Burris Duncan

Immediate and Long-Term Effects of Hippotherapy on Symmetry of Adductor Muscle Activity and Functional Ability in Children With Spastic Cerebral Palsy

OBJECTIVES To investigate the immediate effects of 10 minutes of hippotherapy, compared with 10 minutes of barrel-sitting, on symmetry of adductor muscle activity during walking in children with cerebral palsy (CP) (phase I). To investigate the long-term effects of 12 weeks of hippotherapy on adductor activity, gross motor function, and self-concept (phase II). DESIGN Pretest/posttest randomized controlled trial plus clinical follow-up. SETTING Outpatient therapy center. PARTICIPANTS Children with spastic CP (phase I: n=47; phase II: n=6). INTERVENTIONS Phase I: 10 minutes of hippotherapy or 10 minutes of barrel-sitting; phase II: 12 weekly hippotherapy sessions. MAIN OUTCOME MEASURES Phases I and II: adductor muscle activity measured by surface electromyography. Phase II: gross motor function and self-perception profiles. RESULTS Phase I: hippotherapy significantly improved adductor muscle asymmetry (P<.001; d=1.32). Effects of barrel-sitting were not significant (P>.05; d=.10). Phase II: after 12 weeks of hippotherapy, testing in several functional domains showed improvements over baseline that were sustained for 12 weeks posttreatment. CONCLUSIONS Hippotherapy can improve adductor muscle symmetry during walking and can also improve other functional motor skills.

Iron and the exclusively breast-fed infant from birth to six months

This study was designed to determine whether normal, full-term, exclusively breast-fed infants develop iron deficiency anemia, as defined by hemoglobin or red blood cell indices more than two standard deviations below the age-specific mean, or depletion of iron stores, as defined by an abnormally low serum ferritin level. Thirty-three breast-fed infants were followed from birth to 6 months. Maternal blood and cord blood at delivery, and venous blood from the infants at 2, 4, and 6 months were analyzed for anemia as defined above. At 6 months of age, the mean hemoglobin concentration of these infants was slightly higher than the normal mean; four of 33 infants (12%) had a mean corpuscular volume greater than 2 SD below the reported normal mean; and two of 33 infants (6%) had a serum ferritin level less than 12 ng protein/ml. These data suggest that the infant who is exclusively breast-fed for the first 6 months of life is not at high risk for the development of iron deficiency anemia or the depletion of iron stores during that time.

The Gardner syndrome: need for early diagnosis.

The Gardner syndrome is a triad of soft tissue tumors, bone tumors which are principally but not exclusively limited to facial bones and skull, and intestinal polyps predisposed to malignancy. The disease is due to a single pleiotropic gene and has an autosomal dominant pattern of inheritance with complete penetrance and variable expression. The first manifestations of skin tumors and bone tumors appear in the pediatric age group. They should alert the pediatrician to investigate the entire intestine for potentially malignant polyps and to initiate examinations for other members of the family. Genetic counseling is an important part of the management of this disease.

Maternal phenylketonuria: Implications for growth and development

Eight non-PKU offspring of phenylketonuric mothers are described. All of the patients have mental subnormality and I.Q./D.Q. scores below those of their mothers. Phenylalanine loading tests failed to discriminate between the nonheterozygotes and the heterozygotes. Growth data from these cases and additional previously unpublished growth data on 13 non-PKU offspring of 3 phenylketonuric mothers demonstrated uniform intrauterine and postnatal growth retardation.

Glycine-based oral rehydration solution: Reassessment of safety and efficacy

We evaluated the safety and efficacy of a glycine-based orally administered rehydration solution by comparing it with a standard oral rehydration solution (ORS) without glycine in a randomized double-blind trial in United States infants (age less than 15 months) given treatment for acute gastroenteritis as inpatients or outpatients. The response to therapy (stool volume and duration of illness) was similar in the two groups, except that in four (13%) of 31 hospitalized infants receiving glycine-ORS hypernatremia developed, (one had symptoms) compared with none of 35 receiving ORS (P less than 0.04). Among the 77 outpatients there were no differences between the groups. This study demonstrates that glycine-ORS did not provide any therapeutic advantage over standard ORS, and hypernatremia developed in some patients receiving glycine-ORS. We suggest that caution be used with this type of solution until further safety studies have been done.

Dietary Considerations in Osteopenia in Tube-Fed Nonambulatory Children with Cerebral Palsy

Children with nonambulatory cerebral palsy are frequently found to be osteopenic. We sought factors, in addition to immobility and anticonvulsant therapy, that may contribute to the osteopenia. A retrospective chart review of 19 children with nonambulatory cerebral palsy who received gastrostomy tube feedings of standard commercial formulas was performed. Less than 75% of the Recommended Daily Allowance (RDA) was administered to 95% of the children for calories, 58% for calcium, 68% for phosphorus, and 74% for vitamin D. Five of the 19 chidren sustained fractures without major trauma. This study suggests that inadequate intake of crucial vitamins and minerals may contribute to the severe osteopenia observed in many children with nonambulatory cerebral palsy. The nutritional needs of these children, including those for micronutrients, must be defined and appropriate supplementation given.

BICYCLE HELMET USE BY CHILDREN: KNOWLEDGE AND BEHAVIOR OF PHYSICIANS

A survey of pediatricians and family physicians in Tucson, Arizona revealed that the majority knew that bicycle accidents are an important cause of childhood mortality and were aware that head trauma causes most bicycle-related deaths. Ninety-two per cent knew that children rarely use bicycle helmets and most believed this was due to inadequate parental awareness of the importance of helmets. Despite this, many physicians never include bicycle safety in patient education provided during well-child care.

Parental Perceptions of the Therapeutic Effect from Osteopathic Manipulation or Acupuncture in Children with Spastic Cerebral Palsy

Fifty children were involved in a randomized, controlled trial to evaluate the effectiveness of either osteopathic manipulation or acupuncture as a 6-month therapeutic adjunct for children with spastic cerebral palsy. Exit interviews were used to obtain parental perceptions and form the basis of this report. Only 2 of 17 parents reported positive gains while their child was in a wait-list control period but all 17 reported gains while in the treatment phase of the study. Ninety-six percent (48 of 50) of the parents reported some improvement while their child was receiving treatments but the gains varied from child to child. The most frequent gains were seen in improvement in the use of arms or legs (61% and 68%) and more restful sleep (39% and 68%) in the osteopathic and the acupuncture groups, respectively. Improvement in mood and improved bowel function were also very common benefits noted by the parents in both groups.

Evaluating Intense Rehabilitative Therapies With and Without Acupuncture for Children With Cerebral Palsy: A Randomized Controlled Trial

OBJECTIVE To compare the outcomes of conventional therapies (physical, occupational, and hydrotherapies) plus acupuncture with those without acupuncture when administered intensely in the management of children with spastic cerebral palsy (CP). DESIGN Evaluation-blind, prospective randomized controlled trial. SETTING Therapies and video-recorded assessments at a childrens hospital in Beijing, China, and blind scoring and data analyses at a university in the United States. PARTICIPANTS Children (N=75), 12 to 72 months of age, with spastic CP. INTERVENTIONS Intensely administered (5 times per week for 12wk) physical therapy, occupational therapy, and hydrotherapy either with acupuncture (group 1) or without acupuncture (group 2). To satisfy standard of care, group 2 subsequently received acupuncture (weeks 16-28). MAIN OUTCOME MEASURES The Gross Motor Function Measure (GMFM)-66 and the Pediatric Evaluation of Disability Inventory (PEDI) assessments at 0, 4, 8, 12, 16, and 28 weeks. RESULTS At the end of 12 weeks, there was no statistically significant difference between the 2 groups, but when group 2 received acupuncture (16-28wk) there was a shift toward improvement in the GMFM-66 and the PEDI-Functional Skills Self-Care and Mobility domain. When groups were combined, statistically significant improvements after intense therapies occurred from baseline to 12 weeks for each outcome measure at each Gross Motor Function Classification System (GMFCS) level. After adjusting for expected normative maturational gains based on age, the GMFM gains for children with GMFCS II level was statistically significant (P<.05) with a mean gain of 6.5 versus a predicted gain of 3.4. CONCLUSIONS Intense early administered rehabilitation improves function in children with spastic CP. The contribution from acupuncture was unclear. Childrens response varied widely, suggesting the importance of defining clinical profiles that identify which children might benefit most. Further research should explore how this approach might apply in the U.S.

Understanding of growth monitoring charts by literate and illiterate mothers in northeast Brazil.

Growth failure secondary to malnutrition occurs with a high prevalence in the developing world. Growth monitoring (GM) is one of the key primary health care strategies for controlling this problem. To assess the impact of literacy on the ability to interpret growth monitoring information the understanding of sample growth charts was evaluated among mothers in two communities of Fortaleza where growth monitoring programs had been promoted for several years. Homes were sequentially visited to identify families with children under 5 years of age who had a growth chart showing at least one weight recorded in the previous 12 months. These mothers were then interviewed by a public health nurse and asked to interpret six sets of growth charts portraying data on fictitious children from 6 to 17 months of age. The growth chart was that of the Ministry of Health which included lines for the 10th and 90th percentiles. Scores from 0 to 6 were given based on the number of correct responses given. 64 (45%) of the 142 mothers included in the study were classified as illiterate. Illiterate mothers tended to be older to have more children and a greater proportion lived in one of the two communities. No significant differences were seen in percentage of surviving children proportion of mothers working outside the home and family income. Illiterate mothers showed a higher frequency of participation in GM sessions. The results of the individual questions of the evaluation indicated mean scores for literate and illiterate mothers of 4.5 (SD 1.4) and 3.2 (SD 1.8) respectively (p < 0.001). If four correct answers were used as an arbitrary cut-off for a satisfactory level of understanding 85% and 53% of literate and illiterate mothers respectively achieved this mark. Among illiterate mothers community of residence and attendance at all GM sessions were significantly associated with the mean scores. Among literate mothers age (25-34 years) was significantly associated with higher mean scores.