Cauda equina syndrome after incidental total spinal anesthesia with 2% lidocaine.

A 77 year-old male presented for a right popliteal distal vein bypass graft procedure with continuous epidural anesthesia and light general endotracheal anesthesia. After the uneventful placement of the epidural needle and catheter at the L2-L3 interspace, fentanyl 150 microg and a total of 72 ml of preservative-free 2% lidocaine with epinephrine was continually injected through the epidural catheter for the duration of the more than 5 hour procedure. At the end of the procedure, it was noted that the patient had developed total spinal anesthesia, and his pupils were fixed and dilated. Further examination confirmed that the catheter tip was placed in the subarachnoid space. The patient was unable to turn or sit up by himself for over 1 month. Over a 12-month period, he improved to walking with a quad cane, but he required self-catheterization. Although numerous factors were considered, neurotoxicity of 2% lidocaine solution has been discussed as the potential cause. We were unable to find any other factors that could have caused the cauda equina syndrome.

Evaluation of postural stability in children: current theories and assessment tools.

Children with many types of motor dysfunction have problems maintaining postural stability. Because maintenance of postural stability is an integral part of all movements, therapists evaluate and treat to improve postural stability in these children. This article reviews current pediatric assessment tools for postural stability and issues affecting testing this construct in children. The tests and measurements are classified according to their testing purpose and the National Center for Medical Rehabilitation Research disablement framework, focusing on the impairment and functional limitation dimensions. Postural stability is defined from a systems perspective with tests related to the sensory, motor, and biomechanical systems described. Reliability and validity information on the measurements is discussed. Relatively few measurements of postural stability in children are available that have acceptable reliability and validity documentation. Suggestions for research on test development in this area are discussed.

Performance of preschoolers on the Pediatric Clinical Test of Sensory Interaction for Balance.

The purposes of this study were to describe the performance of 40 children aged 4 and 5 years on the Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB) and to determine whether age- and gender-related differences were present. The P-CTSIB measures standing balance when sensory input is systematically altered. Kruskal-Wallis one-way analyses of variance by ranks (p less than or equal to .05) were used for comparisons by age and gender. When the 4-year-olds were compared with the 5-year-olds, significant duration differences were found in 4 of the 6 conditions in the heel-toe position of the P-CTSIB. The age-related differences on the remaining 2 heel-toe conditions, as well as on Condition 6 of the feet-together position, approached significance. Gender differences with 4-year-olds and 5-year-olds combined were statistically non-significant in all instances; however, girls performed better on 9 of the 12 conditions of the P-CTSIB. The results indicate that the feet-together position can discriminate between children without balance deficits and children with balance deficits. The heel-toe position is difficult for children aged 4 and 5 years without balance deficits and consequently has limited diagnostic value for this age group.

Interrater and test-retest reliability of two pediatric balance tests.

The purpose of this study was to examine the interrater and test-retest reliability of a one-leg balance test and a tiltboard balance test. Twenty-four normally developing children aged 4 through 9 years participated in the study. Time and quality of balance on one leg and degrees of tilt on a tiltboard prior to postural adjustment were measured. Both tests were completed with eyes open and with eyes closed. Interrater reliability was examined using two raters. Test-retest reliability, with a one-week interval between test and retest, was examined for a subgroup consisting of 12 children. Spearman rank-order correlation coefficients were used as indexes of both interrater and test-retest reliability for time and degrees of tilt. To supplement the correlation coefficients, the magnitudes of difference between raters' scores and between test and retest scores were calculated. Spearman coefficients were moderate to high for one-leg balance when scores for both feet were combined for both eyes-open and eyes-closed conditions. The magnitude of difference between scores was low, indicating good agreement between raters and across time. Interrater and test-retest reliabilities of quality of one-leg standing balance were examined by calculating percentages of agreement and Cohen's Kappa statistics. Results of these analyses revealed the need for further study. The Spearman coefficients for the interrater tiltboard test were high; however, the test-retest coefficients were low. The magnitudes of difference between scores were small for the two raters, but large for test and retest. These results are important to consider when using these tests for initial evaluation or for monitoring patient progress.

Clinical implication of the peabody developmental motor scales: a constructive review.

The Peabody Developmental Motor Scales (PDMS) is a standardized, norm-referenced test used to assess the fine and gross motor development of children, birth to 83 months of age. While the PDMS has many positive aspects, several areas of concern are evident which affect the clinical interpretation of test scores. The purpose of this review is to discuss the strengths and areas of concern of the PDMS. In addition, suggestions for improvement are provided. The areas discussed include: (1) test construction, (2) test content, (3) test administration, and (4) scoring and reporting test scores.