Stretching soleus muscle to prevent contractures.
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Cerebral Palsy↗
Biomedical subjects
E A Hurvitz
Publications and source records attributed to E A Hurvitz.
Orthotic technique for dystonia musculorum deformans.
Tone reducing, inhibitive casting, and orthoses have been effectively used in patients with cerebral palsy and head injury to improve gait patterns and decrease tone. We present a patient with dystonia musculorum deformans who had severe inversion and supination of his left foot with weight bearing. He did poorly with metal double-upright ankle-foot orthoses with lateral T-strap. A tone-reducing ankle-foot orthosis (TRAFO) was successful in decreasing problems with abrasions and allowing him to walk without assistive devices.
Adult↗
Rigid removable dressing in a case of poor wound healing.
The rigid removable dressing technique for below-knee amputees has many advantages over other conventional systems. There is some reluctance to use this system in the presence of an open lesion. We present a patient with severe wound dehiscence who had success with this system. The advantages of the rigid removable dressing are protection of the stump and better shrinkage, combined with the ability to remove the dressing and look at the wound. This makes the technique ideal for a stump with poor wound healing.
Aged↗
Functional outcome of paediatric stroke survivors.
OBJECTIVE: To examine the medical and functional outcome of paediatric stroke survivors. PATIENTS: Patients aged 1 month to 18 years diagnosed with stroke over a 10 year period. MAIN OUTCOME MEASURES: Discharge functional outcome data were collected by reviewing therapy, nursing, and other chart notes relating to specific functional tasks. Current functional information, living situation, school placement, and medical outcome data were obtained in the telephone survey. RESULTS: Fifty patients responded. The mean age at event was 8.0 years (range: 7 months to 17 years, 7 months). The mean follow-up time was 70 months. Diagnoses included: haemorrhagic (30%), thrombotic/embolic (46%), and undiagnosed (24%). At follow-up, 76% of the patients were independent in all activities of daily living (ADL), compared to 64% at hospital discharge. Younger age at onset, female gender, history of cardiac disease, and presentation with hemiparesis were significant risk factors for dependence in ADL (p < 0.05), while thrombotic/embolic aetiology demonstrated a trend (p = 0.06). Eighty-four per cent were independent in mobility, compared to 74% at discharge. Forty per cent of the patients had speech and language deficits. Of the school age children, only 50% were in a regular classroom. CONCLUSIONS: Children and adolescents who survive stroke have good outcome for mobility and ADL skills, but more difficulty with language and cognitive recovery. Functional recovery is maintained after discharge, and functional gains occur over time with very little evidence of functional regression. Comorbidities are relatively low. All children in the group returned to a home setting.
Activities of Daily Living↗
Perinatal spinal cord injury requiring long-term home mechanical ventilation: a report of four cases.
Although perinatal spinal cord injury has been discussed in detail in the literature with respect to aetiology and diagnosis, few studies address long-term outcome, and none address the outcome of long-term home mechanical ventilation in this population. The four patients reported here with perinatal spinal cord injury have used home mechanical ventilation for time periods ranging from 6 to 17 years, with varying results. Their courses with respect to respiratory, neuromuscular, neuropsychological, and nutritional issues are described with reference to the current literature. It is believed that, with the advent of organized home mechanical ventilation programmes and increased acceptance of this technology by the lay public and medical community, the prognosis of the child with perinatal spinal cord injury requiring assisted ventilation is much improved, and may be more positive than the literature currently suggests.
Fatal Outcome↗
The use of methylphenidate in paediatric traumatic brain injury.
Methylphenidate (MPH) has been used safely and effectively for many years in children for the treatment of attention deficit disorder with hyperactivity (ADHD). Behavioural and cognitive sequelae to traumatic brain injury (TBI) have features in common with ADHD, and MPH has been reported to be an effective treatment in adults with TBI. There is little literature documenting the efficacy of MPH in children with TBI. A chart review of 10 children who had sustained TBI and were subsequently treated with MPH was performed. Nine of the cases resulted from motor-vehicle accidents, and one from a fall. The severity of TBI ranged from mild to severe. In eight of the cases, MPH was used for cognitive and behavioural problems, and in two cases it was used to stimulate minimally responsive patients. The introduction of MPH improved cognitive function, behaviour and arousal as measured by parental and teacher reports, evaluation by in-/outpatient rehabilitation team, and/or neuropsychometric testing. MPH appears to be an effective treatment for post-TBI cognitive and behavioural sequelae in children, as well as improving arousal in the minimally responsive brain-injured child. Further prospective research is necessary to clarify the role of MPH in children with TBI.
Accidental Falls↗