Lawrence C. Vogel

Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities

BACKGROUND To explore the prevalence of obesity and related secondary conditions associated with obesity in adolescents with intellectual/developmental disabilities (IDD). METHODS In total, 461 parents of adolescents with IDD (M = 14.9 year, SD = 1.9) across 49 US states completed a web-based survey containing questions related to their childs health status, including body weight and existing health conditions. Results were compared with published data for youth without disabilities. RESULTS Adolescents with autism and Down syndrome were two to three times more likely to be obese than adolescents in the general population. Secondary health conditions were higher in obese adolescents with IDD compared with healthy weight adolescents with IDD including high blood pressure, high blood cholesterol, diabetes, depression, fatigue, liver or gallbladder problems, low self-esteem, preoccupation with weight, early maturation and pressure sores. CONCLUSION Obesity is as much of a health problem in youth with IDD as it is among youth without disabilities and, in certain disability groups, is a significantly greater health problem. Obese youth with IDD have a high number of obesity-related secondary conditions predisposing them to greater health problems as they transition into adulthood. Federal and local initiatives to reduce obesity among youth in the general population must recognise the need for interventions that are also relevant (i.e. accessible and effective) for youth with IDD.

International standards to document remaining autonomic function after spinal cord injury

Abstract This is the first guideline describing the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI). This guideline should be used as an adjunct to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) including the ASIA Impairment Scale (AIS), which documents the neurological examination of individuals with SCI. The Autonomic Standards Assessment Form is recommended to be completed during the evaluation of individuals with SCI, but is not a part of the ISNCSCI. A web-based training course (Autonomic Standards Training E Program (ASTeP)) is available to assist clinicians with understanding autonomic dysfunctions following SCI and with completion of the Autonomic Standards Assessment Form (www.ASIAlearningcenter.com).

Scoliosis in Pediatric Spinal Cord-Injured Patients

Summary: One hundred thirty children who sustained spinal cord injuries between birth and age 21 years were reviewed to determine the progression rate of paralytic scoliosis and the effects of bracing and surgery. Patients were divided into two groups: those injured before and those injured after the adolescent growth spurt. Scoliosis developed in 97 and 52%, respectively. Bracing was effective in delaying progression in the preadolescent group. The progressive paralytic spinal deformity did not appear to be related to the level of injury. The older patient is at much less risk for paralytic scoliosis, but still requires routine examination.

Long-term outcomes and life satisfaction of adults who had pediatric spinal cord injuries

OBJECTIVE To determine long-term outcomes and life satisfaction of adults who sustained pediatric spinal cord injury (SCI). DESIGN Structured interview of adults who were 25 years or older who had pediatric SCI. SETTING Community. PARTICIPANTS A convenience sample of 46 patients from a total of 81 patients who received care in an SCI program: 1 refused participation, 4 died, and 30 were lost to follow-up. MAIN OUTCOME MEASURES A structured questionnaire including physical, psychosocial, and medical information. The Craig Handicap Assessment and Reporting Technique and two measures of life satisfaction were also administered. RESULTS Participants were 25 to 34 years old, mean 27 years. Thirty-two had tetraplegia and 14 had paraplegia. Thirty-one were men. Mean years of education was 14. Fifty-four percent were employed, 48% lived independently, and 15% were married. Life satisfaction was associated with education, income, satisfaction with employment, and social/recreation opportunities, and was inversely associated with some medical complications. Life satisfaction was not significantly associated with level of injury, age at injury, or duration of injury. CONCLUSIONS Individuals who had pediatric SCI, much like adult-onset SCI, have the greatest opportunity for a satisfying adult life if rehabilitation emphasizes psychosocial factors such as education, employment, and long-term health management.

Causes of Spinal Cord Injury

BACKGROUND Knowledge of the causes of spinal cord injury (SCI) and associated factors is critical in the development of successful prevention programs. OBJECTIVE This study analyzed data from the National SCI Database (NSCID) and National Shriners SCI Database (NSSCID) in the United States to examine specific etiologies of SCI by age, sex, race, ethnicity, day and month of injury, and neurologic outcomes. METHODS NSCID and NSSCID participants who had a traumatic SCI from 2005 to 2011 with known etiology were included in the analyses (N=7,834). Thirty-seven causes of injury documented in the databases were stratified by personal characteristics using descriptive analysis. RESULTS The most common causes of SCI were automobile crashes (31.5%) and falls (25.3%), followed by gunshot wounds (10.4%), motorcycle crashes (6.8%), diving incidents (4.7%), and medical/surgical complications (4.3%), which collectively accounted for 83.1% of total SCIs since 2005. Automobile crashes were the leading cause of SCI until age 45 years, whereas falls were the leading cause after age 45 years. Gunshot wounds, motorcycle crashes, and diving caused more SCIs in males than females. The major difference among race/ethnicity was in the proportion of gunshot wounds. More SCIs occurred during the weekends and warmer months, which seemed to parallel the increase of motorcycle- and diving-related SCIs. Level and completeness of injury are also associated with etiology of injury. CONCLUSIONS The present findings suggest that prevention strategies should be tailored to the targeted population and major causes to have a meaningful impact on reducing the incidence of SCI.

Epidemiology of Spinal Cord Injury In Chiloren And Adolescents

Abstract Objective: To describe the unique aspects of the epidemiology of pediatric-onset spinal cord injury (SCI). Methods: The characteristics of persans with SCI enrolled in either the Shriners Hospitals for Children SCI database or the National SCI Statistical Center database from 1 9 73 through 2002 were evaluated based on age at time of injury (0–5 years, 6–1 2 years, 13–15 years, 16–21 years, and 22 years and older). Results: Males comprised a consistently decreasing proportion of new cases of SCI, ranging from 83% among persans between 16 and 21 years of age to only 51% among those aged 0 to 5 years. Among children and adolescents (under the age of 22), the proportion of SCI due to motor vehicle crashes was higher than in adults (22+ years). Sports, violence, and medical or surgical complications also accounted for a significantly greater proportion ofSCI in teenagers (13–21 years) than in adults. Violence has become the leading cause ofSCI among African American and Hispanic teenage mal es (1 3–21 years), whereas vehicular crashes are more common among African American and Hispanic men of older ages (22 years of age and above). Approximately one third of new cases of SCI in the youngest two age groups (0–5 years, 6–12 years) had cervical injuries compared with almost one half in the older age groups (age 1 3 and above). SCI was much more likely tobe neurologically complete in younger persans (69% age 0–5 years vs 51% age ;:::: 16 years). Conclusion: The pediatric-onset SCI population is heterogeneaus and exhibits distinct epidemiologic characteristics both within the different pediatric age groups and with the adult-onset SCI population.

Prevalence of Obesity-Related Chronic Health Conditions in Overweight Adolescents with Disabilities.

The prevalence of 15 common obesity-related chronic health conditions was examined in a convenience sample of adolescents, ages 12-18 years old, with mobility and non-mobility limitations (n = 208 and 435, respectively). In both groups, overweight adolescents (BMI ≥ 85th %ile) had a significantly higher number of obesity-related chronic health conditions than their counterparts with healthy weight status (2.74 versus 1.74 for the mobility limitation group, and 1.79 versus 1.45 for the non-mobility limitation group). Prevalence of high blood cholesterol was significantly higher among overweight adolescents than healthy weight adolescents across the two groups. While prevalence of asthma and early maturation appeared to increase as a function of body weight for both groups, a significant difference was found only in the group with non-mobility limitations. Across the two groups, there was a clear tendency toward a higher prevalence of chronic health conditions in overweight adolescents compared to their healthy weight counterparts. Greater efforts must be made to address the higher rates of obesity-related health conditions in youth with disabilities during childhood and adolescence to avoid significant health consequences and health care costs in adulthood.

Reliability of radiographic parameters in neuromuscular scoliosis.

Study Design. Retrospective review of radiographic data. Objectives. This study sought to define interoberserver and intraobserver variability to further delineate reliable means by which radiographs of patients with neuromuscular scoliosis can be examined. Summary of Background Data. Previous studies analyzed the use of Cobb angles in the measurement of idiopathic and congenital scoliosis, but no study until now describes a critical analysis of measurement in evaluating neuromuscular scoliosis. Methods. Forty-eight patients with neuromuscular scoliosis radiographs were reviewed. These were evaluated for Cobb angle, end vertebrae selection, Ferguson angle, apex of the curve, C7 balance, pelvic obliquity, Risser sign, status of the triradiate cartilage, kyphosis Cobb angle, endplate selection for kyphosis, and kyphotic index. Interclass and intraclass variability was examined with statistical analysis. Results. Cobb angle had an intraobserver variability was 5.7° and the interobserver variability was 14.8°. The intraobserver and interobserver variability for Ferguson angle was 6.8° and 20.6°, respectively. The kyphotic Cobb angle intraobserver variability was found to be 17.4°, and the interobserver variability was 24.01°. Conclusions. Neuromuscular scoliosis radiographs can be reliably analyzed with the use of Cobb angle. Other forms of analysis, such as Ferguson angle, are not as reliable. Pelvic obliquity should be measured from the horizontal, as other methods are not as reliable. Kyphosis is best evaluated with the use of the kyphotic Cobb angle. Finally, it is felt that a separate anteroposterior pelvis radiograph should be used to assess skeletal maturity, as scoliosis films often truncate the vital anatomy necessary to determine skeletal maturity.

Assessing patterns of participation and enjoyment in children with spinal cord injury

Aim  To determine patterns of participation and levels of enjoyment in young people with spinal cord injuries (SCI) and to assess how informal and formal participation varies across child, injury‐related, household, and community variables.

Determinants of Intensity of Participation in Leisure and Recreational Activities by Youth With Cerebral Palsy

OBJECTIVE To test a model of determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy (CP). DESIGN Prospective cohort study. SETTING Childrens hospitals (N=7). PARTICIPANTS Youth with CP (N=205; age, 13-21y) and their parents. The sample included 107 (57.2%) males and 26 (12.7%) to 57 (27.8%) youth in each of the 5 levels of the Gross Motor Function Classification System (GMFCS). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Youth completed the Childrens Assessment of Participation and Enjoyment by means of an interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, a demographic questionnaire, and a services questionnaire. RESULTS Structural equation modeling was used to test the model. Fit statistics indicate good model fit. The model explains 35% of the variance in intensity of participation. Path coefficients (P ≤ .05) indicate that higher physical ability, higher enjoyment, younger age, female sex, and higher family activity orientation are associated with higher intensity of participation. GMFCS level and caregiver education have indirect effects on intensity of participation. The path between services and intensity of participation was not significant. CONCLUSIONS Participation by youth with CP is influenced by multiple factors. The influence of physical activity supports the importance of activity accommodations and assistive technology for youth who are not capable of improving physical ability. Knowledge of family activity orientation is important for identifying opportunities for participation. The unexplained variance suggests that the model should include other determinants, such as physical accessibility and availability of transportation and community leisure and recreational activities.