Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study.

PURPOSE: Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. METHODS: This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4-5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge. RESULTS: Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment. CONCLUSIONS: Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.

[Experiences and changes in parents of children with infant cerebral palsy: a qualitative study]. / Experiencias y cambios en los padres de niños con parálisis cerebral infantil: estudio cualitativo.

BACKGROUND: The diagnosis of infant cerebral palsy (ICP) is a traumatic event that can provoke multiple effects and changes in the family. The aim of the study is to discover the difficulties that parents face in the process of parenting, especially in the initial period following diagnosis. METHODS: A qualitative study was carried out through semi-structured interviews. Sixteen mothers and fathers whose children were diagnosed with cerebral palsy participated in the study. Data analysis was performed with Atlas.ti 6.2 software following a strategy of open coding. RESULTS: The reception of the diagnosis is perceived as an unexpected event that makes parents change expectations and hopes related to their children. The mode of relation with the child with ICP is different from that with other children as parents are more focused on the possibility of improvement and the future evolution of their child. Changes in different aspects of the lives of these parents are shown, such as demands on time, their economic and labour situation, as well as the relationship of the couple. CONCLUSIONS: In providing care for children with cerebral palsy it is necessary to take the problems of the parents into account, especially in the initial period after diagnosis. The process of parenting a child with cerebral palsy entails many changes in the family so a global perspective is needed to organize interventions.

Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program.

PURPOSE: The aim of this study was to evaluate the results of a conservative intervention in infants with plagiocephaly according to their specific clinical profile. METHODS: Prospective clinical trial in which 104 infants with plagiocephaly accompanied or not by congenital or positional torticollis were referred to Early Care and Monitoring Unit (USAT) of San Cecilio Hospital in Granada, between 2009 and 2012. All the infants, grouped into three categories of severity, were included in the physiotherapy protocol until adequate craniofacial morphology and motor development were achieved. The study included an assessment of parents and infants. Parents were assessed with a questionnaire about the mother's medical history and birth-related issues. The assessment of infants included anthropometric measures, a positional assessment, the observation of the head, the assessment of severity, and motor development. RESULTS: Birth characteristics were similar in the total sample but showed different clinical profiles according to treatment aspects. More specifically, infants with severe plagiocephaly were referred to treatment later and spent more time in treatment; use of an orthotic helmet was also more prevalent in this category. There were also significant differences (P < 0.05) in the acquisition of specific gross motor skills depending on the severity of plagiocephaly. CONCLUSION: The findings suggest that the physiotherapy protocol presented is effective to correct plagiocephaly. Severity of plagiocephaly is a marker that should be taken into account when designing actions aimed at improving gross motor skill development.

Experiencias y cambios en los padres de niños con parálisis cerebral infantil: estudio cualitativo / Experiences and changes in parents of children with infant cerebral palsy: a qualitative study

Fundamento. El diagnóstico de parálisis cerebral infantil (PCI) supone un evento de carácter traumático que puede provocar una multitud de efectos y cambios en el entorno familiar. Se pretende conocer cuáles son las principales dificultades que encuentran los padres en el proceso de parentalidad, especialmente en los primeros momentos tras el diagnóstico. Método. Se realizó un estudio fenomenológico de carácter cualitativo a través de entrevistas semi-estructuradas. Participaron 16 padres y madres cuyos hijos estaban diagnosticados de PCI. El análisis de los datos se llevó a cabo con el software Atlas.ti6.2 a través de una codificación abierta. Resultados. La recepción de la noticia es percibida como un acontecimiento inesperado que obliga a restructurar las expectativas con respecto a su hijo. La forma de relacionarse con el hijo con PCI es diferente a la que se establece con otros niños, centrándose sobre todo en las posibilidades de mejora y en la evolución de su hijo en el futuro. Se observan cambios en diferentes aspectos de la vida de estos padres como el tiempo, la situación económica y laboral, así como las relaciones de pareja. Conclusiones. En la atención a niños con PCI es necesario incorporar y tomar en cuenta la problemática de los padres, especialmente en los primeros momentos del diagnóstico. El proceso de crianza de un hijo con PCI conlleva un gran número de cambios en la dinámica familiar por lo que se necesita abordarlos mediante una perspectiva global (AU)

Background. The diagnosis of infant cerebral palsy (ICP) is a traumatic event that can provoke multiple effects and changes in the family. The aim of the study is to discover the difficulties that parents face in the process of parenting, especially in the initial period following diagnosis. Methods. A qualitative study was carried out through semi-structured interviews. Sixteen mothers and fathers whose children were diagnosed with cerebral palsy participated in the study. Data analysis was performed with Atlas.ti 6.2 software following a strategy of open coding. Results. The reception of the diagnosis is perceived as an unexpected event that makes parents change expectations and hopes related to their children. The mode of relation with the child with ICP is different from that with other children as parents are more focused on the possibility of improvement and the future evolution of their child. Changes in different aspects of the lives of these parents are shown, such as demands on time, their economic and labour situation, as well as the relationship of the couple. Conclusions. In providing care for children with cerebral palsy it is necessary to take the problems of the parents into account, especially in the initial period after diagnosis. The process of parenting a child with cerebral palsy entails many changes in the family so a global perspective is needed to organize interventions (AU)

Neurodevelopment of neonates in neonatal intensive care units and growth of surviving infants at age 2 years.

SUMMARY: The presence of development disorders in neonates attended in a Neonatal Intensive Care Unit (NICU) is highly variable; the aim of this study, therefore, was to determine the evolution of somatic and neurosensory development in a group of neonates requiring treatment in the NICU and to analyse the perinatal and developmental aspects of children presenting abnormalities. PATIENTS AND METHODS: A total of 492 neonates (275 premature, 106 with birthweight < or =1500 g), who were treated in the NICU between January 1994 and December 1997, were followed-up until the age of 2 years. Data were obtained concerning birthweight, body length, head circumference, gestational age, normality of weight for gestational age, single/multiple birth, duration of stay in the NICU and the hospital, duration of mechanically assisted respiration and evolutive somatometry, neurological examination and the Brunet-Lezine development test, adjusted for the gestational age of the neonates, at 6, 12, 18 and 24 months. When abnormal results were detected, Early Attention (EA) programmes were applied. RESULTS: Somatometry at birth in relation to gestational age revealed a weekly weight gain of 8.6%, an increase in body length of 1% and in head circumference of 1% (p<0.001). The evolution of somatic development to the age of 2 years showed that neonates with a birthweight < or =1500 g did not reach the values of neonates with a greater birthweight. The prevalence of cerebral palsy among all neonates was 6.8%, 14.6% among those weighing < or =1500 g, 4% among those weighing 1501-2500 g and 5% among those weighing >2500 g. The overall rate of neurosensory injury was 10.5%. These neonates presented less somatic development than those did with no neurologic disorder. To sum up, most of the neonates attended in the NICU during the 1990s presented a normal pattern of development. Nevertheless, they should be the object of special attention during the first years of life, particularly those neonates with a birthweight < or =1500 g and those presenting neurosensory risk.

[Developmental diseases of the central nervous system caused by neonatal hyperbilirubinemia]. / Contribución al estudio de las maduropatías del sistema nervioso central por hiperbilirrubinemia neonatal.

Neuropsychological development was evaluated in 71 infants. Groups: G I, healthy full term infants; G II, premature infants; G III, sick newborns. In these groups, total bilirubin (TB), free bilirubin (FB) and bilirubin binding capacity (BBC) of albumin were determined during the neonatal period. TB and FB concentration were determined by Brodersen and Bartels method. Neurological evaluation was estimated by physical exam, EEG, ophthalmological and audiometric exam. Psychological evaluation was done by Brunet-Lezine test. Infants were subdivided in three groups in relation to the degree of encephalopathy. Premature infants in whom FB was detected in the early neonatal period, the risk of suffering encephalopathy was twice that for simply premature infants. The incidence of encephalopathy in sick full term infants was 68%; 63% of which corresponded to newborns with ABO-Rh iso-immunization, in whom FB was detected in 85% of cases.

[Tryptophan metabolism in children with epilepsy]. / Estudio del metabolismo del triptófano en niños afectos de epilepsia.

Authors measured urinary excretion of tryptophan derivatives (kynurenine way) in 13 healthy and 15 epileptic children, modifying the technique qualitatively and quantitatively. In both groups, they measure tryptophan metabolites before and after L-tryptophan overload, the dosage being 100/mg/kg of body weight. They found higher tryptophan derivative values in the group suffering a epilepsy.