The physeal injuries in children occur result of trauma, infection, metabolic or ischemic disease, and these conditions cause significant problems, such as growth disturbance, deformity and premature closure of physis. The authors experienced 7 cases of children who had angular deformity of knee and limb shortenings, but no history of obvious causes of physeal injury. All of these cases had severe osteoporosis and underlying disease, which were osteogenesis imperfecta, fibrous dyplasia and long term steroid therapy. The purpose of this study are evaluation of pathomechanism of physeal injuries in severe osteoporotic children. Patients were range of age from 4 to 9 years and had common clinical features, which were angular deformities of knee, limb shortening. Also they had common radiographic findings, that were severe porosis, metaphyseal sclerosis and in some cases, pop corn like calcification around physis. At this, we supposed that chronic mechanical stress in osteoporotic bone make physis be damaged due to loss of capillary circulation and this event appear to result from collapse of bone plate, through which epiphyseal vessel penetrate. In conclusion, the children with severe osteoporosis should be observed carefully about physeal injuries, which pathomechanism are perhaps deprivation of capillary circulation through bone plate. Therefore, We should try to protect bone plate by being conscious of its existence.
Bone Plates ; Capillaries ; Child ; Congenital Abnormalities ; Extremities ; Humans ; Knee ; Osteogenesis Imperfecta ; Osteoporosis* ; Sclerosis ; Stress, Mechanical ; Zea mays

Technological advances in neonatology led to the improvement of the survival rate in preterm babies with very low birth weights. However, intraventricular hemorrhage (IVH) has been one of the major complications of prematurity. IVH is relevant to neurodevelopmental disorders, such as cerebral palsy, language and cognitive impairments, and neurosensory and psychiatric problems, especially when combined with brain parenchymal injuries. Additionally, severe IVH requiring shunt insertion is associated with a higher risk of adverse neurodevelopmental outcomes. Multidisciplinary and longitudinal rehabilitation should be provided for these children based on the patients’ life cycles. During the infantile period, it is essential to detect high-risk infants based on neuromotor examinations and provide early intervention as soon as possible. As babies grow up, close monitoring of language and cognitive development is needed. Moreover, providing continuous rehabilitation with task-specific and intensive repetitive training could improve functional outcomes in children with mild-to-moderate disabilities. After school age, maintaining the level of physical activity and managing complications are also needed.

The aim of this article was to present a review of the research literature on the outcome of botulinum toxin type A (BTX-A) injection for management of upper limb spasticity in children with cerebral palsy (CP). We searched the electronic databases of MEDLINE, CINAHL and PUBMED for all published studies with full-length English text available. For each study, the quality of the methods and the strength of evidence were assessed by 2 independent reviewers based on the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines. Four studies of level I, 8 studies of level IV and 4 studies of level V were identified. Due to the limited number of studies with high quality evidence and inconsistent results among studies, we were unable to support or refute the usefulness of BTX-A injection for management of upper limb spasticity in children with CP. Moreover, we identified several variables that may affect the outcome of injection, such as timing of age, dosage, dilution volumes, localization techniques of target muscles and participant characteristics. In summary, we have presented a review the literature and a discussion of the considerable uncertainty and variation associated with the clinical use of BTX-A injection for management of upper limb spasticity in children with CP.
Upper Extremity ; Range of Motion, Articular/drug effects ; Neuromuscular Agents/administration & dosage/*therapeutic use ; Muscle Spasticity/drug therapy ; Injections ; Infant ; Humans ; Child, Preschool ; Child ; Cerebral Palsy/*drug therapy ; Botulinum Toxin Type A/administration & dosage/*therapeutic use ; Age Factors ; Adult ; Adolescent

OBJECTIVE: To evaluate the effect of stretching therapy of neurogenic bladder in spinal cord injured patients. METHOD: Twelve spinal cord injured patients who had neurogeic bladder manifested with urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were selected. Oxybutynin solution was instillated via foley catheter and the catheter was clamped until incontinence occur. This was performed twice a day for 7 days. The urodynamic studies were compared before and after therapy. Total volume of daily incontinence and total volume of daily fluid intake were also monitored. RESULTS: After stretching therapy, median maximal bladder capacity increased from 190.08 to 457.17 ml (p<0.01), mean bladder compliance increased from 8.46 to 18.85 ml/cmH2O (p<0.01), mean reflex volume increased from 148.75 to 252.17 ml (p<0.05), mean maximal detrusor pressure decreased from 52.17 to 28.29 cmH2O (p<0.01), mean clinical maximal capacity increased from 277.50 to 537.50 ml (p<0.01), and mean daily incontinent volume decreased from 508.33 ml to 20.83 ml (p<0.01). No significant correlation was found between the duration since onset of injury and the urodynamic finding. CONCLUSION: This study proved that stretching therapy of bladder was an effective method in spinal cord injured patients who had neurogenic bladder with uncontrolled incontinence with conventional therapy.
Administration, Intravesical ; Catheters ; Compliance ; Humans ; Reflex ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Incontinence ; Urodynamics

PURPOSE: To identify the characteristics of static standing balance and its postural control mechanisms during quiet side-by-side standing and the changes in these measures whilst wearing hinged ankle-foot orthoses (AFOs) in children with bilateral spastic cerebral palsy (CP). MATERIALS AND METHODS: Twenty-one children with bilateral spastic CP (6.10 +/- 1.09 year-old) and 22 typically developing (TD) children (5.64 +/- 0.49 year-old) were recruited. Pressure data were recorded while subjects with or without AFOs stood on dual force platforms and net body center of pressure (CoP) coordinates were calculated from this data. Net body CoP was traced for measuring mediolateral (ML) and anteroposterior (AP) displacement and path length per second. Correlation coefficients between parameters representing ankle, hip, and transverse body rotation strategies were also analyzed. RESULTS: ML and AP displacement and path length per second of the CoP trajectory were higher in children with CP compared to TD children (p < 0.05). There were no significant improvements in these parameters whilst wearing hinged AFOs. Compared to TD children, children with CP used less ankle strategy though more hip and transverse rotation strategies for postural control during quiet standing. Whilst wearing hinged AFOs, the contribution of ankle strategy was significantly increased for ML balance control in children with CP (p < 0.05). CONCLUSION: Hinged AFOs for children with CP may be helpful in improving the postural control mechanisms but not the postural stability in quiet side-by-side standing.
Ankle Joint/*pathology ; Cerebral Palsy/rehabilitation/*therapy ; Child ; Child, Preschool ; Humans ; Male ; *Orthotic Devices ; Postural Balance/*physiology

Several cases of acute necrotizing encephalopathy (ANE) with influenza A (H1N1) have been reported to date. The prognosis of ANE associated with H1N1 is variable; some cases resulted in severe neurologic complication, whereas other cases were fatal. Reports mostly focused on the diagnosis of ANE with H1N1 infection, rather than functional recovery. We report a case of ANE with H1N1 infection in a 4-year-old Korean girl who rapidly developed fever, seizure, and altered mentality, as well as had neurologic sequelae of ataxia, intentional tremor, strabismus, and dysarthria. Brain magnetic resonance imaging showed lesions in the bilateral thalami, pons, and left basal ganglia. To our knowledge, this is the first report of ANE caused by H1N1 infection and its long-term functional recovery in Korea.
Ataxia ; Basal Ganglia ; Brain ; Dysarthria ; Encephalitis, Viral ; Fever ; Influenza, Human ; Korea ; Magnetic Resonance Imaging ; Pons ; Prognosis ; Seizures ; Strabismus ; Tremor

PURPOSE: This study used ultrasonography (US) to investigate the architectural changes in gastrocnemius muscles (GCM) after botulinum toxin injection (BoNT-A) in children with cerebral palsy (CP). MATERIALS AND METHODS: Thirteen children with CP who received a BoNT-A injection into their GCM to treat equinus were recruited (9 males and 4 females). Architectural changes in both the medial and lateral heads of the GCM from a total of 20 legs were assessed using B-mode, real-time US. Muscle thickness (MT), fascicle length (FL), and fascicle angle (FA) were measured over the middle of the muscle belly in both a resting and neutral ankle position. Measures at 1 and 3 months after the injection were compared with baseline data taken before the injection. RESULTS: The mean age of the subjects was 5.8 (+/-1.6) years. Spasticity was significantly reduced when measured by both the modified Tardieu scale and the modified Ashworth scale at 1 and 3 months after injection (p<0.05). The MT and FA of both the medial and lateral heads of the GCM were significantly reduced for both neutral and resting ankle positions at 1 and 3 months after the injection. The FL of both the medial and lateral heads of the GCM were significantly increased in a resting position (p<0.05), but not in a neutral position. CONCLUSION: Our results demonstrated muscle architectural changes induced by BoNT-A injection. The functional significances of these changes were discussed.
Acetylcholine Release Inhibitors/*adverse effects/therapeutic use ; Botulinum Toxins/*adverse effects/therapeutic use ; Cerebral Palsy/*drug therapy ; Child ; Child, Preschool ; Female ; Humans ; Male ; Muscle, Skeletal/anatomy & histology/*drug effects/ultrasonography

PURPOSE: Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP. MATERIALS AND METHODS: The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation. RESULTS: The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs. CONCLUSION: ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.
Cerebral Palsy/*drug therapy ; Child ; Child, Preschool ; Ethanol/therapeutic use ; Female ; Humans ; Male ; Muscle Spasticity/drug therapy ; Nerve Block/*methods ; Obturator Nerve/*drug effects ; Retrospective Studies

The upper chest wall does not grow properly in children with spinal muscular atrophy (SMA) with paradoxical breathing. This suggests that long-term inability to take a deep breath in developing children may result in underdevelopment of the upper chest wall. In addition, a rapid and paradoxical breathing pattern is frequently observed in children with severe cerebral palsy (CP), which often corresponds to the underdevelopment of the upper chest wall. The present study is designed to evaluate the ratio of the upper to lower chest wall in children with severe spastic quadriplegic CP, compared with normal children. We compared normal children with children that had spastic quadriplegic CP who did not have kyphosis or scoliosis. Test subjects were matched in terms of age, height, and weight. The diameters of upper chest (D(apex)) and of lower chest (D(base)) were measured on the anteroposterior (AP) view of a chest X-ray and the D(apex) to D(base) ratio was calculated. In selected cases the forced vital capacity (FVC) was measured using a Wright Respirometer. The D(apex) to D(base) ratio was significantly lower in the CP group than in the control group (p < 0.001). The ratio increased linearly with age (p < 0.001) in both CP (R = 0.372) and control groups (R = 0.477). The FVC/preFVC showed significant correlation with the D(apex) to D(base) ratio (R = 0.542, p < 0.01). The results of this study suggest a deviation of optimal chest wall structure in children with spastic quadriplegic CP.
X-Rays ; Vital Capacity ; Time Factors ; Thoracic Wall ; Thoracic Cavity ; Respiratory Tract Diseases/*pathology/physiopathology ; *Respiration ; Quadriplegia/*pathology ; Muscle Spasticity/*pathology ; Male ; Lung/pathology ; Humans ; Forced Expiratory Volume ; Female ; Child, Preschool ; Child ; Cerebral Palsy/*pathology ; Case-Control Studies

The term tracheal bronchus refers to an abnormal bronchus that comes directly off of the lateral wall of the trachea (above the carina) and supplies ventilation to the upper lobe. Tracheal bronchi occur almost exclusively on the right trachea and are associated with other congenital anomalies. In addition, tracheai bronchus may be related to other inflammatory conditions with persistent wheezing, such as recurrent pneumonia, chronic bronchitis and bronchiectasis, which is a result of the relatively poor local drainage of the involved bronchi. An infant with recurrent wheezing is likely to be a challenge for a clinician in the evaluation of the etiology of airway obstruction and in the differential diagnosis of wheezy breathing. The authors report a case of an 8-month-old female infant with a ventricular septal defect, who presented with stridor and recurrent respiratory infection and finally was finally diagnosed with a tracheal bronchus using computed tomography and a bronchoscopy. Therefore, tracheal bronchus should be included in the differential diagnosis of any child who presents with chronic or recurrent respiratory tract symptoms such as coughing, wheezing, stridor and recurrent respiratory infection, particularly in children with other congenital deformities.
Airway Obstruction ; Bronchi ; Bronchiectasis ; Bronchitis, Chronic ; Bronchoscopy ; Child ; Congenital Abnormalities ; Cough ; Diagnosis, Differential ; Drainage ; Equipment and Supplies ; Female ; Heart Septal Defects, Ventricular ; Humans ; Infant ; Pneumonia ; Respiration ; Respiratory Sounds ; Respiratory System ; Trachea ; Ventilation