Validation of the Italian version of the Non-Communicating Children's Pain Checklist-Postoperative Version.

BACKGROUND: This study evaluated the validity and reliability of the Italian version of the Non-Communicating Children's Pain Checklist-Postoperative version (I-NCCPC-PV). METHODS: The original NCCPC-PV version was translated into Italian following the guidelines for "the translation, adaptation, and validation of instruments or scales for cross-cultural healthcare research". We tested the Italian NCCPC-PV version (I-NCCPC-PV) in 40 children (3-18 years of age) with severe to profound Intellectual Disability and no verbal communication. Each child's behavior was observed by a parent or caregiver and by an external observer in a quiet situation and a painful one. They independently assessed the child's level of pain using the translated Italian version of the NCCPCPV (I-NCCPC-PV). RESULTS: The results from 80 assessments showed that children's behavioral signs differed significantly between painful and calm situations (p < 0.001). The inter-rater reliability was poor in a quiet condition (ICC 0.62) and fair in a painful situation (ICC 0.77). The inter-rater agreement was good in both calm and painful conditions (72.50% and 77.50% respectively). CONCLUSION: The Italian version of the NCCPC-PV (I-NCCPC-PV) can be used for pain assessment in children with Intellectual Disability who lack verbal communication.

Instrumental measures of spinal function: is it worth? A state-of-the art from a clinical perspective.

In the last decades, assessment of trunk posture and motion has gained importance in clinical practice, and several instrumental non-invasive techniques have been developed to overcome limitations of manual and radiological methods. Despite the large effort spent in improving the underlying technologies, the actual role of these measures in the clinical setting remains still undefined due to a variety of issues. The main question concerns the provision of parameters providing a significant contribution to the clinical decision making. In this paper, we review the available spine surface measurement techniques from a technical viewpoint, and point out their current and potential applications according to a clinical perspective. Conclusions are drawn on the basis of both the technical features and accessibility in daily clinical practice, as well as of the validity, reliability and clinical value of the provided parameters. A well-defined clinical role is established for surface topography in the follow-up of spine sagittal plane deformities, adulthood scoliosis and spine disorders involving the spino-pelvic alignment. Conversely, further studies are required to identify reliable key parameters for use in the clinical (adolescent scoliosis, back and neck pain), occupational (measurement of spine exposure to mechanical loads) and forensic (assessment of segmental functional impairments) fields.

New tridimensional approach to the evaluation of the spine through surface measurement: the BACES system.

The aim was to test a new instrument, the BACES system, an articulated arm connected to a computer, to improve noninvasive examination of the spine and to reduce X-ray examinations. To this aim, four observers performed three series of eight measurements on a dummy and two healthy volunteers. Data on the projection of the spine, any curve detectable on the frontal and sagittal plane, and any rotation at each thoracolumbar level were collected and analysed. To detect the role of the observer, of the procedure and of the object in measurement variability, a two-factor analysis of variance was performed. The results showed measurement errors for kyphosis and scoliosis generally below 3 degrees, whereas the lordosis showed a major variability, especially in volunteers, because of the attitude role. Rotations showed a limited variability too, generally below 2 degrees. In the clinical setting, > 2 SD may reasonably be considered a clinical change because it has not a great chance of being a measurement error. Thus, the BACES system allowed us to identify with fairly good precision kyphosis, scoliosis and trunk rotations. Even though at the moment no surface measurement method can replace X-rays, the instrument can integrate and limit the use of radiographic evaluations.

Validation of clinical measurement of kyphosis with a simple instrument, the arcometer.

STUDY DESIGN: Evaluation of concordance between different clinical surface measurements and radiographic measurements of kyphosis. OBJECTIVES: To validate a new instrument, the Arcometer, in the clinical assessment of kyphosis. SUMMARY OF BACKGROUND DATA: Although a few instruments are available that are designed to study the spine in the sagittal plane, they usually are not simple to use, and radiographic concordance data, when reported, are not optimal. METHODS: One hundred forty-five outpatients with different degrees of kyphosis were submitted to 1) spinal radiography and Arcometer evaluation (32 patients, 53 measurements); 2) Arcometer evaluation by two different observers (95 patients, 123 measurements); and 3) Arcometer evaluation by the same observer at two different times (16 patients, 56 measurements). RESULTS: The mean difference between the radiographic and Arcometer values was 2.9 degrees, whereas the interobserver difference was 1.1 degrees and intraobserver difference was 0.1 degree; the linear correlation between the first and the second measurement in the three groups was higher than 0.98. However, the standard deviation was rather wide- 8.8 degrees in sample one, 5.6 degrees in sample two, and 5.7 degrees in sample three. CONCLUSIONS: The Arcometer is a practical and reasonably reliable instrument. However, there is considerable disagreement with radiography and some interobserver and intraobserver variability. The arcometer may be useful in following patients with known kyphosis and in the general population screening to decrease x-ray exposure.

[Evaluation problems and indications for handling premature infants (VLBW)]. / Problemi di valutazione e indicazioni per l'handling del neonato pretermine (VLBW).

The authors present their approach to the care of the preterm very-low-birth-weight infant. They consider the importance of the handling of the preterm infant in the Neonatal Intensive Care Unit (NICU) and the co-operation among the neonatologist, the physiotherapist and the parents in the individualized care, both in the NICU and in the follow-up.

[Hematoma of the sternocleidomastoid. Results of a non-invasive treatment in newborn infants]. / L'ematoma dello sternocleidomastoideo. Risultati di un trattamento non invasivo in età neonatale.

Nine infants with haematoma of the SCM muscle were evaluated. A review of previous reports and a comparison of the clinical features of this group of patients to ones considered in other reports is reported and a simple therapeutic program is outlined: during the first year of life, postures and simple exercises performed by the mother under the pediatrician's supervision are suggested. In the eight cases in which the therapeutic program was followed, the long-term outcome was satisfactory from both cosmetic and functional point of view. Therefore this method should be preferred during the first year of life, also taking into account the lack of negative influence on the mother-infant relationship and on the infant's neurological development.

[Endosteal hyperostosis with dominant transmission. Description of 8 cases in 3 generations of the same nuclear family]. / Iperostosi endostale a trasmissione dominate. Descrisione di 8 casi in 3 generazioni dello stesso nucleo familiare.

The authors report on 8 patients with the dominant type of endosteal hyperostosis (Worth's disease), found in the same kindred over 3 generations. Three were males, five females, from 5 to 49 years of age. Major radiographic features were an increased density of bones of the skull and spine, with thickening of the diaphyseal cortex of tubular bones, without any change in remodeling. Seven patients were almost asymptomatic. A decompressive craniotomy had been performed in one, who showed a compression of the 2nd, 5th and 8th cranial nerves. Blood alkaline phosphatase was normal. The bone density increases with age, but in spite of this the clinical course if milder than in recessive type of generalized cortical hyperostosis (Van Buchem's disease, as reported in the 35 cases of endosteal hyperostosis (dominant type) previously described.