Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II.

Aims: To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP).

Method: A consecutive selection of 40 children, ages 4-12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I-II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections.

Botulinum toxin A does not improve the results of cast treatment for idiopathic toe-walking: a randomized controlled trial.

Background: There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toe-walking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems.

Sociodemographic factors influence the risk for femur shaft fractures in children: a Swedish case-control study, 1997-2005.

Aim: To investigate how sociodemographic factors relate to the risk of femur shaft fractures in children and how the relationship differs by gender and age.

Methods: Population-based case-control study. Swedish children (n = 1,874), 0-14 years of age, with a femur shaft fracture diagnostic code occurring between 1997 and 2005 were selected from the Swedish national inpatient register and compared with matched controls (n = 18,740).

Does botulinum toxin A improve the walking pattern in children with idiopathic toe-walking?

Background: Numerous recommendations have been made for treating idiopathic toe-walking (ITW), but the treatment results have been questioned. The purpose of this study was to investigate whether botulinum toxin A (BTX) improves the walking pattern in ITW as examined with 3-D gait analysis.

Participants And Methods: A consecutive series of 15 children (aged 5-13 years) were enrolled in the study.

Incidence and trends in femur shaft fractures in Swedish children between 1987 and 2005.

Background: The surgical treatment of femur shaft fractures in children is changing, and the time spent in hospital is shorter than before. The purpose of this nationwide epidemiology study is to report incidence of pediatric femur shaft fractures in Sweden during 1987 to 2005 by age, sex, cause of injury, severity of injury, and seasonal variation, and to analyze the change in incidence, treatment modalities, and length of hospital stay over time.

Methods: Children (N = 4984) with a diagnostic code for femur shaft fracture in Sweden 1987 to 2005 were selected from the Swedish National Hospital Discharge Registry.

Long-term effects of botulinum toxin A in children with cerebral palsy.

The long-term effects of botulinum toxin A (BoNT-A) treatment in children with cerebral palsy (CP) are still elusive. We studied a prospective clinical cohort of 94 children with different subtypes (50% spastic diplegic CP, 22% hemiplegic CP, 25% tetraplegic CP, 3% dyskinetic CP), sex (55% male, 45% female), severity according to Gross Motor Function Classification System (29% Level I, 15% Level II, 16% Level III, 17% Level IV, 23% Level V), and age (median 5y 4mo, range 11mo-17y 8mo). The longest follow-up time was 3 years 7 months (median 1y 6mo) and included a maximum of eight injections per muscle (median two injections to a specific muscle).

Power generation in children with spastic hemiplegic cerebral palsy.

Background: Spastic hemiplegic cerebral palsy is a challenging disorder often affecting children with high functional and cognitive level, who are good candidates for physiotherapy treatment, including co-ordination and muscle strengthening exercises. The goal of this study was to investigate hip and ankle power generation on both the hemiplegic and uninvolved sides in children with spastic hemiplegic cerebral palsy and no previous surgery.

Methods: Ninety-nine patients with spastic hemiplegic CP with a mean age of 8.

Classification of spastic hemiplegic cerebral palsy in children.

Background: The Winter classification of spastic hemiplegic cerebral palsy (CP) is based on sagittal kinematic data from 3-dimensional gait analysis used in preoperative decision making and postoperative evaluation. Our goal was to investigate how well children with spastic hemiplegic CP can be classified using Winter criteria. Second, we assessed if patients move between groups over time and/or with surgical intervention.

Trunk and center of mass movements during gait in children with juvenile idiopathic arthritis.

Motion of the body center of mass (CoM) can often indicate the overall effect of the strategy of forward progression used. In the present study, focus is placed on trunk movements in the sagittal, coronal, and transverse/rotation plane, as well as placement of the CoM, during gait in children with juvenile idiopathic arthritis (JIA). Seventeen children with JIA, all with polyarticular lower extremity involvement were examined before and approximately two weeks after treatment with intra-articular cortico-steroid injections.

The relationship between developmental dysplasia of the hip and congenital muscular torticollis.

Multiple studies report a correlation between congenital muscular torticollis (CMT) and developmental dysplasia of the hip (DDH) at a rate between 2% and 29%. Most of these studies were completed before the routine use of hip ultrasound. This study assesses the incidence of DDH in a referral population with CMT and the incidence of CMT in a referral population with DDH.

The influence of spasticity in the lower limb muscles on gait pattern in children with sacral to mid-lumbar myelomeningocele: a gait analysis study.

Gait analysis and recording of standing position were performed in 38 ambulatory children with myelomeningocele. Thirty-four were independent ambulators and four required a walking aid. All subjects were assigned one of four muscle function groups based on muscle strength.

Kinetics of compensatory gait in persons with myelomeningocele.

This study investigated the kinetic strategy and compensatory mechanisms during self-ambulatory gait in children with lumbo-sacral myelomeningocele. Thirty-one children with mid-lumbar to low-sacral myelomeningocele who walked without aids and 21 control children were evaluated by three-dimensional gait analysis. Joint moments in all planes at the hip and knee and sagittal moments at the ankle, as well as joint power and work done at all three joints, were analyzed.

Characteristic gait kinematics in persons with lumbosacral myelomeningocele.

Thirty self-ambulatory children with mid-lumbar to low-sacral myelomeningocele who walked without aids and 21 control children were evaluated by three-dimensional gait analysis. Characteristic kinematic patterns and parameters in the trunk, pelvis, hip, knee and ankle were analyzed with respect to groups with successive weakness of the ankle plantarflexor, ankle dorsiflexor, hip abductor, hip extensor and knee flexor muscles. Extensive weakness of the plantarflexors resulted in kinematic alterations in the trunk, pelvis, hip and knee and in all three planes seen as knee flexion, anterior pelvic tilt and trunk and pelvic rotation.

Centre of mass motion during gait in persons with myelomeningocele.

The movement of the centre of mass in the vertical and lateral directions during gait in children with myelomeningocele was analyzed. The children were classified into five groups depending on the successive paresis of lower limb muscle groups and compared to a control group. In the groups with dorsi- and plantarflexor weakness, the excursions increased and an anterior trend in the centre of mass was observed.