Background: The lack of consensus regarding optimal nonoperative management of idiopathic toe walking (ITW) results in wide variation in treatment across providers and institutions. Untreated toe walking can cause persistence of abnormal gait and symptomatic foot deformity in adulthood. Objective: To examine the outcomes of multiple commonly used nonoperative treatment techniques in a large cohort of children with ITW to better inform management of this condition. Design: Retrospective cohort study. Setting: Single tertiary care children's hospital from 2008 to 2015. Patients: Two hundred four children with ITW, aged 4 to 7 years at time of diagnosis, nonoperatively managed in orthopedic surgery, rehabilitation medicine, neurodevelopmental medicine, neurology, or physical therapy clinics. Interventions: Nonoperative techniques included observation, home stretching program, physical therapy program, use of anklefoot orthoses (AFOs), and serial casting. Main Outcome Measures: Greater than or equal to 10 of ankle dorsiflexion with the knee extended or walking on toes less than 25% of the time at last visit. Failure of treatment was defined as not achieving resolution criteria or requiring surgical intervention following failed nonoperative management. Results: Only 121 children (59.3%) attended at least one follow-up visit. Of those, 55 (45.5%) had a successful outcome. Increasing severity of ITW was associated with increased rate of follow-up (P = .03) and lower rates of successful treatment (P = .03). The use of AFOs was the only treatment modality associated with a successful outcome (unadjusted/adjusted odds ratio 3.97; [95% confidence interval, 1.80-8.74] and 4.81 [95% confidence interval, 1.91-12.1], respectively; P = .001). Conclusions: Loss to follow-up is common in children with ITW. Of those children who returned to clinic, less than half had a successful outcome. The only treatment technique statistically associated with short-term resolution of toe walking was the use of AFOs.
6MWT and GMFM-E have the strongest associations with level, amount and intensity of walking in daily life. Results suggest that the 6MWT and GMFM-E can be employed to estimate community walking activity in ambulatory children with CP. Future studies should focus on environmental and personal factors that influence community walking performance.
PURPOSE:
To examine the relationship of physical activity (PA) and walking performance to QOL in ambulatory children with CP, as function is not consistently associated with QOL in this population.
METHODS:
A secondary analysis of a cross-sectional cohort of 128 ambulatory children with CP, ages 2.2–9.9 years and GM-FCS levels I–III, was employed. Individual multivariate regression models were developed for physical, psychosocial, and total domains of QOL as measured by the Pediatric Quality of Life Inventory (PedsQL) controlling for physical activity and walking performance, participation level and frequency, topography of CP, walking capacity, age, and satisfaction with participation.
RESULTS:
Physical, psychosocial and total QOL averaged 52.2, 60.9, and 56.5 respectively. PA was positively associated with physical (0.64, p < 0.01) and total QOL (0.54, p < 0.01). Walking performance was associated with physical QOL (0.16, p = 0.05), participation level was positively related to psychosocial (0.44, p < 0.01), and age negatively for all QOL domains (> −0.43, p < 0.01).
CONCLUSIONS:
Physical activity, walking performance, and level of participation in daily life are associated with varying domains of QOL. Future work should explore factors that influence the relationship of daily physical/walking activity and participation to QOL in children with ambulatory CP as they age.
Children with CNS-based functional impairments with cancer and noncancer diagnoses made functional gains with similar WeeFIM efficiencies after undergoing inpatient rehabilitation. However, patients with noncancer diagnoses made greater gains in self care, mobility, and total scores with longer stays on the rehabilitation service. No significant difference was found in unplanned transfer rates between cancer and noncancer groups for acute medical care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.