Changes in gait which occur before and during the adolescent growth spurt in children treated by selective dorsal rhizotomy.

This paper presents long term follow up results from 17 children (6 girls, 11 boys, GMFCS levels II-IV), treated by means of selective dorsal rhizotomy (SDR). The particular focus is on the effect of the adolescent growth spurt on patients who had previously undergone SDR. The children were all assessed using 3D gait analysis, in combination with clinical examination at three time points-before SDR surgery (PRE), after SDR surgery when pre-adolescent (POST1) and post-adolescence (POST2). The total follow up period to POST2 was 8 years 6 months for girls and 9 years 5 months for boys. All children maintained or improved their GMFCS level. Positive changes in ranges of motion and gait were observed at POST1 and these were generally maintained over adolescence to POST2. The mean Gait Profile Score (GPS) had improved by 3.2 points (14.7-11.5) at POST1, with a non-significant deterioration of 0.3 over the adolescent growth spurt. These positive results reflect the total package of care for the children, involving careful pre-operative selection by a multidisciplinary team and post-operative management including intensive physiotherapy and maintenance in tuned ankle foot orthoses. Fifty-nine per cent of children had some additional orthopaedic surgery, mostly bony procedures. The overall benefits arising from their management need to be considered in the light of the likely deterioration experienced by this patient group. The results of this study support the use of SDR as part of a management strategy for carefully selected children with cerebral palsy with the aim of optimizing gait at skeletal maturity.

The process of transitioning to digital operations in a clinic setting.

Transitioning to digital imaging operations in a department of radiology is often difficult for many radiologists, but it is a change that many have made effectively. Transitioning to digital operations in a clinic setting is even more difficult for the referring physician operating a business in the clinic. This paper will discuss our experience with transitioning several off site clinics to digital imaging operations. We will discuss the process followed to identify the physical equipment required to support clinic operations in a digital imaging environment, the process followed to help the physicians adjust their work patterns to allow them to practice in a digital imaging environment, and the benefits and pitfalls of implementing digital imaging in an off site clinic. Four off site clinic locations will be evaluated: 1. cancer clinic located immediately adjacent to the main hospital that relies heavily on CT and MRI images in their practice, 2. small clinic located about 60 miles from the main hospital that acquires xray images on site, 3. larger clinic located about 20 miles from the main hospital that acquires xray, MRI and CT images on site, 4. sports medicine clinic located about 2 miles from the main hospital that acquires xray images on site. Each of these clinics has a very different patient clientele and therefore operates differently in nearly all aspects of their daily operations. The physician's need for and use of film and digital images varies significantly between the sites and therefore each site has presented different challenges to our implementation process. As we explain the decisions that were made for each of these sites and reveal the methods that were used to help the physicians make the transition, the readers should be able to draw information that will be helpful to them as they make their own transition to a digital operation.

The role of the ocularist.

The ocularist plays a significant role in the rehabilitation of patients suffering the loss of an eye. As with any role, the function of the ocularist is a multidisciplinary one, involving a wide range of services in the overall management of the patient.

Giant nerve fibre activity in intact, freely moving earthworms.

1. An approach is described for recording and characterizing giant nerve fibre activity in intact, freely moving earthworms. 2. Medial giant fibre (MGF) spikes were conducted in an anterior-posterior direction at a mean rate of 32.2 m/s; lateral giant fibre (LGF) spikes were conducted in a posterior-anterior direction at a mean rate of 12.5 m/s. 3. Rates of giant fibre spike conduction and maximal frequencies of firing (up to 500/s) in intact animals were higher than values previously reported in isolated preparations. 4. MGF spikes were followed 1:1 by presumed giant motor axon spikes and facilitating muscle potentials. 5. Single MGF or LGF spikes evoked by applying tactile stimulation were not accompanied by longitudinal contraction, but a series of two or more MGF spikes or three or more LGF spikes were accompanied by such contractions. 6. MGF and LGF spikes occurred infrequently during locomotory movements in the absence of any experimenter-applied stimulation, suggesting that sensory inputs associated with normal locomotion over an irregular substrate are sufficient to excite giant fibres.