Pediatric spinal cord injury: approach for urological rehabilitation and treatment.

PURPOSE: As proposed in this report, early urological rehabilitative management of patients with spinal cord injuries (SCIs) is mandatory, in order to prevent a poorly compliant bladder with related upper urinary tract complications and secondary renal failure. Moreover, the approach to treating this traumatic condition in children must be as much rapid as appropriate. MATERIALS AND METHODS: We evaluated our experience of the last 5 years with 17 patients (12 males and five females), with a mean age of 9.6 years at injury (range 6 months-18 years), all affected by an SCI and with direct trauma involved in more than 50%. Mechanism of injury, lesional level, the mean interval between injury and bladder management onset, and the mean interval between bladder management onset and our last control were evaluated. A standardized diagnostic approach was instituted, and all patients received at least a video-urodynamic evaluation before and after the start of urological management. A continence score was established and evaluated before and at least 6 months after the application of rehabilitation treatments (catheterization, medication). Follow-up ranged from 12 to 60 months (average 29.6 months). RESULTS: Sixteen of the 17 patients showed, at first urodynamic evaluation, a neurogenic overactive bladder. Mean bladder maximum capacity was 287.7 ml+/-146.4 SD. Mean reflex volume and end filling pressure were 119.7 ml+/-76.4 SD and 44.6 cmH(2)O+/-25 SD, respectively. Detrusor sphincter dyssynergia was present in 16 out of 17 of the cases. All patients but one began self-catheterization and medication (anticholinergics). Urinary continence improved in all patients but one. An adjunctive endoscopic procedure for continence was carried out in five out of 17 cases. The upper urinary tract was involved in two out of 17 cases. CONCLUSIONS: A prompt and standardized urological approach to pediatric SCIs is mandatory. The aims of this initial management are the prevention of further secondary damage to the upper tract and the achievement of a socially acceptable degree of urinary continence as soon as possible after the traumatic event.

Anoxic brain injury following near-drowning in children. Rehabilitation outcome: three case reports.

PRIMARY OBJECTIVE: To describe the outcome of near-drowning and rehabilitation contexts for recovery. METHODS AND PROCEDURES: Standardized measures were used to emphasize the functional impact of deficits over the first year post-injury in three children <2 years. Multimodal contexts for meaningful interplay were early adapted to the three cases. MAIN OUTCOMES AND RESULTS: The clinical pathways of recovery are identified. Initially all three cases manifested a generalized dystonia. Case 1 exhibited a good outcome with transient dyskinetic-dystonic syndrome; subsequently Bálint's syndrome emerged. In this case, the rehabilitation approach was organized on the pickup of direct perception of task-specific affordances. Cases 2 and 3 had poor outcomes presenting the worsening of torsion dystonia (status dystonicus) that hindered rehabilitation intervention. CONCLUSIONS: The dynamic reaggregation of spatial organization through meaningful interaction in specific ecological contexts is the principal goal of rehabilitation intervention. Status dystonicus represents the worst feature for recovery.

Follow-up of neuropsychological function recovery in a 9-year-old girl with anoxic encephalopathy: a window on the brain re-organization processes.

OBJECTIVE: To investigate comprehensive neuropsychological outcome, disabilities in daily life and individual recovery processes in a case of anoxic encephalopathy. DESIGN: A 9-year-old child's functional outcome after anoxic coma was evaluated in a follow-up study with assessments at 5, 9 and 12 months post-injury. A comprehensive neuropsychological protocol was administered. Qualitative methods of analysis and ecological observation were associated with standard and non-standard quantitative measures. RESULTS: The child presented pervasive functional deficits with prevalence of gnosic, praxic and self-regulatory dysfunction. Dissociated functional recovery was documented in 12 months time. Improvement of self-regulatory abilities was likely a 'propeller' of global system re-organization. CONCLUSION: A descriptive longitudinal study of functional and ecological behavioural changes after anoxic coma provides insight into the re-adaptation processes in the brain connected to post-lesion ecological and training experiences. Contextual factors and their relations to functional improvements deserve further study.

A novel device to evaluate the stiffness of ankle-foot orthosis devices.

The evaluation of mechanical behavior of plastic Ankle-Foot Orthosis (AFO) is important since AFO can provide an efficient support to patients with disabilities in locomotion. This paper reports on a novel testing apparatus that allows: (a) the evaluation of AFO stiffness in sagittal and frontal planes; (b) the conduction of semi-automatic trials; and, finally, (c) a global accuracy associated to the AFO stiffness values always less than 4%. The stiffness values are determined by the measurements of the imposed relative displacements between the foot and the shank of the orthosis and the induced reaction forces. The data collected together in an exact 2-D approach, together with those provided by gait analysis systems, allows to better understand gait alteration induced by ankle orthosis, and to improve clinical management of patients.

Evaluation of communicative and functional abilities in Wolf-Hirshhorn syndrome.

BACKGROUND: Wolf-Hirschhorn syndrome (WHS) is a genetic condition characterized by many clinical disorders, learning difficulties, dysphagia, neuromotor deficits and communicative deficits. Up until now, no studies in the literature have described the development of communicative and functional abilities in subjects with WHS. METHOD: In the present study of 11 patients with WHS, a descriptive analysis was made of several abilities and three groups of patients were identified on the basis of the severity of their functional deficit. RESULTS: A non-homogeneous picture of impairment emerged in various areas of development. Overall, the neuromotor abilities of these patients were more adequate than their abilities related to autonomy in personal life, alimentary function, and cognitive and communicative-linguistic aspects. CONCLUSION: Based on the identification of specific patterns of communicative and functional impairment in subjects with WHS, rehabilitative intervention strategies can be planned to increase their communicative opportunities, and possibilities for active and autonomous participation in various life contexts (e.g. home, school and the social environment).