Prevalence of low bone mineral density in inpatients with traumatic brain injury receiving neurobehavioural rehabilitation: a postoperative, observational study.

BACKGROUND: Osteoporosis is characterised by low bone mineral density (BMD) leading to an increased risk of fracture. Patients who have sustained a significant traumatic brain injury may have an increased risk of secondary reduced BMD as a result of immobility and other factors. OBJECTIVES: To describe BMD in a cohort of patients recovering from traumatic brain injury, and to discuss the implications of the findings for physiotherapy practice. DESIGN: Prospective, observational. SETTING: Specialist, residential unit providing care for individuals with brain injury, many with a history of severe challenging behaviour. PARTICIPANTS: Current inpatients (n=51, 80% male) with the capacity to provide consent, as judged by their responsible clinician. The median age was 41 years (range 20 to 60 years), and the median time since the brain injury was sustained was 22 years (range 4 to 54 years). METHODS: Participants' BMD was measured at the radius and tibia using quantitative ultrasound. Various clinical and demographic details were collected. RESULTS: Participants had suboptimal BMD measurements that were generally low for their age and gender. Nine (18%) participants met the criteria for osteopenia measured at the radius, and 26 (51%) participants met criteria for osteoporosis or osteopenia measured at the tibia. CONCLUSIONS: Some participants had reduced BMD, putting them at risk of fracture or of developing such risk in the future. This group is at particular risk because they frequently display challenging aggressive behaviours that may be met with responses including proportionate use of manual restraint. Physiotherapists should bear this increased risk in mind when devising exercise programmes assessing risk in neurobehavioural rehabilitation settings.

Prevalence and patterns of medication use in children and adolescents with autism spectrum disorders in the Western Cape, South Africa.

OBJECTIVE: This study was conducted to investigate the prevalence and patterns of medication use amongst a sample of school going children and adolescents with autism spectrum disorders (ASD) in the Western Cape, South Africa. METHOD: This was a descriptive, quantitative, analytic study. A survey questionnaire and the Nisonger Child Behaviour Rating Form (NCBRF) were administered to parents of children and adolescents recruited from two schools for children with ASD in Cape Town and from the Autism Action database. RESULTS: A total of 24.6% of the 65 children used psychotropic medications. Antipsychotics were the most common reportedly used psychotropics followed by stimulants, antidepressants and mood stabilisers. Complementary and alternative medications were also commonly used with 40% of children using over the counter medications (OTC) and 15.4% being on a special diet for autism. Children of black African or coloured ethnicity were less likely to use OTC medication than children in the white/ Asian ethnic group. CONCLUSIONS: In keeping with international studies this sample of children with ASD was a highly medicated group. The findings of this pilot study were limited by the response rates and sample size, but provide valuable insight into medication use in the South African ASD population.