Management of Major Burns in 37 Casualties of a Colored Powder Explosion: Experience of the Linkou Burn Center in Taiwan.

BACKGROUND: On June 27, 2015, a colored powder explosion occurred in Taiwan. As a result, 499 people were injured, and over 200 people were in critical condition because of severe burns. Forty-nine casualties were transported to the Chang Gung Memorial Hospital. METHODS: We undertook a single-center retrospective observational study using clinical data for 37 patients with major burns with more than 20% total burn surface area (TBSA). We describe the experience of managing patients with acute burn injuries in these patients. Patient-specific data were analyzed and expressed as mean ± standard deviation. RESULTS: Thirty-seven major burn patients were admitted to our hospital. The mean ± SD age was 22.5 ± 5 years. The mean ± SD TBSA was 48.9% ± 20%. All patients were stabilized within 6 hours after admission, and no patient experienced hypothermia or hypovolemia. We performed 95 debridement procedures and 88 skin grafts. A mean of 5.6 surgeries were performed for each patient. The mean ± SD hospital stay was 62 ± 32 days. The ratio for hospital days/%TBSA was 1.36, and hospital charges/hospital days ratio was US $973 a day for surviving patients. Two mortalities (2/37, 5.4%) were reported: one was related to cardiac insult, and another was caused by sepsis. CONCLUSIONS: We share our experience in managing 37 major burn patients in a colored powder explosion to improve the holistic care in modern mass burn casualties. Aggressive early debridement and skin grafting reduced hospital stay and costs.

Anterolateral Thigh Flap for Reconstruction in Postburn Axillary Contractures.

BACKGROUND: Reconstruction of postburn axillary contractures is difficult and particularly challenging without healthy adjacent soft tissue for axillary scar resurfacing. In this case, a free soft-tissue transfer is among the best treatment options. Here, we describe our experience with free anterolateral thigh (ALT) flap for reconstruction in postburn axillary contractures. METHODS: We enrolled 10 patients with postburn axillary contractures from August 2003 to July 2015. They all underwent wide scar contracture release through a transverse incision from the anterior axillary fold to the posterior axillary fold. The ALT flap was subfascially raised. The huge soft tissue defect after scar release was resurfaced with the ALT flap. RESULTS: Eight male patients and 2 female patients (age, 16-64 years; mean, 46 years) were included. The mean total burn surface area, follow-up time, duration between injury onset and free-flap transfer surgery, and flap size were 48%, 27 months, 7.7 months, and 12 × 23 cm, respectively. The most common recipient vessels were the thoracodorsal artery and vein (77%). The mean improvement in the range of motion of shoulder abduction was 86 degrees (range, 60-130 degrees). The mean operative time was 7 hours. All flaps survived without reexploration or failure. All but 1 donor site was managed by split-thickness skin grafting. No infection, hematoma, or deaths were noted postoperatively. Transient brachial palsy was noted in a 16-year-old male patient postoperatively, with full recovery 3 months after. CONCLUSIONS: For postburn axillary contractures without healthy adjacent soft tissue for scar resurfacing, ALT flap reconstruction represents a suitable treatment option. It allows simultaneous surgery on both the donor and recipient sites, without the need to change the patient's position. Furthermore, the ALT flap provides sufficient soft tissue and blood flow for reconstruction, leading to satisfactory functional outcomes.

Younger Children with Cerebral Palsy Respond Better Than Older Ones to Therapist-Based Constraint-Induced Therapy at Home on Functional Outcomes and Motor Control.

AIMS: To examine the differences in efficacy of home-based constraint-induced therapy (CIT) on functional outcomes and motor control in two age groups of children with cerebral palsy (CP). METHODS: Twenty-three children with spastic unilateral CP receiving 4-week home-based CIT by a therapist were divided into younger (6-8 years; n = 11) and older (9-12 years; n = 12) groups. The home-based CIT involved intensive functional training of the more affected upper-limb while restraining the less affected upper-limb. The outcome measures were Peabody Developmental Motor Scale-2nd edition (PDMS-2) that was being used in a modified way, Functional Independence Measure for Children (WeeFIM), and reach-to-grasp kinematic parameters, including reaction time (RT), normalized movement time (MT), normalized movement units (MUs), peak velocity (PV), and maximum grip aperture (MGA). The outcome measures were assessed at baseline, 4-weeks (post-treatment), 3- and 6-months (follow-up). RESULTS: The younger group showed greater changes in visual motor integration skills and RT at all post-tests after intervention than the older group. Groups had comparable changes on any other measures. CONCLUSIONS: Younger children with CP responded better to home-based CIT on some areas of upper-limb functions and reach-to-grasp motor control strategies than older children.

Predictors of participation change in various areas for preschool children with cerebral palsy: a longitudinal study.

This study identifies potential predictors of participation changes in various areas for preschool children with cerebral palsy (CP). Eighty children with CP (2-6 years) were enrolled. Seven potential predictors were identified: age; sex; socioeconomic status, CP subtype; cognitive function, Function Independence Measure for Children (WeeFIM), and motor composite variable from 5 motor factors (gross motor function classification system (GMFCS) level; bimanual fine motor function level; selective motor control score; Modified Ashworth Scale score; and Spinal Alignment and Range of Motion Measure). Outcome was assessed at baseline and at 6-month follow-up using the Assessment of Preschool Children's Participation (APCP) including diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation, social activities (SA), and total areas. Dependent variables were change scores of APCP scores at baseline and 6-month follow-up. Regression analyses shows age and sex together predicted for APCP-total, APCP-SD diversity and APCP-total intensity changes (r(2)=0.13-0.25, p<0.001); cognitive function and WeeFIM were negative predictors for APCP-SA and APCP-PA diversity changes, respectively. CP subtype, motor composite variable, and socioeconomic status predicted for APCP changes in some areas. Findings suggest that young boys with poor cognitive function and daily activity predicted most on participation changes.

Sedative music facilitates deep sleep in young adults.

OBJECTIVES: To investigate the effect of sedative music on the different stages of the sleep cycle in young adults with various sleep latencies by using polysomnography (PSG). DESIGN: Prospective, randomized, controlled, crossover study. SETTING: Sleep center of a teaching hospital. PARTICIPANTS: Young adults with different sleep latencies. Poor sleepers (Pittsburgh Sleep Quality Index score ≥5) were excluded. INTERVENTIONS: Each participant stayed one night in the sleep center for adaptation and on each of the following two nights was assigned to (1) music and (2) control (without music) conditions in random order. In the music condition, sedative music composed by certified music therapists was played on a compact disc player for the first hour the participant was in bed. OUTCOME MEASURES: Sleep measures recorded with PSG, including sleep latency and durations of sleep stages. RESULTS: Twenty-four young adults (mean±standard deviation, 24.5±2.6 years) participated. They were classified into the short sleep latency (SL) group if the baseline SL of the adaptation night was shorter than 10 minutes or into the long SL group if the baseline SL was 10 minutes or longer. Sedative music did not alter the SL in either group. Sedative music reduced stage II sleep in both SL groups (main effect of music, p=0.03; interaction effect, p=0.87) but increased the duration of deep sleep (stages III and IV) only in the long SL group (main effect of music, p=0.15; interaction effect, p=0.02). CONCLUSIONS: In participants with long SL, sedative music improved the quality of sleep by prolonging the duration of deep sleep. This effect provides an alternative and noninvasive way to improve sleep in selected persons experiencing sleep problems.

Validity and clinimetric properties of the Spinal Alignment and Range of Motion Measure in children with cerebral palsy.

AIM: The aim of this study was to assess the validity, responsiveness, and clinimetric properties of the Spinal Alignment and Range of Motion Measure (SAROMM) in children with cerebral palsy (CP). METHOD: Sixty-two children with CP (40 males, 22 females) with a median age of 3 years and 11 months (range 1-6y) and their caregivers participated in this study. Among the children, 56 had spastic CP while six had non-spastic CP; 53 had bilateral CP, while nine had unilateral limb involvement. Thirty-three children were classified as Gross Motor Function Classification System (GMFCS) levels I to III and 23 as levels IV or V. Fifty-six children (90%) received regular rehabilitation by means of regular physical or occupational therapy (50% once or twice per week and 40% more than two times per week) and six children (10%) received irregular rehabilitation (less than once a week). Construct validity was determined by assessing the strength of the correlation between the spinal alignment SAROMM (SAROMM-SA), the range of motion SAROMM (SAROMM-ROM), and the total SAROMM (SAROMM-total), and construct measures, including the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measures for Children (WeeFIM), at baseline and at 6-months follow-up. Responsiveness was examined using effect size. Minimal detectable change (MDC) at the 90% confidence level (MDC90) and minimal clinically important difference (MCID) were analysed. RESULTS: The SAROMM with the GMFM-66 and WeeFIM had fair to good construct validity. The effect size values of all SAROMM scales were 0.24 to 0.48. The MDC90 values and MCID range were 1.43 and 0.47 to 1.67 for the SAROMM-SA, 3.12 and 3.68 to 4.07 for the SAROMM-ROM, and 3.22 and 4.53 to 4.62 for the SAROMM-total. INTERPRETATION: The clinimetric properties of the SAROMM allow clinicians to determine whether a change in SAROMM score represents a clinically meaningful change.

Motor factors associated with health-related quality-of-life in ambulatory children with cerebral palsy.

OBJECTIVE: This study aimed to examine the relationship between fine and gross motor skills and cerebral palsy-specific quality-of-life in ambulatory children with cerebral palsy. DESIGN: Thirty-nine children with cerebral palsy (29 boys, 10 girls; mean age ± SD, 8.8 ± 2.3 yrs) classified under Gross Motor Function Classification System Level I or II were enrolled. Health-related quality-of-life was evaluated using the Cerebral Palsy Quality of Life Questionnaire for Children (parent-proxy version). Motor functions were measured using the Bruininks-Oseretsky Test of Motor Proficiency. RESULTS: Regression analysis for QOL revealed fine motor skills, including upper-limb speed and dexterity, which are positively correlated to functioning (r = 0.205, P < 0.01), and visual-motor control that is positively correlated to other domains, including social well-being and acceptance, participation and physical health, emotional well-being and self-esteem, and family health (r = 0.150-0.188, P < 0.05). CONCLUSIONS: Fine motor functions, including upper-limb speed and dexterity and visual-motor control, were the most important motor factors associated with health-related quality-of-life in ambulatory children with cerebral palsy.

Factors associated with bone density in different skeletal regions in children with cerebral palsy of various motor severities.

AIM: To analyse factors associated with bone density in different skeletal regions in children with cerebral palsy (CP) of various motor severities. METHOD: We examined 56 children with spastic CP (10 diplegia, 12 hemiplegia and 34 quadriplegia) aged 4 to 12 years (35 males, 21 females) and 29 typically developing children. Children with CP were stratified into three groups based on Gross Motor Function Classification System (GMFCS) levels I to II (n = 22), III (n = 8), and IV to V (n = 26). Growth and clinical variables, bone markers, distal femur and lumbar areal bone mineral density (BMDa), and calcaneal broadband ultrasound attenuation (BUA) were assessed. RESULTS: The femur BMDa and calcaneal BUA values were lower in children in low GMFCS levels than in children in high GMFCS levels (p<0.05; femur BMDa: levels I-III, 0.6-0.7 g/cm(2); levels IV-V, 0.5 g/cm(2); calcaneal BUA: levels I-II, 39 db/MHz; levels III-V, 20-21 db/MHz). Lumbar BMDa and most bone markers did not differ significantly among CP and healthy groups. Regression analysis revealed that growth variables and GMFCS level were mainly associated with lower limb BMDa and BUA, and growth variables were mainly associated with lumbar BMDa (adjusted r(2) = 0.48-0.56). None of the bone markers were associated with bone density. INTERPRETATION: Bone densities vary and are associated with a number of factors in different skeletal regions in children with CP with a range of motor severities.

Relationship between unstimulated salivary flow rate and saliva composition of healthy children in Taiwan.

BACKGROUND: Saliva is one of the most important factors in regulating oral health, with flow rate and composition changing throughout development and during disease. In view of the shortage of data, the present study aimed to shed light on the relationship between unstimulated salivary flow rate and saliva composition of healthy children in Taiwan. METHODS: Forty-four normal, healthy children from 3-14 years of age were divided into three age groups: pre-school, elementary school and junior-high school. All participants received salivary flow rate, pH and saliva composition analysis under unstimulated conditions. One-way ANOVA and Pearson's correlation were used. Statistical significance was set at p < 0.05. RESULTS: Our results suggest that, under unstimulated conditions, the salivary flow rate of the elementary school group was greater than that of the pre-school group (p < 0.05). No difference in pH was found among the three groups. Intergroup salivary calcium, phosphorus and amylase did not reach statistical difference. As the flow rate increased, the pH increased (r = 0.364, p < 0.05) but the protein level decreased (r = -0.473, p < 0.05). In addition, salivary protein was positively correlated to age (r = 0.479, p < 0.05) and negatively correlated to pH (r = -0.361, p < 0.01). CONCLUSION: Age-related increase in the unstimulated salivary flow rate of pre-school and elementary school groups was noted. As the flow rate increased, the pH increased but the protein level decreased. The information obtained may serve as reference values for the growing interest in saliva as a diagnostic tool, especially monitoring those with neurological or oral motor dysfunction.

Effect of Kinesio taping on muscle strength in athletes-a pilot study.

Muscle strength is a key component of an athlete's performance and may be influenced by taping. This study examined the possible immediate and delayed effects of Kinesio taping on muscle strength in quadriceps and hamstring when taping is applied to the anterior thigh of healthy young athletes. Fourteen healthy young athletes (seven males and seven females) free of knee problems were enrolled in this study. Muscle strength of the subject was assessed by the isokinetic dynamometer under three conditions: (1) without taping; (2) immediately after taping; (3) 12h after taping with the tape remaining in situ. The result revealed no significant difference in muscle power among the three conditions. Kinesio taping on the anterior thigh neither decreased nor increased muscle strength in healthy non-injured young athletes.

Autonomic dysreflexia triggered by an unstable lumbar spine in a quadriplegic patient.

A 40 year-old man with C5 complete quadriplegia, had L2-L3 pyogenic spondylitis treated with debridement and fusion of the lumbar spine with left iliac bone graft. Three months later he developed symptoms of autonomic dysreflexia, including headache, cold sweating, and hypertension whenever he was in an upright position. These symptoms resolved after lying down. Roentgenograms of the lumbar spine revealed absorption of the bone graft at the L2-L3 level. A spinal stabilization procedure was done after eight weeks of antibiotic therapy under the impression of unstable spine caused by pyogenic spondylitis. Symptoms were relieved immediately following the surgery. This report may be helpful for physicians caring for quadriplegic patients with autonomic dysreflexia induced by an unstable spine.