Stephen F. Noll

Disorders of the spinal cord: Spinal cord injury, myelodysplasia

This self-directed learning module provides review and references for the basic concepts of, and highlights new advances in, disorders of the spinal cord in children. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. For spinal cord injury, only data pertinent to the pediatric age group are discussed. Myelodysplasia is presented in detail to include genetic implications, early intervention, long-term management planning, psychosocial impact, and quality-of-life considerations.

Musculoskeletal and soft tissue disorders

Abstract This self-directed learning module highlights advances in evaluation and treatment of congenital and acquired musculoskeletal disorders in the child. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains information on alterations of limb structure and gait, scoliosis, torticollis, sports injuries and overuse syndromes, and unexplained pain in children.

Brain damage causing disability

Abstract This self-directed learning module addresses rehabilitation issues in the child with brain damage. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. In addition to the motor manifestations, intellectual, social, and emotional impairment are addressed. Problems vary with developmental stage. Emphasis is on the etiology, severity, and combination of deficits in order to develop a plant of management, including physical, occupational, and speech therapy, recreational and social milieu, and family and community resources.

General principles and special considerations

Abstract This self-directed learning module addresses core concepts in the assessment of any child with disability, including physical growth and development, evolution of reflexes, and cognitive and personality development. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The rehabilitation perspective is emphasized, especially as it changes to accommodate the developing child, with a focus on specific chronic disorders such as respiratory disease, congenital heart disease, and malignancy. These types of disorders serve as a model for the management of problems that require special medical, rehabilitative, and psychosocial consideration.

Poster 67: Lumbar intraspinal synovial cyst: a case report1

Abstract Setting: Tertiary medical center physical medicine and rehabilitation unit. Patient: A 67-year-old woman with intractable right lower-extremity pain and paresthesias. Case Description: The patient presented with a 2 month-history of acute onset right buttock pain with radiation into calf and foot. She also had numbness and tingling in her right foot. There was no trauma or unusual activity, however, she had subtle right leg discomfort for many years prior to onset of pain. The patient had no subjective weakness or difficulty in bowel or bladder control. Neurologic examination revealed absent right ankle jerk and reduced sensation in S1 distribution. Motor strength was normal. Lumbar spine magnetic resonance imaging (MRI) revealed a juxta-facet intraspinal synovial cyst at the right L5-S1 level. This caused deformity and compression of the right S1 nerve root. There were also smaller extraspinal synovial cysts at L5-S1 level posteriorly. Assessment/Results: The patient underwent right L5 partial, inferior hemilaminectomy, L5-S1 medial facetectomy, foraminotomy of the S1 nerve root, and gross total resection of the L5-S1 level synovial cyst. Postoperatively, she reported relief of right lower-extremity pain for several hours. She then developed recurrence of right leg pain without weakness. MRI revealed hematoma formation at the operative bed. The hematoma was evacuated promptly, resulting in complete resolution of symptoms. Discussion: This case represents a classic presentation of a large intraspinal synovial cyst causing radiculopathy and outcome of surgical excision with the infrequent postoperative complication of hematoma. Conclusion: Intraspinal synovial cysts can cause intractable radicular pain. MRI studies are warranted for intractable radiculopathies.

Joint and connective tissue diseases

Abstract This self-directed learning module presents pertinent information about rehabilitation management of specific joint and connective tissue diseases affecting children. This section highlights juvenile rheumatoid arthritis, Lyme disease, rheumatic fever, hemophilia, dermatomyositis, polymyositis, systemic lupus erythematosus, and other forms of arthritis. It is a section of the chapter of pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation.

Disorders of the motor unit

Abstract This self-directed learning module addresses diagnostic and rehabilitation issues in children with the most common disorders of the motor unit. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Conditions occurring only in infancy or childhood and differences in diagnostic and rehabilitation approaches as compared with those used in adults are highlighted.