Age-related balance changes in hearing-impaired children.

This study compared balance skills of hearing-impaired children with those of hearing children in order to determine whether a deficit in balance exists in hearing-impaired children and to ascertain whether this deficit is age-related. Twenty-eight hearing-impaired subjects were chosen as a sample of convenience from the Pennsylvania School for the Deaf and placed into one of three age groups. Ten subjects were in the 4.5 to 6.5-year-old age group, 8 in the 8- to 10-year-old age group, and 10 in the 12.5 to 14.5-year-old age group. Selection criteria included bilateral sensorineural hearing loss of greater than or equal to 65 dB and normal intelligence (IQ greater than or equal to 80). Balance was measured by the use of the Balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency. For each age group, a z test was used to compare the subjects' scores with the Balance subtest standard scores. The results showed that for each age group, the mean score for the hearing-impaired children was lower than the standard score. Both older groups had significantly higher scores than the youngest group, but the mean scores of the older groups were not significantly different. No difference between the subjects' balance scores and the Balance subtest standard scores was found among the age groups, suggesting that the balance deficit was not age-related. Gender differences were not found for balance scores.

Comparison of lumbar curves when sitting on the Westnofa Balans Multi-Chair, sitting on a conventional chair, and standing.

The purpose of this study was to determine whether the Balans Multi-Chair (BMC) approximates the amount of standing lumbar curve better than a standard conventional chair (SCC) in seated subjects writing at a desk. The length of the curve from L1 to S2 was measured with a flexible ruler in 44 healthy subjects who were standing and sitting on both an SCC and a BMC. A one-way analysis of variance for repeated measures and the Student-Newman-Keuls test were used to examine the differences in the curves created in the three positions. The frequency of subjects sitting in lumbar flexion was compared using a chi-square test with those not in flexion. Lumbar curves measured in the three positions were significantly different (p less than .01). The BMC approximated the standing lumbar curve in seated subjects writing at a desk to a greater degree than the SCC. In addition, the BMC produced lumbar flexion less frequently (chi 2 = 4.33, p less than .05) than did the SCC. These data suggest that the BMC may be an appropriate adjunct in client care when minimal lumbar flexion or lumbar extension is indicated.

Lumbar traction: its effect on respiration.

The purpose of this study was to examine the effects of lumbar traction on inspiratory vital capacity (IVC), tidal volume (TV), and respiratory rate (fb). Using an 8-L recording spirometer, we measured the above values on 30 healthy volunteers during three conditions--lying supine, lying supine with a traction garment applied, and lying supine with the traction garment and a distractive force applied. The differences in IVC, TV, and fb among the three conditions were examined by using an analysis of variance for repeated measures followed by a Tukey test. Statistically significant differences were found for IVC, TV, and fb among the three conditions (p less than .001). The results indicated that IVC and TV were lowest and fb was highest when the distractive force was applied to the traction garment. We suggest that when lumbar traction is used for patients who have respiratory disease, the patients should be observed closely for signs of respiratory distress during the first few treatments.

Pregnancy in patients with cystic fibrosis.

As more patients with cystic fibrosis reach adulthood, questions arise about the potential hazards of pregnancy. We reviewed the medical records of eight women with cystic fibrosis who had a total of 11 completed pregnancies and had been evaluated within 1 year before conception. In five women (Group 1), the overall maternal condition was little affected by the pregnancy, and in three women (Group 2), the mother's condition deteriorated during and after pregnancy and did not return to the pregravid state. With regard to pregravid status, significant differences between patients in Group 1 and Group 2 were found in Shwachman-Kulczycki clinical scores, weight for height values, Brasfield chest radiograph scores, and pulmonary function. A quantitative assessment of pregravid nutritional and pulmonary status is useful in counseling women with cystic fibrosis about the risk of pregnancy.

Physical therapy for children with chronic lung disease.

Chronic lung disease is a major health problem among children. Estimates suggest that one child in six has a chronic respiratory condition. This article reviews three common chronic respiratory conditions occurring in childhood for which physical therapy is usually recommended. The cause, pathophysiology, and medical treatment are explained for asthma, respiratory complications of chronic neuromuscular disease, and cystic fibrosis. The rationale for physical therapy and the concepts of treatment for the three disorders are presented. Major clinical studies that have attempted to document the efficacy of physical therapy are discussed. Questions for future research are proposed.

A critical evaluation of bronchial hygiene in pediatric pulmonary disease.

The variables inherent in analyzing the effectiveness of modalities used to achieve bronchial hygiene are numerous. Treatments may be given in a variety of settings, including intensive-care units, pediatric wards, respiratiory therapy departments, physical therapy departments, chronic-care hospitals, special education centers, and patient homes. Treatments are administered by a variety of medical professionals, allied health personnel, and lay volunteers. Motivation of the care providers as well as of the patients may vary greatly. Also, efforts are needed to study patients at comparable stages in their growth and development and in the progression of their particular diseases. Rather than perpetuating the unquestioning use of these various treatments, a series of carfully constructed and controlled studies done in collaborative fashion need to be performed. Until that time, the recommendations we have outlined dealing with each of the various segments of bronchial hygiene may serve as useful guidelines.

Bronchial drainage with aerosol medications in cystic fibrosis.

Examined in this study are the immediate effects of bronchial drainage preceded by the inhalation of aerosol solutions of a mucolytic agent, a bronchodilator, and their combination upon four measures of pulmonary function in 20 patients with cystic fibrosis. On three separate occasions, pulmonary function was tested preceding and following treatments consisting of one of the above three aerosol solutions followed by bronchial drainage. The order of solutions used was random and each subject received one treatment with each solution. The greatest overall improvement in function was seen with the bronchodilator and bronchial drainage. The combination of the bronchodilator/mucolytic agents and bronchial drainage was the next most effective technique. The mucolytic agent, when used alone with bronchial drainage, decreased function. Comparison of the pulmonary function scores indicated a significant difference among the three treatments.

Evaluation of bronchial drainage in patients with cystic fibrosis.

Examined in this study are the results of six tests of pulmonary function immediately preceding and following bronchial drainage in twenty-six patients with cystic fibrosis. Highly significant increases averaging 5.67, 4.13, 13.47, and 6.98 percent occurred in peak expiratory flow rate, forced vital capacity, expiratory reserve volume, and inspiratory capacity respectively. Significant increases in peak expiratory flow rate, forced vital capacity, and inspiratory capacity were observed in a subgroup of six of the above patients who had evidence of bronchospasm. The authors conclude that bronchial drainage will produce significant increases in routine pulmonary function values. The results suggest that this treatment is most effective in clearing the larger, more proximal, airways and is of benefit even in the presence of clinical bronchospasm.