Rehab Centers: Child Abuse and Osteogenesis Imperfecta: How Can They Be Still Misdiagnosed? a Case Report.
Child abuse and osteogenesis imperfecta: how can they be still misdiagnosed? A case report.
Filed under: Rehab Centers
Clin Cases Miner Bone Metab. 2012 Sep; 9(3): 195-7
D’Eufemia P, Palombaro M, Lodato V, Zambrano A, Celli M, Persiani P, De Bari MP, Sangiorgi L
Osteogenesis imperfecta (OI) is a rare hereditary disease caused by mutations in genes coding for type I collagen, resulting in bone fragility. In literature are described forms lethal in perinatal period, forms which are moderate and slight forms where the only sign of disease is osteopenia. Child abuse is an important social and medical problem. Fractures are the second most common presentation after skin lesions and may present specific patterns.The differential diagnosis between slight-moderate forms of OI and child abuse could be very challenging especially when other signs typical of abuse are absent, since both could present with multiple fractures without reasonable explanations. We report a 20 months-old female with a history of 4 fractures occurred between the age of three and eighteen months, brought to authorities’ attention as a suspected child abuse.However when she came to our department physical examination, biochemical tests, total body X-ray and a molecular analysis of DNA led the diagnosis of OI.Thus, a treatment with bisphosphonate and a physical rehabilitation process, according to Vojta method, were started with improvement in bony mineralization, gross motor skills and absence of new fracture.In conclusion our case demonstrates how in any child presenting fractures efforts should be made to consider, besides child abuse, all the other hypothesis even the rarest as OI.
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Barriers to Exercise in People With Parkinson Disease.
Filed under: Rehab Centers
Phys Ther. 2013 Jan 3;
Ellis T, Boudreau JK, Deangelis TR, Brown LE, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Dibble LE
BACKGROUND: Exercise is known to reduce disability and improve quality of life in persons with Parkinson disease (PD). Although barriers to exercise have been studied in older adults, barriers are not well defined in persons with chronic progressive neurological diseases, such as PD. OBJECTIVE: The purpose of this study was to identify perceived barriers to exercise among persons with PD. DESIGN: Cross-sectional METHODS: Community-dwelling individuals with PD (N= 260), mean age = 67.7 years, and Hoehn & Yahr = 2.4, participated in a cross-sectional study. Participants were categorized as exercisers (N= 164) or non-exercisers (N= 96). Subjects self-administered the barriers subscale of the Physical Fitness and Exercise Activity Levels of Older Adults Scale endorsing or denying specific barriers to exercise participation. Multivariate logistic regression analysis was used to examine the contribution of each barrier to exercise behavior and odds ratios were reported. RESULTS: Three barriers were retained in the multivariate regression model. Non-exercisers had significantly greater odds of endorsing low outcome expectation (OR= 3.93, 95% CI 2.08-7.42), lack of time (OR= 3.36, 95% CI 1.55-7.29) and fear of falling (OR= 2.35, 95% CI 1.17-4.71) compared to exercisers (p < 0.05). LIMITATIONS: The cross-sectional nature of the study limited our ability to make causal inferences. CONCLUSIONS: Low outcome expectation of exercise, lack of time to exercise, and fear of falling appear to be important perceived barriers to engaging in exercise among ambulatory, community-dwelling persons with PD. These may be important issues for physical therapists to target among patients with PD who are not regularly exercising. The efficacy of intervention strategies to facilitate exercise adherence in persons with PD requires further investigation. HubMed – rehab
Effect of Inspiratory Muscle Training Before Cardiac Surgery in Routine Care.
Filed under: Rehab Centers
Phys Ther. 2013 Jan 3;
Valkenet K, de Heer F, Backx FJ, Trappenburg JC, Hulzebos EH, Kwant S, van Herwerden LA, van de Port IG
BACKGROUND: Inspiratory muscle training (IMT) before cardiac surgery has proved to be a promising intervention to reduce postoperative pneumonia in a randomized controlled trial setting. Effects of IMT in routine care have not been reported. OBJECTIVE: To investigate the effect of IMT before cardiac surgery on postoperative pneumonia in routine care at a Dutch University Medical Center using propensity scoring. DESIGN: Observational cohort study. METHODS: All candidates for cardiac surgery were preoperatively stratified by a physical therapist for low or high risk for postoperative pulmonary complications. High-risk patients either engaged in an unsupervised IMT program (20 min/day) at home for at least two weeks until surgery (group 1) or received usual care (no IMT) (group 2). Results in terms of outcome measures were adjusted with propensity scores to reduce bias caused by non-random treatment assignment. RESULTS: Results show that of the 94 high-risk patients in group 1 (IMT), 1 (1.1%) developed a postoperative pneumonia. In group 2 (no IMT), 8 out of 252 high-risk patients (3.2%) developed this pulmonary complication (adjusted OR 0.34, 95% CI 0.04 – 3.38). No significant differences were found regarding median (25th-75th percentile) ventilation time (7 (5-9) hrs vs 7 (5-10) hrs), length of stay (LOS) on the ICU (23 (21-24) hrs vs 23 (21-25) hrs) or total postoperative LOS (7 (6-11) days vs 7 (5-9) days). LIMITATIONS: Most important limitations of this study are confounding, incomplete data collection and a low incidence of the primary outcome. CONCLUSIONS: Propensity scoring is believed to be a valuable tool of great potential interest to researchers in the field of observational studies. Whether IMT in routine care resulted in less postoperative pneumonia cannot be concluded.
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Cross-Exercise on Quadriceps Deficit after ACL Reconstruction.
Filed under: Rehab Centers
J Knee Surg. 2012 May 15;
Papandreou M, Billis E, Papathanasiou G, Spyropoulos P, Papaioannou N
A few studies concerning the improvement of quadriceps muscle strength deficit (QD) at an early stage following anterior cruciate ligament (ACL) reconstruction have been conducted whereas, ACL rehabilitation protocols based on contralateral quadriceps strength (QS) do not exist. Given these, the goals of our study were (1) to evaluate the effects of cross-eccentric exercise (CEE) on QD on ACL reconstructed knees, and (2) to explore any changes in QD following CEE provided at the frequencies of 3 or 5 times per week. For this study, 42 ACL-reconstructed patients were randomly assigned into 3 groups, two experimental and one control and followed an 8-week rehabilitation program. Additionally, the experimental groups received CEE for 3 and 5 days per week for 8 weeks in their uninjured knees. QS was evaluated with an isokinetic/isometric test, at 60 degrees of knee flexion of both limbs before and after completion of CEE. Two-factor ANOVA showed a significant improvement of QD between groups (F?=?5.16, p?=?0.01) after CEE completion on ACL reconstructed knees. Statistically significant results arose from the 3 days per week (D?=?18.60, p?=?0.01) and 5 days per week (D?=?15.12, p?=?0.04) experimental groups, whereas the control group did not yield any statistically significant differences. CEE used as an adjunct to the ACL traditional rehabilitation program at the weekly frequencies of 3 and 5 times at the early stage of reconstruction significantly improved QD.
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