Visceral and Neural Manipulation in Children with Cerebral Palsy and Chronic Constipation: Five Case Reports.

The purpose of this case study series was to assess improvement in the quality of life, function, and colonic motility before and after visceral and neural manipulation in five children with cerebral palsy and chronic constipation who had Gross Motor Function Classification System (GMFCS) levels of IV and V. Quality of life and function were assessed using the CPCHILD and the WeeFIM respectively. The CPCHILD and WeeFIM were administered at baseline before the intervention, after the intervention, and again at least three months post intervention. Colonic motility was assessed radiographically at baseline and post-intervention utilizing ingested radiopaque markers (Sitz markers). Bowel movement number and quality were assessed through family diaries. All subjects showed some degree of improved quality of life and function on the CPCHILD and WeeFIM at the end of the intervention. Colonic motility assessed radiographically before and after treatment was not statistically significant due to the small number of participants; however, the number of bowel movements increased during the study for 100% of the participants. Visceral and neural manipulation modalities may provide clinicians and families with an alternative to medications and/or other more invasive interventions.

Pediatric vitamin D deficiency in a southwestern luminous climate.

BACKGROUND: Few studies look at vitamin D levels in children living in sunny climates as it is assumed that they receive adequate vitamin D from sun exposure. In light of changing lifestyles of children and studies documenting vitamin D deficiency among children in extreme climates, a study to examine vitamin D levels in healthy children living in a luminous climate was conducted. METHODS: A retrospective chart review of vitamin D levels in healthy children with vague musculoskeletal pain (such as "growing pains") was done. Healthy children, specifically without musculoskeletal pain, were prospectively recruited as controls. RESULTS: Eighty-eight children, 42 children with "pain" and 46 controls were studied. No statistical difference in vitamin D levels was found between the "pain" group (mean vitamin D level 29.1 ng/mL) and the control group (mean vitamin D level 32.4 ng/mL, P<0.52). Overall, 14% of the entire group had levels <20 ng/mL, 49% had levels <30 ng/mL, and 15% had levels >40 ng/mL. CONCLUSIONS: A consensus has yet to be established as to what an "optimal" vitamin D level is for growing children to develop strong bones for a lifetime. This study demonstrated that 14% of children living in a sunny climate had vitamin D levels below 20 ng/mL, a level universally accepted as insufficient, and 49% were below 30 ng/mL, arguably a "desired" level. A sunny climate does not assure vitamin D sufficiency. Virtually all children should be supplemented, with laboratory follow-up for those at high risk for low bone density/those with insufficiency fractures.

Does office-based counseling of adolescents and young adults improve self-reported safety habits? A randomized controlled effectiveness trial.

PURPOSE: The purpose of this study was to evaluate brief physician advice regarding seatbelt and bicycle helmet use in adolescents and young adults. METHODS: We recruited 200 patients ages 11-24 years presenting for all visits to a primary care clinic in the Southwestern United States from January 2000 to March 2001. Patients were randomized to control or a single 2- to 3-minute scripted motivational counseling intervention delivered by physicians with an educational brochure and discount helmet coupon. We conducted telephone follow-up evaluation at 3 months. Main outcome measures were self-reported seatbelt and bicycle helmet use assessed on a 4-point Likert scale and attitudes toward these behaviors assessed on a 5-point Likert scale and analyzed by the Wilcoxon signed-rank test. RESULTS: For the intervention group, mean Likert scores precounseling and postcounseling for self-reported seatbelt use were 1.3 and 1.4, respectively, with a mean difference of .04 (95% confidence interval [CI], -.1 to .2). For self-reported bicycle helmet use, scores were 3.1 and 3.0, respectively, with a mean difference of .1 (95% CI, -.3 to .2). Combined mean Likert scores measuring subject's attitudes about seat belt use were 13.8 and 14.0, respectively, with a mean difference of .2 (95% CI, -.3 to .6). For bicycle helmet use, scores were 20.0 and 20.9, respectively, with a mean difference of .9 (95% CI, -1.4 to 3.3). CONCLUSION: We were unable to detect a significant improvement in safety behaviors or attitudes by adolescents and young adults after a brief intervention by physicians during routine office visits.