Consensus paper on postural dysfunction: recommendations for prevention, diagnosis and therapy.

Good fundamentals of posture and balance are essential for the efficient performance of both simple daily tasks and more complex movement patterns. In particular, postural balance is the ability to keep the body in equilibrium and to regain balance after the shift of body segments: postural control mechanisms of integration of the visual, vestibular and foot afferential channels contribute to this. This document provides recommendations based on scientific evidence, clinical practice, and consensus between experts concerning the prevention, diagnosis, and treatment of postural dysfunction at the three stages of life as the developmental age, adult age, and old age > 65 years and follows the "National Guidelines on Classification and Measuring of Posture and its Dysfunctions" per the Italian Ministry of Health (December 2017). The paper answers four main questions: i) "Which measures can be adopted to prevent postural dysfunctions?" ii) "What can we do in order to make a correct diagnosis of postural dysfunction?" iii) "What are the correct treatment programs for postural dysfunctions?" iv) Which professional competencies and experiences are useful for preventing, diagnosing and treating postural dysfunctions? By the Consensus of the Experts and the scientific evidence, emerge that the approach to postural dysfunctions requires a multidisciplinary and interdisciplinary team. Furthermore, rehabilitation treatment interventions must be specific to the age groups that have been indicated, to consider the integration of the main systems and subsystems of postural control that change with age.

The association between kinesiophobia and dynamic balance in patients with patellofemoral pain syndrome.

OBJECTIVE: The aim of the study was to examine the relationship between Kinesiophobia and dynamic balance in patients with patellofemoral pain syndrome (PFPS). PATIENTS AND METHODS: Forty subjects with PFPS [20 Low Kinesiophobia (LK), 20 High Kinesiophobia (HK)], and 20 pain-free subjects (control group) were enrolled in the study. All subjects performed a Y-balance test to measure the dynamic balance. Normalized reach distance and balance parameters were recorded. RESULTS: Our findings indicated that patients with PFPS who have a greater Kinesiophobia showed a poorer dynamic balance. In addition, the HK group showed a significantly lower mean reach distance score in the anterior, posterolateral, and posteromedial directions compared to LK and healthy groups. CONCLUSIONS: Addressing the psychological factors such as Kinesiophobia during examination and treatment of people with PFPS may be important to improve the dynamic balance.

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals.

STUDY DESIGN: Between-groups design with repeated measures. OBJECTIVE: To quantify spastic hypertonia in spinal cord-injured (SCI) individuals. SETTING: Rehabilitative Center, Italy. SUBJECTS: 29 individuals with a motor complete SCI (American Spinal Injury Association impairment scale grade A or B) and 22 controls. METHODS: According to the modified Ashworth scale (MAS), patients were subgrouped as SCI-1 (MAS=1, 1+) and SCI-2 (MAS=2, 3). Passive flexo-extensions of the knee were applied using an isokinetic device (LIDO Active) at 30°, 60°, 90° and 120° s(-1). We measured the peak torque, mean torque (MT) and work. Simultaneous electromyography (EMG) was recorded from leg muscles. RESULTS: At the speed of 120° s(-1) all SCI-2 patients presented EMG reflex activities in the hamstring muscle. All biomechanical parameter values increased significantly according to speed, but analysis of variance revealed a significant interaction between the angular velocity and group (F(d.f. 6, 138) = 8.89, P < 0.0001); post hoc analysis showed significantly greater torque parameter values in the SCI-2 group compared with the SCI-1 group and the control group at 90° and 120° s(-1). Receiver operating characteristic curves showed that using peak torque values the probability of correctly classifying a patient into SCI-1 and SCI-2 was 95%, compared with 70% for MT and 68% for work. CONCLUSIONS: The isokinetic device is useful for distinguishing individuals with a high level of spastic hypertonus. Examination of EMG activity may help ascertain whether increased muscle tone is caused by reflex hyper excitability and to determine whether muscle spasm is present. Peak torque and simultaneous EMG assessment should be considered for the evaluation of individuals with SCI in the rehabilitative context, that is, in measuring therapeutic interventions.

Prevalence of overweight and obesity in urban and semi-urban Jordanian children aged 3-6 years.

OBJECTIVES: To show the prevalence of overweight and obesity among the Jordanian urban and semi-urban children; to compare their body mass index (BMI) with the international standards of BMI. METHODS: We measured 1695 healthy children (842 boys and 853 girls) between 3 and 6 years for height, weight and mid upper arm circumference. BMI was calculated and transformed into percentiles. Children were divided into boys and girls. RESULTS: The mean and SD values of BMI observed in our study were 16.69 +/- 4.9 kg/m(2) for boys and 16.82 +/- 4.77 kg/m(2) for girls aged 3-6 years. The prevalence of obesity and overweight among boys was 20.8% and 3.8% respectively and among girls was 19.1% and 7.2% respectively. In total, 48.0% of boys and 38.1% of girls were of healthy weight. CONCLUSIONS: The mean BMI observed in our study's children aged 3-6 years was higher than the expected 50th percentile of the (World Health Organization/Centers for Disease Control and Prevention) reference values for a similar age range but, it was equivalent to the 75th percentile values. Obesity was more frequent than overweight among boys and girls aged 3-6 years.

Long-term effect of botulinum toxin (A) in the management of calf spasticity in children with diplegic cerebral palsy.

AIM: The aim of this study was to determine possible long-term effects of multi-injections of botulinum toxin A (BT-A) on muscle tone and functional abilities in children with cerebral palsy. METHODS: A randomized, single blind study was carried out. Sixty patients with spastic diplegia were enrolled; 40 received 3 successive doses of BT-A to the calf muscle bilaterally at intervals of 3 to 4 months; 20 received no injections and were considered the control group. Evaluation included measurement of muscle tone, passive ankle dorsiflexion range of motion, and gross motor function. The children in the study group were assessed at entry into the study, at 3 months, and at 18 months after the last injection. An identical assessment protocol was applied to the control group, with measurements taken at entry into the study, at 12 to 15 months, and then at 27 to 30 months, roughly corresponding to the time periods set for the study group. RESULTS: Muscle tone and passive ankle dorsiflexion range showed clinically and statistically significant improvement following BT-A injection at 3 months (P=0.000, P=0.04, respectively) and at 18 months (P=0.005, P=0.007, respectively) compared to the control group, but gross motor function showed significant improvement only at 18 months (P=0.02). Comparison between the first and second evaluations after the last injection in the study group showed a significant improvement in gross motor function and ankle dorsiflexion range (P=0.000 for both parameters); however, muscle tone was significantly increased (P=0.002). CONCLUSION: This study gives support to a possible prolonged effect of intramuscular BT-A as an adjunct to conventional physiotherapy to reduce spasticity and improve functional mobility in children with spastic diplegic cerebral palsy.

Functional outcome of botulinum toxin injection of gastrocnemius and adductors in spastic hemiplegic cerebral palsied children.

AIM: The aim of this paper was to compare between the various effects of botulinum toxin type A (BT-A) when it is injected at gastrocnemius or adductors or at both sites in ambulant spastic hemiplegic cerebral palsy (CP) children. METHODS: Sixty ambulant CP children with spastic hemiplegia were chosen. They were divided into 4 equal homogenous groups. Study groups (A, B, and C) received 3 successive injections of BT-A at 3 to 4 months interval. The injection sites were as follows: gastrocnemius for group A; adductors for group B; gastrocnemius and adductors for group C. Group D received no injections and was considered as a control group. Muscle tone and gait evaluation were conducted for every child in the BT-A groups at his entry and 6 months after the last injection dose. Also, the same evaluation protocol was conducted for every child in the control group at his entry and after 6 month's period. RESULTS: When BT-A groups were compared to the control group, results showed significant improvement in muscle tone following injection in all BT-A groups. A statistically significant increase of the unaffected step length and decrease of step width and foot angle was noted in gastrocnemius group (P=0.04, P=0.003, P=0.002) respectively, as well as in gastrocnemius/adductors group (P=0.006, P=0.002, P=0.003), respectively. However, the cadence and speed of walking showed significant increase in the gastrocnemius/adductors group; only P=0.03, P=0.004 respectively. Comparing between BT-A groups, there was significant improvement in all parameters between adductors and gastrocnemius/adductors groups in favor of the last group. Moreover, there was significant improvement in muscle tone (P=0, cadence P=0.04), and speed of walking P=0.01 between gastrocnemius and gastrocnemius/adductors groups in favor of the last group; however, there was no significant difference between these 2 groups in respect to the step width P=0.96 and the foot angle P=0.92. CONCLUSIONS: Our findings indicate that, in spastic hemiplegic CP, botulinum toxin has a better effect on tone reduction and improvement of gait parameters when it is given at the gastrocnemius and adductors muscles collectively.

Evaluation of bone mineral density in children with perinatal brachial plexus palsy: effectiveness of weight bearing and traditional exercises.

PURPOSE: (1) To investigate any evidence of bone mineral density (BMD) changes in children with Perinatal Brachial Plexus Palsy (PBPP). (2) To detect any relationship between these changes and the child age, weight, height, BMI, power index, gender, ethnicity, and the side affected. (3) To determine any possible effects of a designed weight bearing exercise program and the traditional one upon BMD of those children. STUDY DESIGN: Randomized single blind controlled trial. METHOD: A convenience sampling strategy was used to obtain 45 children with unilateral PBPP. Their ages ranged from 3 to 10 years. They were randomly divided to three equal groups. Groups were, then, randomly assigned to either interventions [Weight Bearing Exercises Program (WBEP) or Traditional Exercises Program (TEP)] or to the control treatment. Dual Energy X-Ray Absorptiometry (DXA) was used to evaluate BMD for all children at entry and approximately after six months treatment period. RESULTS: We detected significant low entry level measurements of all BMD parameters of the affected side when compared to that of the unaffected sides (p=0.000). The mean value of the entry level calculated Z score for the affected side of all study children was equal to -1.12 ± 0.327 being in the osteopenic risk range. Furthermore, thirty children (66.7%) recorded less than (-1) Z score being in this risky range. Also, we recorded a significant improvement of all BMD parameters of the affected side after treatment in favor of the WBEP group when compared to that of the control and TEP groups (p=0.02, p=0.03 respectively for the affected both bones BMD parameter). CONCLUSIONS: BMD is significantly reduced in PBPP children. The retardation of bone accrual increases as the child height and weight decreases and the degree of paralysis increases. WBEP significantly promoted BMD improvement when compared to the TEP.

Traumatic brain injury in the Gaza Strip: adults and children and their caregiver disability burden.

BACKGROUND: Traumatic brain injury (TBI) may lead to long term behavioral, cognitive, physical, mental, social deficits which might influence daily activities of patient and caregiver. AIM: To determine the disability aspects and its levels among patients with TBI and their caregivers in Gaza Strip. DESIGN: Cross section study with analytic descriptive structure. SETTING: El-Wafa Medical Rehabilitation and Specialized Surgery Hospital in Gaza Strip in the period between 2000 to 2007. POPULATION: A convenience sampling strategy was used to obtain one hundred patients with TBI and their caregivers. METHODS: On-site visits were arranged with all participants to collect data about their functional outcome measures. These measures included: 1) Functional Independence Measurement (FIM); and 2) Disability Rating Scale (DRS) to evaluate the functional independence level and the degree of disability of patients with TBI respectively; 3) Community Integration Questionnaire (CIQ) to evaluate the degree of community integration of caregivers. RESULTS: The worst performance of patients with TBI according to FIM was recorded in bowel and bladder control (40.1% and 35.8% respectively) while the DRS questionnaire revealed that employability established the area of greatest disability for patients with TBI (69.33%). In CIQ the greatest burden on caregivers was noted in productivity, social integration, and home integration with weight means equal 50.00%, 51.67% and 56.00% respectively. CONCLUSION: Both patients with TBI and their caregivers reported high level of disability burden. Caregivers showed low level of community integration in the society due to caring patients with TBI. Clinical Rehabilitation Impact. This study enhances the responsible rehabilitation organizations (governmental, non-governmental and international) to improve the provided health services to patients with TBI and their caregivers and advocates these individuals' rights.

Physical growth and nutritional status of Jordanian preschool-aged children.

AIM: The purpose of the present paper was to examine the growth pattern and nutritional status of Jordanian preschool children and to compare it with the growth reference charts developed by the World Health Organization, Center for Disease Control and Prevention (CDC/WHO). METHODS: One thousand six hundred ninety-five healthy urban and semi-urban preschool children between 3 and 6 years of age were measured during this study. Children were divided into sex groups. Standardized methods were used to measure weight; height; and mid upper arm circumference for all children. Height for age, weight for age, and weight for height z-scores and percentiles as well as the mid upper arm circumference for height z-scores were calculated using the anthropometric standards developed by (CDC/WHO). RESULTS: The results of weight for height z-score revealed that 2.0% of boys and 0.5% of girls were below the cut-off point of -3 SD which denotes sever under-nourishment and sever wasting. Furthermore, about 7.4% of boys and 5.2% of girls fell in the group of (-3 SD to <-2 SD) which means under-nourishment and wasting. CONCLUSION: The majority of Jordanian children aged 3-6 years were within the 5-95th percentile range for height for age percentile (HAP), weight for age percentile (WAP), and weight for height percentile (WHP) (74.7%, 71.9%, and 63.8% respectively for boys) while were (67.5%, 69.4%, and 64.2% respectively for girls).