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Poster 133 Recreational preferences and experiences of children with disabilities
1066
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
not identified. We address the role anticoagulation plays in potentially altering the rehabilitation program and future activities of a child.
Poster 131 "Intractable Seizures in Children: Outcome of Rehabilitation Following Hemispherectomies." Paul T. Scheatzle, DO (MetroHealth Medical Center, Cleveland, OH); Shu Quey Huang, MD; T.J. CittaPietrolungo, DO. Young children with seizures refractory to treatment with multiple medications present a challenging management dilemma. In selected cases, hemispherectomies are a radical, potential treatment option. This report presents 3 cases, ages 6 months, 3 years, and 15 years admitted for pediatric rehabilitation after hemispherectorny for intractable seizures. The 6-month-old child had hemimegalencephaly and the 15-year-old patient had Rasmussen's encephalitis as etiologies for their seizures. Both had failed to respond to previous, more selective seizure foci ablation procedures. On admission to rehabilitation, an integrated team approach was initiated. The mobility of each patient improved postoperatively. The 6-month-old patient had been severely disabled by greater than 100 seizures per day. At discharge, he was able to prop himself up in the prone position. He advanced 2 months on the Receptive Expressive Language Scale-Second Edition and his seizure frequency dropped to 5 daily. The 3-year-old child had autistic behavior and a mild left hemiparesis which both improved throughout his rehab course. The 15-year-old patient became more functionally independent at the wheelchair level. All of the patients were continued on seizure medications and 2 had no further seizures postoperatively. In all cases, the patients improved from baseline while demonstrating a positive response to conventional, multidisciplinary team treatment.
Poster 132 "Juvenile Fibromyalgia: A Case Report." Brian H. Morgan, MD (Rehabilitation Institute of Chicago, Chicago, IL); Charles E. Sisung, MD; Norman Harden, MD. Juvenile fibromyalgia, while rarely reported in the medical literature, may be a commonly overlooked disease in the pediatric population and deserves special consideration in the rehabilitation setting. The literature concerning primary fibromyalgia, familial fibromyalgia, and hereditary fibromyalgia in the pediatric population is sparse. Additionally, the psychosocial effects of primary juvenile fibromyalgia have never been addressed. The pediatric population has special considerations that make a precise diagnosis critical: time lost from school and the loss of peer relationships. This report describes a 13-year-old boy who presented with an initial diagnosis of spondyloarthropathy. Review of his previous medical record showed an extensive workup that was negative for an inflammatory process. The physical exam made it evident that he did not have an spondyloarthropathy, but had primary fibromyalgia. His mother had been diagnosed with fibromyalgia at the same time he developed symptoms. This patient demonstrated the difficulty in diagnosing and in treating the multifactorial aspects of juvenile fibromyalgia. Our report describes a rehabilitation course that was successful in returning this patient to school and helping him to regain his independence in daily activities.
Poster 133 "Recreational Preferences and Experiences of Children with Disabilities." Eric T. Morse, MD (University of Kentucky, Lexington, KY); Randal E. Schieenbaker, MD; Robert W. Moore, PhD; Jami S. Coleman, MD. Children with disabilities face challenges with their participation in recreational activities. Literature review provided little information regarding recreational activities of these children. Forty-five children who were inpatients in a pediatric orthopedic hospital, along with their caregivers, were surveyed. Children were asked about their recreational preferences and experiences, and adult caregivers were asked for their perceptions of limitations of the children's involvement in recreational activities. The 18 females (40%) and 26 males (60%) ranged from 4 to 20 years old (mean = 11.9; SD = 4.5). Diagnoses included orthopedic malformations (26%), myelomeningocele (17%), cerebral palsy (15%), amputation (8%), or other orthopedic conditions (31%). Eighty-two percent of the children had normal sensory function and 62% had normal motor function. The 45 children gave 206 responses of 67 possible
Arch Phys Med Rehabil Vol 76, November 1995
recreational activities. Seventy-five percent of the children listed watching television, 57% watching movies, 42% listening to music, and 35% playing electronic games. These 4 activities accounted for 46% of the responses given. The amount of ADL assistance children require correlates significantly with (1) difficulty the children had in finding playmates (r = .39, p = .0092); (2) amount of isolation the caregivers feel helping their children with recreation (r = .58, p = .017); and (3) amount of discomfort the caregivers feel talking about their children's conditions (r = .65, p = .005). Children with disabilities choose sedentary recreational activities. Burden of care influences caregiver isolation. Physiatrists should address issues of limitation of recreational opportunities for children with disabilities and their caregivers.
Poster 134 "Use of Botox for Upper Extremity Deformities." David A. Richman, MD (University of Rochester School of Medicine & Dentistry, Rochester, NY); Deborah J. Gaebler-Spira, MD; Gerald Marty, MD. Although injection of Botox has been studied for lower extremity use with positive results for improving ankle range and gait parameters, limited information is available regarding functional gains following upper extremity Botox injections. When range of motion compromises the upper extremity there may be impact on activity of daily living skills such as dressing, feeding and activation of augmentative communication devices. Our 2 case reports illustrate the use of Botox to improve activities of daily living skills with children with cerebral palsy, spastic quadriplegia, and upper extremity range limitations. A 13-year-old boy with spastic quadriplegia is wheelchair dependent with poor head truck control. His upper extremities were held in flexion, interfering with use of communication system and dressing. We injected 4u/kg Botox to the biceps bilaterally with 2 long are serial casts applied to increase the extension. Pre-Botox elbow lacked 65 ° extension; post-Botox elbows extension lacked 40 °, thus enabling the patient to position his arms more appropriately on his laptray. FIM scores did not change; however, time for dressing decreased, head and trunk extension increased, hygiene was made easier, and increased hand use for activating a communication system was noted. Case 2 is a 16-year-old boy with spastic quadriplegia who is wheelchair dependent and has severe thumb in palm deformity. Hand splints were ineffective, and hand hygiene was declining as was all school activities related to fine motor control. We injected 2u/kg Botox to the thumb flexor pollicis brevis and abductor pollicis brevis. Pre-Botox, the patient exhibited 0 ° thumb carpal matacarpal extension and 0 ° abduction. Post-Botox, 40 ° of extension and 35 ° of abduction was obtained. Serial casting was utilized to obtain these results. After the casting and Botox injection, splinting was successful with a reinstitution of an augmentative communication system in the school. No adverse effects were seen in either child. The application of Botox of upper extremities has the potential to improve function as well as quality of life issues for children with spastic upper extremity deformity.
Poster 135 "Consequences of Prolonged Use of Steroids and Veeuronium in the Pediatric Intensive Care Unit." Rhonda C. Caldwell-Williams, MD (University of California, Los Angeles, CA); Betty Bernard, MD. Acute tetraplegia can be a serious complication of prolonged use of neuromuscular blocking agents with high dose corticosteroids, With the increasing use of these agents in the pediatric intensive care unit, it is important that further research be conducted to explore these potential complications. We report a 14-month-old boy (28 weeks gestation) with an acute onset of pneumonia who required methy!prednisolone, Vecuronium, and mechanical ventilation for 27 days. On discontinuation of these agents, profound hypotonia, decline in motor and verbal developmental milestones, and an acute tetraplegia were present. An electroencephalogram showed diffuse encephalopathy. An electromyelogram was significant for decreased recruitment patterns. Nerve conduction studies revealed decreased amplitude of the right peroneal nerve with normal conduction velocity. No muscle biopsy was performed. Creatine phosphokinase and blood chemistries were normal. After a 3-week course of comprehensive inpatient physical, speech, and occupational therapies, the patient regained developmental milestones back to his moderately delayed baseline and had improvement in motor strength of all extremities with normal tone. There are few reported cases of this disorder.
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
not identified. We address the role anticoagulation plays in potentially altering the rehabilitation program and future activities of a child.
Poster 131 "Intractable Seizures in Children: Outcome of Rehabilitation Following Hemispherectomies." Paul T. Scheatzle, DO (MetroHealth Medical Center, Cleveland, OH); Shu Quey Huang, MD; T.J. CittaPietrolungo, DO. Young children with seizures refractory to treatment with multiple medications present a challenging management dilemma. In selected cases, hemispherectomies are a radical, potential treatment option. This report presents 3 cases, ages 6 months, 3 years, and 15 years admitted for pediatric rehabilitation after hemispherectorny for intractable seizures. The 6-month-old child had hemimegalencephaly and the 15-year-old patient had Rasmussen's encephalitis as etiologies for their seizures. Both had failed to respond to previous, more selective seizure foci ablation procedures. On admission to rehabilitation, an integrated team approach was initiated. The mobility of each patient improved postoperatively. The 6-month-old patient had been severely disabled by greater than 100 seizures per day. At discharge, he was able to prop himself up in the prone position. He advanced 2 months on the Receptive Expressive Language Scale-Second Edition and his seizure frequency dropped to 5 daily. The 3-year-old child had autistic behavior and a mild left hemiparesis which both improved throughout his rehab course. The 15-year-old patient became more functionally independent at the wheelchair level. All of the patients were continued on seizure medications and 2 had no further seizures postoperatively. In all cases, the patients improved from baseline while demonstrating a positive response to conventional, multidisciplinary team treatment.
Poster 132 "Juvenile Fibromyalgia: A Case Report." Brian H. Morgan, MD (Rehabilitation Institute of Chicago, Chicago, IL); Charles E. Sisung, MD; Norman Harden, MD. Juvenile fibromyalgia, while rarely reported in the medical literature, may be a commonly overlooked disease in the pediatric population and deserves special consideration in the rehabilitation setting. The literature concerning primary fibromyalgia, familial fibromyalgia, and hereditary fibromyalgia in the pediatric population is sparse. Additionally, the psychosocial effects of primary juvenile fibromyalgia have never been addressed. The pediatric population has special considerations that make a precise diagnosis critical: time lost from school and the loss of peer relationships. This report describes a 13-year-old boy who presented with an initial diagnosis of spondyloarthropathy. Review of his previous medical record showed an extensive workup that was negative for an inflammatory process. The physical exam made it evident that he did not have an spondyloarthropathy, but had primary fibromyalgia. His mother had been diagnosed with fibromyalgia at the same time he developed symptoms. This patient demonstrated the difficulty in diagnosing and in treating the multifactorial aspects of juvenile fibromyalgia. Our report describes a rehabilitation course that was successful in returning this patient to school and helping him to regain his independence in daily activities.
Poster 133 "Recreational Preferences and Experiences of Children with Disabilities." Eric T. Morse, MD (University of Kentucky, Lexington, KY); Randal E. Schieenbaker, MD; Robert W. Moore, PhD; Jami S. Coleman, MD. Children with disabilities face challenges with their participation in recreational activities. Literature review provided little information regarding recreational activities of these children. Forty-five children who were inpatients in a pediatric orthopedic hospital, along with their caregivers, were surveyed. Children were asked about their recreational preferences and experiences, and adult caregivers were asked for their perceptions of limitations of the children's involvement in recreational activities. The 18 females (40%) and 26 males (60%) ranged from 4 to 20 years old (mean = 11.9; SD = 4.5). Diagnoses included orthopedic malformations (26%), myelomeningocele (17%), cerebral palsy (15%), amputation (8%), or other orthopedic conditions (31%). Eighty-two percent of the children had normal sensory function and 62% had normal motor function. The 45 children gave 206 responses of 67 possible
Arch Phys Med Rehabil Vol 76, November 1995
recreational activities. Seventy-five percent of the children listed watching television, 57% watching movies, 42% listening to music, and 35% playing electronic games. These 4 activities accounted for 46% of the responses given. The amount of ADL assistance children require correlates significantly with (1) difficulty the children had in finding playmates (r = .39, p = .0092); (2) amount of isolation the caregivers feel helping their children with recreation (r = .58, p = .017); and (3) amount of discomfort the caregivers feel talking about their children's conditions (r = .65, p = .005). Children with disabilities choose sedentary recreational activities. Burden of care influences caregiver isolation. Physiatrists should address issues of limitation of recreational opportunities for children with disabilities and their caregivers.
Poster 134 "Use of Botox for Upper Extremity Deformities." David A. Richman, MD (University of Rochester School of Medicine & Dentistry, Rochester, NY); Deborah J. Gaebler-Spira, MD; Gerald Marty, MD. Although injection of Botox has been studied for lower extremity use with positive results for improving ankle range and gait parameters, limited information is available regarding functional gains following upper extremity Botox injections. When range of motion compromises the upper extremity there may be impact on activity of daily living skills such as dressing, feeding and activation of augmentative communication devices. Our 2 case reports illustrate the use of Botox to improve activities of daily living skills with children with cerebral palsy, spastic quadriplegia, and upper extremity range limitations. A 13-year-old boy with spastic quadriplegia is wheelchair dependent with poor head truck control. His upper extremities were held in flexion, interfering with use of communication system and dressing. We injected 4u/kg Botox to the biceps bilaterally with 2 long are serial casts applied to increase the extension. Pre-Botox elbow lacked 65 ° extension; post-Botox elbows extension lacked 40 °, thus enabling the patient to position his arms more appropriately on his laptray. FIM scores did not change; however, time for dressing decreased, head and trunk extension increased, hygiene was made easier, and increased hand use for activating a communication system was noted. Case 2 is a 16-year-old boy with spastic quadriplegia who is wheelchair dependent and has severe thumb in palm deformity. Hand splints were ineffective, and hand hygiene was declining as was all school activities related to fine motor control. We injected 2u/kg Botox to the thumb flexor pollicis brevis and abductor pollicis brevis. Pre-Botox, the patient exhibited 0 ° thumb carpal matacarpal extension and 0 ° abduction. Post-Botox, 40 ° of extension and 35 ° of abduction was obtained. Serial casting was utilized to obtain these results. After the casting and Botox injection, splinting was successful with a reinstitution of an augmentative communication system in the school. No adverse effects were seen in either child. The application of Botox of upper extremities has the potential to improve function as well as quality of life issues for children with spastic upper extremity deformity.
Poster 135 "Consequences of Prolonged Use of Steroids and Veeuronium in the Pediatric Intensive Care Unit." Rhonda C. Caldwell-Williams, MD (University of California, Los Angeles, CA); Betty Bernard, MD. Acute tetraplegia can be a serious complication of prolonged use of neuromuscular blocking agents with high dose corticosteroids, With the increasing use of these agents in the pediatric intensive care unit, it is important that further research be conducted to explore these potential complications. We report a 14-month-old boy (28 weeks gestation) with an acute onset of pneumonia who required methy!prednisolone, Vecuronium, and mechanical ventilation for 27 days. On discontinuation of these agents, profound hypotonia, decline in motor and verbal developmental milestones, and an acute tetraplegia were present. An electroencephalogram showed diffuse encephalopathy. An electromyelogram was significant for decreased recruitment patterns. Nerve conduction studies revealed decreased amplitude of the right peroneal nerve with normal conduction velocity. No muscle biopsy was performed. Creatine phosphokinase and blood chemistries were normal. After a 3-week course of comprehensive inpatient physical, speech, and occupational therapies, the patient regained developmental milestones back to his moderately delayed baseline and had improvement in motor strength of all extremities with normal tone. There are few reported cases of this disorder.