Postoperative stability following a triple pelvic osteotomy is affected by implant configuration: a finite element analysis

BackgroundThe triple pelvic osteotomy is an established surgical method with multiple modifications regarding surgical technique and choice of implant. The stability of the osteotomy is affected by numerous factors, and among these, the three-dimensional implant configuration is a scientifically less explored aspect.MethodsWe used a finite element model of a hemi-pelvis with a standardized triple osteotomy to calculate relative flexibility for loads in all translational degrees of freedom for five different implant configurations. Two of the configurations used entry points only feasible when implant removal was not necessary.ResultsThe stability of the osteotomy improved with an increased distance between the implants in the plane of the osteotomy as well as for a more perpendicular angle relative to the osteotomy plane. The implant configurations with more entry points available made this easier to adhere to.ConclusionThe use of bioabsorbable implants may provide better opportunities for optimal implant constructs which can, to a certain degree, compensate for the lesser mechanical stiffness of bioabsorbable polymers as compared to metal implants

Pediatric feeding and swallowing rehabilitation: An overview

Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive. This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders

Sitting and standing performance in a total population of children with cerebral palsy: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Knowledge of sitting and standing performance in a total population of children with cerebral palsy (CP) is of interest for health care planning and for prediction of future ability in the individual child. In 1994, a register and a health care programme for children with CP in southern Sweden was initiated. In the programme information on how the child usually sits, stands, stands up and sits down, together with use of support or assistive devices, is recorded annually.</p> <p>Methods</p> <p>A cross-sectional study was performed, analysing the most recent report of all children with CP born 1990-2005 and living in southern Sweden during 2008. All 562 children (326 boys, 236 girls) aged 3-18 years were included in the study. The degree of independence, use of support or assistive devices to sit, stand, stand up and sit down was analysed in relation to the Gross Motor Function Classification System (GMFCS), CP subtype and age.</p> <p>Result</p> <p>A majority of the children used standard chairs (57%), could stand independently (62%) and could stand up (62%) and sit down (63%) without external support. Adaptive seating was used by 42%, external support to stand was used by 31%, to stand up by 19%, and to sit down by 18%. The use of adaptive seating and assistive devices increased with GMFCS levels (p < 0.001) and there was a difference between CP subtypes (p < 0.001). The use of support was more frequent in preschool children aged 3-6 (p < 0.001).</p> <p>Conclusion</p> <p>About 60% of children with CP, aged 3-18, use standard chairs, stand, stand up, and sit down without external support. Adding those using adaptive seating and external support, 99% of the children could sit, 96% could stand and 81% could stand up from a sitting position and 81% could sit down from a standing position. The GMFCS classification system is a good predictor of sitting and standing performance.</p

Positioning improves the oral and pharyngeal swallowing function in children with cerebral palsy

Many children with cerebral palsy have feeding difficulties. The aim of this study was to investigate if trunk and neck positioning influenced oral and pharyngeal swallow. Five children with feeding problem aged 3-10 years with cerebral palsy were examined using videofluoroscopy. All children had tetraplegia with dystonia, i.e. poor head control and poor trunk stability. All children had gross aspiration and posterior oral leak. The pharyngeal phase was delayed in relation to the oral phase. Two children had pharyngeal retention. The children were positioned with both an extended and flexed neck. The flexed neck position was combined with a 30 degrees reclined sitting position. In both positions they were given puree with barium and liquid barium during video recording. In the reclined position with the neck flexed, aspiration decreased in all five children, oral leak diminished in two children and retention improved in one child

Arbetsterapeutiska interventioner i skolan för elever med diagnoserna ASD och/eller ADHD : En scoping review

Inledning och Bakgrund: Flertalet elever med Autism spectrum disorder (ASD) uppnår inte kunskapsmålen i skolan. Eleverna kan ha svårigheter att förbereda och färdigställa uppgifter. Svårigheterna för eleverna med Attention deficit hyperactivity disorder (ADHD) gäller vanligtvis instruktioner och förståelse för uppgifter. Syfte: Syftet med studien var att identifiera vilka arbetsterapeutiska interventioner som används i skolan för elever med diagnoserna ASD och/eller ADHD. Metod: Studien genomfördes i form av en scoping review. Resultat: Totalt inkluderades 13 artiklar. Resultatet visade på fyra teman av interventioner: Aktiviteter för förbättring av kognitiva strategier, Kognitiva hjälpmedel för ökad delaktighet, Stabilitets-/terapibollar och tyngdvästar för större fokus på skoluppgifter samt Strategier för att förbättra utförande av aktiviteter i skolan. Slutsats: Det finns en variation av arbetsterapeutiska interventioner i skolan för elever med ASD och/eller ADHD. Interventionerna ledde till ökad delaktighet, förbättrade kognitiva strategier, större fokus på skoluppgifter, medvetenhet av känslor, ökad självständighet, samt förbättring av koncentrationen för eleverna i skolan.Introduction and Background: Most students with Autism Spectrum Disorder (ASD) do not achieve the knowledge goals in school. Students might have difficulties preparing and completing assignments. The difficulties for students with attention deficit hyperactivity disorder (ADHD) usually relate to instructions and understanding tasks. Aim: The aim of the study was to identify which occupational therapy interventions are used in school for students aged 9–13 years with diagnoses ASD and/or ADHD. Method: The study was conducted in form of a scoping review. Results: In total, 13 articles were included. The results showed four themes of interventions: Activities for improving cognitive strategies, Cognitive aids for increased participation, Stability/therapy balls and weighted vests for greater focus on school tasks and Strategies for improving the performance of activities at school. Conclusion: There is a variety of occupational therapy interventions in school for students with ASD and/or ADHD. The interventions led to increased participation, improved cognitive strategies, greater focus on school tasks, awareness of emotions, increased independence, and improved concentration for students in school

Arbetsterapeutiska interventioner i skolan för elever med diagnoserna ASD och/eller ADHD : En scoping review

Inledning och Bakgrund: Flertalet elever med Autism spectrum disorder (ASD) uppnår inte kunskapsmålen i skolan. Eleverna kan ha svårigheter att förbereda och färdigställa uppgifter. Svårigheterna för eleverna med Attention deficit hyperactivity disorder (ADHD) gäller vanligtvis instruktioner och förståelse för uppgifter. Syfte: Syftet med studien var att identifiera vilka arbetsterapeutiska interventioner som används i skolan för elever med diagnoserna ASD och/eller ADHD. Metod: Studien genomfördes i form av en scoping review. Resultat: Totalt inkluderades 13 artiklar. Resultatet visade på fyra teman av interventioner: Aktiviteter för förbättring av kognitiva strategier, Kognitiva hjälpmedel för ökad delaktighet, Stabilitets-/terapibollar och tyngdvästar för större fokus på skoluppgifter samt Strategier för att förbättra utförande av aktiviteter i skolan. Slutsats: Det finns en variation av arbetsterapeutiska interventioner i skolan för elever med ASD och/eller ADHD. Interventionerna ledde till ökad delaktighet, förbättrade kognitiva strategier, större fokus på skoluppgifter, medvetenhet av känslor, ökad självständighet, samt förbättring av koncentrationen för eleverna i skolan.Introduction and Background: Most students with Autism Spectrum Disorder (ASD) do not achieve the knowledge goals in school. Students might have difficulties preparing and completing assignments. The difficulties for students with attention deficit hyperactivity disorder (ADHD) usually relate to instructions and understanding tasks. Aim: The aim of the study was to identify which occupational therapy interventions are used in school for students aged 9–13 years with diagnoses ASD and/or ADHD. Method: The study was conducted in form of a scoping review. Results: In total, 13 articles were included. The results showed four themes of interventions: Activities for improving cognitive strategies, Cognitive aids for increased participation, Stability/therapy balls and weighted vests for greater focus on school tasks and Strategies for improving the performance of activities at school. Conclusion: There is a variety of occupational therapy interventions in school for students with ASD and/or ADHD. The interventions led to increased participation, improved cognitive strategies, greater focus on school tasks, awareness of emotions, increased independence, and improved concentration for students in school

Positioning improves the oral and pharyngeal swallowing function in children with cerebral palsy

Many children with cerebral palsy have feeding difficulties. The aim of this study was to investigate if trunk and neck positioning influenced oral and pharyngeal swallow. Five children with feeding problem aged 3-10 years with cerebral palsy were examined using videofluoroscopy. All children had tetraplegia with dystonia, i.e. poor head control and poor trunk stability. All children had gross aspiration and posterior oral leak. The pharyngeal phase was delayed in relation to the oral phase. Two children had pharyngeal retention. The children were positioned with both an extended and flexed neck. The flexed neck position was combined with a 30 degrees reclined sitting position. In both positions they were given puree with barium and liquid barium during video recording. In the reclined position with the neck flexed, aspiration decreased in all five children, oral leak diminished in two children and retention improved in one child

Hip displacement in relation to age and gross motor function in children with cerebral palsy

Purpose: Hip dislocation in cerebral palsy (CP) is a serious complication. By radiographic screening and prophylactic surgery of children at risk most dislocations can be prevented. CPUP, the Swedish CP registry and follow-up program, includes annual radiographic examinations of children at Gross Motor Function Classification System (GMFCS) levels III-V. Data from CPUP were analysed to assess the risk of hip displacement in relation to GMFCS levels and age. Methods: All children at GMFCS levels III-V (N = 353) whose first radiographic screening occurred before 3 years of age were followed between the ages 2-7 years. Migration percentages (MPs) were recorded annually (1,664 pelvic radiographs) and analysed using discrete time survival analysis. Results: The risk of hip displacement between 2 years and 7 years of age was significantly (p < 0.05) higher for children at GMFCS level V during the entire study period. The risk was highest at 2-3 years of age and decreased significantly (p < 0.001) with each year of age (OR = 0.71, 95 % CI 0.60-0.83). The cumulative risk at age 7 years for those at GMFCS V for MP ≥ 40 % was 47 % (95 % CI 37-58). The corresponding risk at GMFCS IV was 24 % (16-34) and at GMFCS III 23 % (12-42). Conclusions: Children at GMFCS V have a significantly higher risk of hip displacement compared with children at GMFCS III-IV. The risk is highest at 2-3 years of age. The results support a surveillance program including radiographic hip examinations as soon as the diagnosis of severe CP is suspected

The Ambiguity of Names and Landmarks in Radiographs of the Pediatric Pelvis: Variations and a Historical Perspective

For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular index, the center-edge angle, and the migration percentage, have stood the test of time and remain the default tools for any pediatric orthopaedic surgeons. However, in contemporary research, the terminology regarding these measurements has become markedly inconsistent. A substantial number of synonyms, acronyms, and similar, but not identical, terms are used to label measurements. This is perhaps unsurprising, considering decades of use and numerous suggested modifications. The results of treatment cannot be reliably compared if the measured parameters are not identical, and scientific analysis of disease requires consistent terminology. In this review, we aim both to provide historical definitions and identification of radiographic landmarks commonly used in three parameters of interest on pediatric AP radiographs and to examine the variability of landmarks and definitions in contemporary research