged child]. / Impactul PSIHO-social la copilul de vârsta scolara suferind de deformatii ale aparatului locomotor.

Depending on their severity, congenital or acquired, the deformations of the locomotor system affect more or less the child's mental status. Adolescence is the time when their impact is most important. When the physical, mental or functional suffering become a disability, professional and psycho-social integration problems occur. The role of the team treating such a patient is to orientate him toward a specific job corresponding to his abilities, while the social services must support him in achieving this goal. The psychotherapist is the most important person in his fight against depression and, more important, suicide.

Effectiveness of pulmonary rehabilitation in restrictive lung disease.

BACKGROUND: Pulmonary rehabilitation is effective in improving exercise endurance and quality of life in chronic obstructive pulmonary disease (COPD). However, the efficacy of pulmonary rehabilitation in restrictive lung disease has not been extensively studied. METHODS: Forty-six patients with restrictive lung disease (35 interstitial lung diseases, 11 skeletal abnormalities) were admitted to a pulmonary rehabilitation program; 26 completed the 8-week program and 15 were followed to a 1-year reassessment. Fifteen noncompliant patients were excluded and 1 patient with interstitial lung disease died at 8 weeks. Pulmonary function tests, exercise endurance, quality of life (Chronic Respiratory Disease Questionnaire, St. George's Respiratory Questionnaire, Hospital Anxiety and Depression scale and dyspnea) were measured at baseline, 8 weeks, and 1 year. RESULTS: Exercise endurance (treadmill) improved at 8 weeks (mean improvement, 10.2 +/- 7.4 minutes) and at 1 year (mean improvement, 8.7 +/- 12.2 minutes). Shuttle test improved at 8 weeks (mean improvement, 27.2 +/- 75.9 m) but not at 1 year. Patients using long-term oxygen therapy (LTOT) had a better improvement in the treadmill test (P < .01) at 8 weeks compared with those not using LTOT. Thirty-three percent of patients failed to complete the program. There was significant improvement in dyspnea and quality of life in Chronic Respiratory Disease Questionnaire, St. George's Respiratory Questionnaire, and Hospital Anxiety and Depression scale for depression at 8 weeks compared with baseline; there was a sustained significant reduction in hospital admission days noted at 1-year postrehabilitation (P < .05). CONCLUSIONS: Pulmonary rehabilitation is effective in improving exercise endurance and the quality of life and in reducing hospital admissions in this small group of patients with significant restrictive lung disease. The relatively large dropout number suggests that a standard chronic obstructive pulmonary disease program may not be ideal for patients with restrictive lung disease.

Manejo de la displasia del desarrollo de la cadera en el periodo ambulatorio / Treatment of developmental dysplasia of the hip in the ambulatory age

A través de los años numerosos autores han hecho énfasis en la detección temprana de la displasia del desarrollo de la cadera (DDC), sin embargo, sigue existiendo un alto porcentaje de casos diagnosticados en la etapa de inicio de la deambulación, momento en que ya se encuentran establecidos cambios adaptativos como displasia acetabular, anteversión y valgo femoral; habiéndose perdido el periodo de "oro" del niño con capacidad de remodelación de la cadera displásica. En el periodo comprendido entre 1972 y 1990, se registraron en el Hospital Shriner's para Niños Lisiados, Unidad de México, 638 casos de DDC; para nuestra revisión se excluyeron los casos asociados a otras malformaciones congénitas y los casos inveterados, contando con 338 pacientes diagnosticados y tratados entre el periodo neonatal y los 3 años de edad, sin embargo el objetivo de nuestro estudio es la evaluación de los casos tratados en el periodo ambulatorio por lo que nos quedamos con 210 pacientes con 264 caderas con displasia del desarrollo. Dividimos nuestros casos en 4 grupos: Grupo I, 96 caderas tratadas sólo con reducción abierta; Grupo II, 129 caderas, tratadas mediante reducción abierta y osteotomía del iliaco; Grupo III, 11 caderas (4.1 por ciento), tratadas con reducción abierta y osteotomía femoral y Grupo IV, 28 caderas (10.6 por ciento), tratadas mediante un solo procedimiento quirúrgico combinando reducción abierta y osteotomía femoral y del iliaco. Los resultados fueron evaluados de acuerdo a los criterios clínicos de Barret y radiológicos de Severin. En cada uno de los grupos se encontraron caderas que requirieron de una segunda o tercera intervención quirúrgica debido a la presencia de deformidades residuales o persistentes, por lo que evaluamos los mismos grupos después del primer y último tratamiento. Al momento de la primera evaluación, los mejores resultados se encontraron en el grupo IV, y un alto porcentaje de resultados regulares y malos o pobres en los grupos I, II y III, debido a la persistencia o recidiva de la luxación; en la evaluación final encontramos disminución de los resultados malos o pobres al haber corregido deformidades residuales o persistentes. Por lo tanto, creemos que un sólo procedimiento quirúrgico combinado es el mejor tratamiento para un complejo patológico ya establecido y acentuado en la etapa ambulatoria sin necesidad de someter al niño a múltiples intervenciones quirúrgicas, retrasando además el periodo de rehabilitación.

Orthopaedic management in four cases of mucolipidosis type III.

Four patients with mucolipidosis type III, three of them brothers, were seen initially in the first two decades of life. Their main symptoms were carpal tunnel syndrome, trigger fingers and generalized joint stiffness. Radiographs showed spinal deformities and hip dysplasia, but these were not causing pain. Carpal tunnel syndrome was treated surgically but joint stiffness and hip and knee contractures were managed by physiotherapy. Up to the age of 24 none of these patients has had pelvic osteotomy for hip dysplasia; this operation, not yet reported in mucolipidosis type III, may eventually be necessary.