Barbara H. Connolly

Aging and Down Syndrome: Implications for Physical Therapy

The number of people over the age of 60 years with lifelong developmental delays is predicted to double by 2030. Down syndrome (DS) is the most frequent chromosomal cause of developmental delays. As the life expectancy of people with DS increases, changes in body function and structure secondary to aging have the potential to lead to activity limitations and participation restrictions for this population. The purpose of this update is to: (1) provide an overview of the common body function and structure changes that occur in adults with DS as they age (thyroid dysfunction, cardiovascular disorders, obesity, musculoskeletal disorders, Alzheimer disease, depression) and (2) apply current research on exercise to the prevention of activity limitations and participation restrictions. As individuals with DS age, a shift in emphasis from disability prevention to the prevention of conditions that lead to activity and participation limitations must occur. Exercise programs appear to have potential to positively affect the overall health of adults with DS, thereby increasing the quality of life and years of healthy life for these individuals.

Relationships Among Severity of Osteonecrosis, Pain, Range of Motion, and Functional Mobility in Children, Adolescents, and Young Adults With Acute Lymphoblastic Leukemia

Background and Purpose: Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonecrosis, often without symptoms. Little is known about the association between the degree of osteonecrosis and functional mobility in this population. The purpose of this study was to examine relationships among the degree of osteonecrosis, pain, range of motion (ROM), and functional mobility in people with ALL. Subjects: Thirty-three subjects aged 5 to 27 years with ALL and osteonecrosis participated. Methods: The extent of osteonecrosis was determined by magnetic resonance imaging (MRI) of the hip and knee according to 2 classification systems, including the Association Research Circulation Osseous (ARCO) and a knee staging scale. Pain, hip and knee ROM, and the Timed Up and Down Stairs (TUDS) Test were used as measures. Results: Correlations were observed between ARCO and hip pain (r=.34), between hip flexion ROM and hip pain (r=−.34), and between knee pain and time on the TUDS Test (r=−.35). Discussion and Conclusion: Physical therapists should consider that people with ALL may have hip or knee osteonecrosis without clinical symptoms. This notion supports the need for MRI in addition to a comprehensive examination of functional mobility.

Concurrent validity of the Bayley Scales of Infant Development II (BSID-II) Motor Scale and the Peabody Developmental Motor Scale II (PDMS-2) in 12-month-old infants.

Purpose: This study was designed to examine concurrent validity of the Peabody Developmental Motor Scale II (PDMS-2) and the Bayley Scales of Infant Development II (BSID-II) Motor Scale. Methods: The PDMS-2 and the BSID-II Motor Scale were administered to fifteen 12-month-old infants who were developing typically. PDMS-2 raw scores were converted to the Gross Motor Quotient (GMQ), the Fine Motor Quotient (FMQ), and the Total Motor Quotient (TMQ). BSID-II raw scores were converted to the Psychomotor Development Index (PDI). Age equivalent scores were obtained for all PDMS-2 Gross and Fine Motor Subscales and for the BSID-II Motor Scale and compared using the Pearson Product-Moment Correlation Coefficient. Results: Low correlations were found between the PDMS-2 FMQ, GMQ, TMQ, and the PDI of the BSID-II. Low correlations were found between age equivalent scores of the PDMS-2 subtests for grasp, stationary, and Visual Motor Integration and the BSID-II Motor Scale. A low negative correlation was found between age equivalent scores of the PMDS-2 subtest for Object Manipulation and the BSID-II Motor Scale. A high correlation (r = 0.71, P < 0.05) was found between age equivalent scores of the PDMS-2 subtest for locomotion and the BSID-II Motor Scale. Conclusions: There is a lack of concurrent validity between the PDMS-2 standard scores and standard scores of the BSID-II Motor Scale and a lack of agreement between age equivalent scores of the BSID-II Motor Scale and the PDMS-2 subtests except for Locomotion. The investigators caution about using only one standard score or age equivalent score for decisions about the need for early intervention for children at 12 months of age when using the BSID-II or the PDMS-2.

Effects of Backpack Carriage on Gait Parameters in Children

Purpose: Carrying a backpack over 2 shoulders is the most efficient means of carriage, but often backpacks are carried over 1 shoulder. Our purpose was to assess walking base of support, stride length, double support time, and velocity when backpacks were carried on 1 or 2 shoulders. Methods: Thirty-two children (12–13 years) were assessed under 2 load conditions using the GAITRite® system. Results: No significant differences were found in base of support, stride length, or velocity when compared with the unloaded baseline walk. Double limb support significantly increased (p < 0.0001) with both load conditions when compared with the baseline, but not between 1-shoulder and 2-shoulders carriage. Conclusion: Little change in temporal-spatial gait parameters was noted during backpack use with loads limited to 15% body weight. Future studies need to examine the effects of the child’s height, body mass index, and strength on safe backpack use.

Aging in Individuals with Lifelong Disabilities

The major research data and findings related to aging among persons with developmental disabilities are discussed. Differences between the aging processes noted in the general population and individuals who have developmental disabilities are highlighted. Topics addressed include prevalence of developmental disabilities and mortality rates for individuals with developmental disabilities. The effects of aging on the senses, the neuromusculoskeletal system, and the cardiopulmonary system are presented along with the clinical implications of these changes in individuals with developmental disabilities

General Effects of Aging on Persons with Developmental Disabilities

The major research data and findings related to aging in the general population, as well as aging among persons with developmental disabilities, are discussed. Topics addressed include definitions of developmental disabilities and prevalence and mortality rates, as well as the effects of aging on the senses, the neuromusculoskeletal system, and the cardiopulmonary system. Discussions are also included on the clinical implications of these changes in the aging individual with a developmental disability.

Rehabilitation of a child with a split cord malformation and hemimeningomyelocele.

PURPOSE The purpose of this case report is to recount the rehabilitation progress of a child with a hemimeningomyelocele and to clarify terminology used to describe this condition. SUMMARY OF KEY POINTS A young girl with a diagnosis of a hemimeningomyelocele, involving the left hemicord only, at the level of the seventh to the ninth thoracic vertebrae, was followed from two and a half months until seven years of age. Deciphering the medical record was a challenge because clinicians involved in the case used different terminology to describe the split cord malformation. The authors had to review the literature about split cord malformations to interpret the medical record. The child also had a severe kyphoscoliosis and a ventriculoperitoneal shunt (Arnold-Chiari II deformity). The child was followed by an orthopedist and a neurosurgeon. She participated in an early intervention program that included physical therapy. Her clinical course did not follow that anticipated for a child with a meningomyelocele at the seventh through ninth thoracic vertebrae. Standing and ambulation typically are goals for children with thoracic-level lesions, primarily for exercise and for movement within the home or classroom. However, by four years of age this child was able to ambulate on even and uneven surfaces using a single-quad cane. She exhibited a normal gait pattern in the right lower extremity during ambulation. Additionally, functional movement in the left lower extremity during ambulation occurred without the use of an ankle-foot orthosis. CONCLUSIONS The rehabilitation progress of this child was atypical of that seen in a child with a meningomyelocele at the level of the seventh through ninth thoracic vertebrae. Because of her split cord malformation, she retained normal function in the right lower extremity although function was impaired in the left lower extremity.

A Plea about PhC

To the Editor: Because of its various responsibilities assigned by the Board of Directors, the Associations Committee on Research has occasion to take note of the credentials of members, especially of those members who have been, or are, engaged in research. A number of months ago, under our previous chairman, we had occasion to note the use of the initials “PhC” after a members name. We were at first a bit nonplussed by what “PhC” meant but an informal inquiry, and other information available to us, revealed that the initials are used in at least one academic setting to indicate “candidate for the PhD.” Quite naturally, we were disturbed by the apparent public use of initials, after a name, that ordinarily (in the United States) indicate academic degree, professional degree, or official registration, licensure, or certification, but that, in this instance, represented none of these things.…