The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3–5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant’s later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III–V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

This clinical, practice-based study explores the research question: Is there a relationship between hearing loss and functional disturbance in elderly patients? We analyzed the impact of hearing impairment on 153 patients over 65 years of age screened in primary care practice. Functional and psychosocial impairment were measured using the Sickness Impact Profile (SIP), a standardized measure for assessing sickness related dysfunction. Hearing level was determined with pure tone audiometry. Multiple linear regression was used to adjust for patient case-mix differences and other clinical variables. After adjustment, a 10 dB increase in hearing loss was found to result in a 2.8 point increase in Physical SIP scores (95% confidence interval = 1.8-3.8), a 2.0 point increase in psychosocial SIP scores (95% confidence interval = 0.8-3.2) and a 1.3 point increase in overall SIP scores (95% confidence interval = 0.1-2.5). Poor hearing was associated with higher SIP scores and increased dysfunction. Thus, hearing impairment is an important determinant of function in the elderly.

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Objective: This investigation was designed to determine whether people in the early to middle phases of Alzheimer's disease (AD) show impaired central auditory processing as compared with nondemented elderly.Design: A peripheral and central auditory test battery was administered to 10 subjects diagnosed with mild-to-moderate AD based on a neuropsychological test battery and radiographic techniques, and a control group of 10 subjects with no evidence of dementia, matched for age, gender, and average degree of hearing loss. Immittance audiometry, pure-tone and speech audiometry, and otoacoustic emissions were recorded in all subjects. Central auditory assessment included the synthetic sentence identification with ipsilateral competing message, dichotic digits, dichotic sentence identification, pitch patterns, and duration patterns.Results: Peripheral auditory status was statistically similar between subject groups. Neither average high frequency hearing sensitivity nor mean speech recognition ability was significantly different. However, a significant difference was noted between groups for average low frequency hearing sensitivity in the left ear @ < 0.06). Subjects with AD showed slightly poorer low frequency thresholds versus matched controls. Based on analysis of performance on each measure of the central auditory test battery, the AD group scored significantly lower than the matched control group on four of the five measures utilized. Differences for right versus left ear performance were found among AD subjects. Conclusions:Overall patterns in findings cannot be easily explained as artifacts of cognitive decline. Results support screening for central auditory dysfunction in the AD population, since impaired processing could influence psychiatric assessment of cognitive deficit as well as audiologic management of peripheral hearing loss in this population. (Ear & Hearing 1995;16;230-238) A significant amount of literature has attempted to reveal a relationship between hearing impairment and cognitive dysfunction (Gennis, Gamy,

Background Adolescent idiopathic scoliosis (AIS) is one of the most common structural spinal deformities in adolescents, becoming apparent around the time of puberty. Schroth scoliosis-specific exercises have demonstrated promising results in reducing the progression of AIS. Objectives The aim of this study was to identify, critically appraise and establish the best available evidence for the effectiveness of Schroth exercises in comparison to non-surgical management to reduce the progression of AIS. Methodology Seven databases were searched in April 2018. Main key search terms included AIS, Schroth exercises, physiotherapy, exercise, electrical stimulation, yoga, Pilates, tai chi and bracing . The quality of the trials was critically appraised according to the PEDro scale. Revman© Review Manager Software was used to pool the quality of life (QOL) results. Results Four randomised control trials with an average PEDro score of 6.75/10 were included in this study. Results indicated that Schroth exercises had a significant effect in decreasing the Cobb angle ( p < 0.05) in comparison to non-surgical management. The pooled effect on QOL showed a significant result in favour of Schroth exercises at 12 weeks ( p < 0.002) and at 24 weeks ( p < 0.0004). Conclusion Level II evidence suggests that Schroth exercises have a significant effect on reducing the Cobb angle and improving QOL in adolescents with idiopathic scoliosis. Clinical implications This review’s findings should be considered with caution for physiotherapy practice because of the limited number of identified articles and their methodologic limitations. Based on the current available and limited evidence, clinicians could combine supervised Schroth exercises with conventional physiotherapy care (observation, exercise, bracing and manual therapy) when treating adolescents with idiopathic scoliosis.

BackgroundThree-dimensional gait analysis (3DGA) is commonly used to assess the effect of orthopedic single-event multilevel surgery (SEMLS) in children with spastic cerebral palsy (CP).PurposeThe purpose of this systematic review is to provide an overview of different orthopedic SEMLS interventions and their effects on 3DGA parameters in children with spastic CP.MethodsA comprehensive literature search within six databases revealed 648 records, from which 89 articles were selected for the full-text review and 24 articles (50 studies) included for systematic review. The Oxford Centre for Evidence-Based Medicine Scale and the Methodological Index for Non-Randomized Studies (MINORS) were used to appraise and determine the quality of the studies.ResultsExcept for one level II study, all studies were graded as level III according to the Oxford Centre for Evidence-Based Medicine Scale. The MINORS score for comparative studies (n = 6) was on average 15.7/24, while non-comparative studies (n = 18) scored on average 9.8/16. Nineteen kinematic and temporal-distance gait parameters were selected, and a majority of studies reported improvements after SEMLS interventions. The largest improvements were seen in knee range of motion, knee flexion at initial contact and minimal knee flexion in stance phase, ankle dorsiflexion at initial contact, maximum dorsiflexion in stance and in swing phase, hip rotation and foot progression angles. However, changes in 3DGA parameters varied based on the focus of the SEMLS intervention.DiscussionThe current article provides a novel overview of a variety of SEMLS interventions within different SEMLS focus areas and the post-operative changes in 3DGA parameters. This overview will assist clinicians and researchers as a potential theoretical framework to further improve SEMLS techniques within different SEMLS focus groups. In addition, it can also be used as a tool to enhance communication with parents, although the results of the studies can’t be generalised and a holistic approach is needed when considering SEMLS in a child with spastic CP.

The cross-sectional associations between clinical variables and biomechanics platform measures of balance (sway) were determined in a random sample of 50 aged single women living in high rise apartment buildings. A history of falling in the previous year was associated with increased areas of sway. Increased body mass was associated with decreased velocity of sway. Poor near, but not far, visual acuity was associated with increased areas of sway. A postural drop of 10 mmHg or more in diastolic pressure was associated with increased velocity of sway. The associations between these variables and the balance measures persisted after adjustment for age and each other to adjust for potential confounding. Slower hand reaction times and poor hearing were associated with increased areas of sway, but these associations were removed after adjustment for age and near visual acuity. There were no associations between any of the balance measures and postural changes in systolic pressure and heart rate. There were no associations between balance measures and base of support. The observed associations, if causal, can aid in development and testing of effective interventions to improve balance and prevent falls in the elderly.

The purpose of the present study was to determine the long-term outcome of 76 children (40 females and 36 males) diagnosed and treated with modern antituberculosis drugs. The median age of the children on admission was 29.5 months and on follow-up 9 years. Antituberculosis therapy consisted of daily isoniazid (20 mg/kg), rifampicin (20 mg/kg), ethionamide (20 mg/kg), and pyrazinamide (40 mg/kg) for 6 months. Twenty-three children received daily prednisone (2-4 mg/kg) for the first month of treatment. Raised intracranial pressure was actively monitored and treated. Patients with non-communicating hydrocephalus received ventriculo-peritoneal shunts shortly after admission while communicating hydrocephalus was treated with oral acetazolamide (100 mg/kg/day) and furosemide (1 mg/kg/day) in 3-4 divided doses. Communicating hydrocephalus that did not respond to this regimen within the first month of treatment also underwent ventriculo-peritoneal shunting. Only 20% of children were functionally completely normal at follow-up. Main areas of functional deficit were cognitive impairment (80%), poor scholastic progress (43%), and emotional disturbance (40%). Twenty-five per cent of children had evidence of motor impairment, but all could walk and only 5 of 76 children (6% of total) were unable to run. One child was blind but no child had sensori-neural deafness. It was concluded that these disabilities in children from mainly deprived socioeconomic backgrounds have serious implications for their future social, academic, and career prospects. A high index of suspicion of TBM in high tuberculosis incidence communities will help prevent the morbidity documented in this study.