Técnicas de tratamiento utilizadas por Terapia Ocupacional para niños con dispraxia del desarrollo / Treatment techniques used by Occupational Therapy for children with developmental dyspraxia

Objetivo. Documentar las técnicas de tratamiento utilizadas por Terapia Ocupacional para niños con dispraxia. Metodología. Revisión de literatura que incluye tesauros reconocidos en los MeSH y DeCS como «dispraxia», «desorden del desarrollo de la coordinación», «niños» y «Terapia Ocupacional». Se indagó en ProQuest, EBSCO, Scopus, Science Direct, Embase, Pubmed, OT Seeker, PEDro y National Guideline Clearinghouse. Se organizaron los hallazgos por base de datos, año, país de publicación, revista, enfoque y se procesó dicha información a través de un análisis cualitativo y de frecuencias. Resultados. Se encontraron veintisiete artículos (100%), el 20% de las publicaciones se reportó en Scopus, el 33% incluyeron el enfoque de orientación cognitiva de desempeño ocupacional como el más utilizado en los estudios, los años en los que más se publicó sobre el tema fueron 2012 y 2013 con un 33% y la revista con más publicaciones fue Physical and Occupational Therapy in Pediatrics con un 20%. Conclusión. El enfoque con mayor evidencia es orientación cognitiva de desempeño ocupacional, encaminado a mejorar el rendimiento motor en las actividades ocupacionales (AU)

Objective. To document the treatment techniques used in occupational therapy for children with dyspraxia. Methodology. Literature review that included thesauri recognized in MeSH and DeCS as «dyspraxia», «disorder developmental coordination», «children» and «Occupational Therapy». A search was conducted in the following databases: ProQuest, EBSCO, Scopus, Science Direct, Embase, Pubmed, OT Seeker, PEDro, and the National Guideline Clearinghouse. The findings were organized by database, year, country of publication, journal, and approach. This information was organized and processed through a qualitative analysis and frequency analysis. Results. Twenty-seven ítems (100%) were retrieved. Twenty percent of the publications were reported in Scopus. Thirty-three percent included the approach of cognitive orientation of occupational performance as the most widely used in the studies. The years with the greatest number of publications (33%) on the subject were 2012 and 2013. The journal with most publications (20%) was physical and Occupational Therapy in pediatrics. Conclusion. The approach supported by the greatest evidence is cognitive orientation occupational performance, which seeks to improve motor performance in occupational activities (AU)

Persistent proatlas with additional segmentation of the craniovertebral junction - The Tsuang-Goehmann-Malformation.

Case study description and analysis of a complex craniovertebral dysplasia in an 8-year-old male patient, in which conventional cervical spine radiographs demonstrated a regularly differentiated occipital base, as well as the presence of two lateral masses of the proatlas vertebra and two lateral masses of the atlas vertebra. Further assessment included computed tomography of the occipital base and the upper cervical spine as well as three-dimensional reconstruction. Malsegmentation of the fourth occipital vertebra can result in various anomalies that are known as 'manifestation of the proatlas'. The occurrence of a persistent proatlas with additional segmentation of the craniovertebral junction represents an extremely rare dysplasia. To our knowledge, it is the second report concerning the persistence of a complete human proatlas vertebra. We consider the biomechanical and embryological particularities of this complex dysplasia to represent sufficient basis for future differentiation from other malformations of the fourth occipital vertebra. Comprehensive literature review and discussion about the entity will be provided.

A life-course perspective on stigma-handling: resilience in persons of restricted growth narrated in life histories.

PURPOSE: The aim of the study is to explore how personal and contextual experiences throughout the life course are recollected as having influenced the development of stigma-handling strategies among people associated with disability and stigma. The article describes the development of stigma handling among ageing persons of restricted growth in order to avert negative effects, develop resilience, strengthen the self and support a positive identity. METHOD: Qualitative retrospective interviews were conducted with ten persons - seven women and three men aged between 45 and 65 years - of short stature. Their narratives are analysed from a life-course perspective and the results presented under two main themes: the development of strategies during different stages of life, and the use of general non-stage-bound strategies. RESULTS: The study shows how stigma-handling has evolved from childhood to become, by adult years, refined, contextualised strategies demonstrating human resilience. The analysis documents the impact of human agency on personal lives and the subjects' efforts and strengths in handling adversity. CONCLUSION: The results demonstrate how the "insider perspective" reveals the individual's resources, resilience and strategies and provides an important perspective for the rehabilitation setting. Implications for Rehabilitation The study document human agency, resilience and strength in a life course perspective among people of restricted growth faced with stigmatization. The efforts and stigma handling strategies developed during the life course, such as withdrawal, humour, ignoring and positive thinking, are important tools to be recognized with relevance for other patient groups. The "insider perspective" revealing the potentialities and strength of human agency and resilience, should be further explored within the field of rehabilitation.

Activity participation intensity is associated with skeletal development in pre-pubertal children with developmental coordination disorder.

PURPOSE: This study aimed (1) to compare the skeletal maturity and activity participation pattern between children with and without developmental coordination disorder (DCD); and (2) to determine whether activity participation pattern was associated with the skeletal development among children with DCD. MATERIALS AND METHODS: Thirty-three children with DCD (mean age: 7.76 years) and 30 typically developing children (mean age: 7.60 years) were recruited. Skeletal maturity was assessed with the Sunlight BonAge system. Motor ability was evaluated by the Movement assessment battery for Children-2 (MABC-2). Participation patterns were evaluated using the Children Assessment of Participation and Enjoyment assessment. Analysis of variance was used to compare the outcome variables between the two groups. Multiple regression analysis was performed to examine the relationship between skeletal development, motor performance and activity participation intensity in children with DCD. RESULTS: The DCD group had significantly delayed skeletal development, lower MABC-2 derived scores, and participated less intensely in various types of physical activities than their typically developing peers. After accounting for the effects of age and sex, activity participation intensity score remained significantly associated with delay in skeletal development, explaining 28.0% of the variance (F(change1, 29)=11.341, p=0.002). CONCLUSION: Skeletal development is delayed in pre-pubertal children with DCD. Limited activity participation intensity appears to be one of the contributing factors.

Bilateral dysplasia epiphysealis hemimelica of the talus associated with a lower leg intramuscular cartilaginous mass.

Dysplasia epiphysealis hemimelica (DEH), or Trevor disease, is a rare skeletal dysplasia characterised by an osteocartilaginous mass arising from an epiphysis. It affects single or multiple epiphyses in children, usually in the lower limb, predominantly the knee and ankle. Bilateral involvement is extremely rare, with only four cases reported in the literature to date. We report an additional case of bilateral DEH of the talus in a 14-year-old girl with an associated, not previously reported, intramuscular cartilaginous mass of the left lower leg. Clinical, radiological and pathological findings are presented. We emphasise the role of MRI and US in the diagnosis of DEH.

Implant reconstruction of a large mandibular defect following removal of a nonossifying fibroma.

The fixed implant-supported restoration of this mandibular surgical defect deliberately violated the principles of mandibular flexure, crown-to-implant ratio, and off-axis loading. A custom-made implant-mounted jig revealed no mandibular flexure in this patient, but crown-to-root ratios of up to 39:12 were unavoidable. The restoration has needed no maintenance for 14 years. This apparent success calls into question the blind application of prevailing clinical principles.

Prosthetic rehabilitation of segmental odontomaxillary dysplasia: seven-year follow-up.

Segmental odontomaxillary dysplasia is an uncommon maxillofacial deformity. Clinically, overgrowth and maturation of the maxillary right or left posterior alveolus and the respective gingiva, lack of premolars, delayed eruption of the adjacent teeth, and malformed primary molars are observed. The purpose of this report was to describe the clinical and radiographic findings of a 47-year-old female with segmental odontomaxillary dysplasia and summarize the prosthetic rehabilitation with fixed and removable partial dentures. A 7-year follow-up did not reveal biomechanical or functional problems except the loss of the mandibular left central incisor and wear of the artificial teeth.

Blount's disease: a lesser known cause of bowlegs mandating early differentiation from physiological bowing.

We present a 16-month-old child, with progressively increasing bowing of legs, having a normal serum calcium, phosphorus and alkaline phosphatase level; lower limb radiographs revealed bilateral medial tibial metaphyseal beaking. Based on these findings, a diagnosis of Blount's disease (infantile tibia vara) was made and an orthotic management program was instituted for the child.

Humeral lengthening using the Ilizarov technique.

Significant shortening of the humerus may cause cosmetic, psychologic and functional problems. From 1989 to 1993, we performed humeral lengthening using the Ilizarov technique on six patients. The indications were: 1) significant inequality (> 4-14 cm); 2) significant functional impairment; and 3) poor aesthetic appearance or related psychologic problems. THere were three females and three males, with a mean age of 17.7 years. The right humerus was affected in two patients, the left in four. Etiologies included sequelae of neonatal septic shoulder in three patients, sequelae of childhood trauma in one, malunion in one and congenital bone anomaly in one. Mean shortening of the humerus was 9.2 cm. Total average treatment time was 250 days. Mean lengthening was 8.7 cm. Complications included transient radial nerve palsy in one patient and delayed union in another. Bone grafting was performed on the patient who sustained delayed union. Fracture of the distraction site occurred after removing the Ilizarov device, and open reduction and internal fixation was performed. Functional and aesthetic status was improved in all six patients, over a minimum of 2 years follow-up. Lengthening of the humerus can be performed satisfactorily using the Ilizarov technique.

[Lengthening, axial correction and segmental reconstruction of the extremities using the distraction method]. / Verlängerungen, Achsenkorrekturen und Segmentrekonstruktion an den Extremitäten durch Callotasis.

Between 1988 and 1992 lengthenings axial, corrections and reconstructions have been performed by distraction on lower arms, upper and lower legs in 25 patients because of deviations in length due to either congenital or acquired (multiple cartilaginous exostoses, posttraumatic conditions, congenital pseudarthrosis deformations or defects (fibula-defect, amnion-band-complex, amputation). On the average elongation amounted to 4 cm for an average installation time of the fixator system of 22 weeks and a mean duration of 25 weeks for the adaptation to full strength. Problems arose in the form of soft tissue infections at the rod perforation sites, the necessity for secondary interventions because of early fractures and for corrections of the fixator respectively. Complications compromising the expected goal of treatment did not occur. Consideration of the biological principle of distraction is essential whereas the type of fixator-system is of only minor importance.

Hypoplasia of the glenoid. A review of sixteen patients.

We reviewed the records of sixteen patients, fifteen to sixty-two years old, who had glenoid hypoplasia with or without an associated deformity of the humeral head. The patients were divided into three groups: those who had bilateral glenoid hypoplasia without instability of the shoulder (Group I), those who had bilateral glenoid hypoplasia with instability of the shoulder (Group II), and those who had unilateral glenoid hypoplasia with deformity of the humeral head (Group III). When first seen by us, thirteen of the sixteen patients had pain in the shoulder, which they had noted after an increase in their previous level of activity. All were managed with a specific rehabilitation program for the shoulder. The patients were followed for an average of five years, and most were able to return to their previous level of activity with the resolution of the symptoms.

Considerations related to weight-bearing programs in children with developmental disabilities.

Standing is a common modality used in the management of children with developmental disabilities. The purpose of this article is to examine the scientific basis for standing programs, with specific emphasis on the known effects of weight bearing on bone development. Guidelines for the use of standing programs are presented, and the supporting rationale is discussed.

Late orthopedic effects in children with Wilms' tumor treated with abdominal irradiation.

Between 1970 and 1984, 31 children with biopsy-proven Wilms' tumor received nephrectomy, chemotherapy, and abdominal irradiation and were followed beyond skeletal maturity. Three patients (10%) developed late orthopedic abnormalities requiring intervention. Ten children received orthovoltage irradiation, and all cases requiring orthopedic intervention or developing a scoliotic curve of greater than 20 degrees were confined to this group, for a complication frequency of 50%. Those children who developed a significant late orthopedic abnormality (SLOA) as defined were treated to a higher median dose (2,890 cGy) and a larger field size (150 cm2) than those who did not (2,580 cGy and 120 cm2). Age at irradiation, sex, and initial stage of disease did not appear to influence the risk of developing an SLOA. No child who received megavoltage irradiation developed an SLOA despite treatment up to 4,000 cGy or to field sizes of 400 cm2. We conclude that modern radiotherapy techniques rarely lead to significant late orthopedic abnormalities previously associated with abdominal irradiation in children with Wilms' tumor.

Rotational deformities of the lower limb in myelomeningocele. Evaluation and treatment.

We studied the results of surgical treatment for rotational deformities of the lower extremity in fifty children. The preoperative rotational deformities were subdivided as follows: (1) external rotation deformity of the hip (nine hips), (2) external tibial torsion (twenty-nine limbs), and (3) toeing-in gait (thirty-one limbs). These were further analyzed as to imbalance between the forces of the medial and lateral hamstrings, that imbalance associated with fixed internal tibial torsion, and isolated internal tibial torsion. The average length of follow-up was four years and six months. For the external rotation deformity of the hip we performed a derotation osteotomy with internal fixation at the subtrochanteric level. That procedure led to eight good results and one fair result. The external tibial torsion was treated by a derotation osteotomy of the tibia and fibula distally, with correction of the valgus deformity of the ankle if that was more than 10 degrees. In twenty patients a good result was obtained. For the toeing-in gait associated with a medial-lateral hamstring imbalance, the semitendinosus was transferred to the biceps and the head of the fibula. Good results were seen in ten of the fourteen patients. In twelve limbs a derotation osteotomy of the distal ends of the tibia and fibula was done alone, with eight good and fair results. In five patients a simultaneous semitendinosus transfer and derotation osteotomy was used. All had a good result. The over-all rate of good and fair results in the entire series was 79.6 per cent.

[Skeletal morphology of inbred rats during hypokinesia and variants as a result of rehabilitation]. / Morfologiia skeleta inbrednykh krys pri gipokinezii i variantakh ee reabilitatsii.

Statistically significant dependence between physical loading and drug treatment in hypokinesia, on the one hand, and bone adaptation, on the other hand, was shown. Correction variants studied were expressed unequally in the animals of different strains. This indicates genetic growth determination and formation of limb bones.