Self-concept of adults with cerebral palsy.

PURPOSE: To describe the self-concept of adults with cerebral palsy (CP). METHOD: Cross-sectional design included the Tennessee Self-Concept Scale, version 2 (TSCS:2), Functional Independence Measure (FIM™), Beck Depression Index II (BDI®-II), Craig Hospital Inventory of Environmental Factors (CHIEF), Diener's Satisfaction with Life Scale (SWLS), Gross Motor Functional Classification System (GMFCS) levels and demographic questions. RESULTS: One hundred and two people with CP (52 females, mean age=26) participated. Thirty-eight participants had unreliable answers as indicated by validity scales and were excluded from the analysis. Ten participants had high self-concept; 41 had average self-concept and 13 had low total self-concept. Self-concept had a fair and inverse association with the BDI-II (Pearson's r= -0.3, p<0.01) and a moderate and direct association with the SWLS (Pearson's r=0.4, p<0.001). Self-concept was not associated with GMFCS level or FIM score. Family and Personal sub-domain scores were lowest sub-domain scores for people with low self-concept (p<0.01). CONCLUSION: The majority of the participants in this sample had a healthy self-concept; and self-concept was not associated with severity of CP, but with lack of depression and life satisfaction. Results suggest the need for family centred care into adulthood.

Reliability of acetabular measures in developmental dysplasia of the hip.

The purpose of this study was to determine the reliability in the measurement of the acetabular index and the acetabular angle in children with developmental dysplasia of the hip. Seventeen children with unilateral developmental dislocation of the hip treated by closed reduction were reviewed. The acetabular index and the acetabular angle of 34 hips were measured twice by two observers. The method of Bland and Altman as outlined by Loder was used to calculate reliability. Mean age at reduction was 9 months. Radiographs were reviewed at a mean of 58 months following reduction. The intraobserver reliability of the acetabular index in involved hips was +/-4.1 degrees. The intraobserver reliability of the acetabular angle for involved hips was +/-3.6 degrees. The interobserver reliability of the acetabular index in involved hips was +/-13.7 degrees. The interobserver reliability of the acetabular angle for involved hips was +/-7.8 degrees. To ensure true change, a single observer should document at least an 8 degrees change in the acetabular index or a 7 degrees change in acetabular angle between two radiographs.

Is operative blood loss associated with valproic acid? Analysis of bilateral femoral osteotomy in children with total involvement cerebral palsy.

Valproic acid (VPA) may increase surgical bleeding. The purpose of this study was to review the effect of VPA on blood loss during bilateral femoral osteotomy in children with cerebral palsy. The medical records of 29 children were retrospectively reviewed. Blood volume, total blood loss, and postoperative blood loss were calculated. Fourteen children were taking no anticonvulsant medications, nine children were taking anticonvulsant medications other than VPA, and six children were taking anticonvulsant medications including VPA. The group taking anticonvulsant medications including VPA had significantly lower preoperative platelet counts (204,000) and a significantly greater incidence of transfusion (50%). Compared with the group taking no anticonvulsant medications, the group taking anticonvulsant medications including VPA had a significantly greater change in hematocrit and greater blood loss. Blood loss and the need for transfusion should be anticipated for in children with cerebral palsy taking VPA who undergo femoral osteotomy.

Nonsurgical treatment to regain hip abduction motion in Perthes disease: a retrospective review.

The purpose of this study was to document the ability of a nonsurgical program to improve restricted passive hip abduction in children with Perthes disease. Containment as a form of treatment was recommended if passive hip abduction of 30 degrees or more could be achieved. Medical records and radiographs were retrospectively reviewed for 74 children. Age at admission and onset, side, length of stay, and measurement of passive hip abduction at admission/discharge were recorded. The average increase in abduction with the hip extended was 13 degrees. Forty-two children achieved 30 degrees or more of abduction with the hip extended. Average length of stay was 13 days. Management of restricted abduction in an inpatient setting can allow consideration of containment in 61% of children previously not thought to have the required motion.

Is the absence of the ossific nucleus prognostic for avascular necrosis after closed reduction of developmental dysplasia of the hip?

The presence of the ossific nucleus before reduction of developmental dysplasia of the hip may reduce the rate of avascular necrosis. Forty-eight hips in 45 children who underwent successful closed reduction had at least a 2-year follow-up. Medical records were reviewed for sex, side, Pavlik harness, traction, age at reduction, adductor tenotomy, cast duration, length of follow-up, and subsequent surgery. Prereduction radiographs were reviewed for presence or absence of the ossific nucleus. Avascular necrosis was noted as present if there was evidence of Bucholz and Ogden type II, III, or IV on the postreduction radiographs. Avascular necrosis was noted postreduction in 17 hips. Adductor tenotomy may reduce the rate of avascular necrosis following closed reduction. Delaying closed reduction until the presence of the ossific nucleus can be detected radiographically may reduce the rate of avascular necrosis. The presence of avascular necrosis increases the need for subsequent surgery.