Common Complications of Pediatric Neuromuscular Disorders

Skalsky, Andrew J.; Dalal, Pritha B.

doi:10.1016/j.pmr.2014.09.009

Cited by 13 publications

(13 citation statements)

References 29 publications

(33 reference statements)

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“…The most common motor disability in childhood is represented by cerebral palsy (CP) [1], defined as a group of the motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain [2]. Immobility and muscular weakness are underlying features of all these disorders, which predispose the sufferers to nutritional and infective complications [3].…”

Section: Introductionmentioning

confidence: 99%

Gastrostomy Placement and Management in Children: A Single-Center Experience

et al. 2019

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BACKGROUND: To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series. METHODS: This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents’ opinion. RESULTS: Eighty-four gastrostomies were placed in total (35 F; 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients; late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux; five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile; the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube. CONCLUSION: This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive.

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Section: Introductionmentioning

confidence: 99%

Gastrostomy Placement and Management in Children: A Single-Center Experience

et al. 2019

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“…Postoperative gastrointestinal complications are not uncommon in pediatric patients, especially in patients with neuromuscular disorders. 34 The presence of nutritional support, by way of total parenteral nutrition or nasogastric, gastrostomy, or jejunal feeding, was associated with an increased rate of postoperative complications. However, previous studies have shown that gastrostomy tube feeding can have a significantly positive effect on weight gain and nutritional indices in pediatric neuromuscular disorders.…”

Section: Discussionmentioning

confidence: 99%

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

Shaw

Fletcher

Devito

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe aim of this study was to evaluate the effect of postoperative admission status on 30-day perioperative complications in patients with growing spinal instrumentation undergoing surgical lengthening.METHODSThis retrospective case-control study of records from the 2014–2015 National Surgical Quality Improvement Program–Pediatric database was performed to identify surgical lengthening procedures of spinal implants in patients with growing instrumentation by Current Procedural Terminology code. The 30-day postoperative complications were classified according to the Clavien-Dindo system. Patients were subdivided according to their postsurgical admission status. Admission status, American Society of Anesthesiologists (ASA) Physical Status classification, tracheostomy, neuromuscular diagnosis, ventilator dependence, and nutritional support were considered as possible risk factors in univariate and multivariate logistic regression analyses.RESULTSA total of 796 patients were identified (mean age 9.09 ± 3.44 years; 54% of patients were female), of whom 73% underwent lengthening on an inpatient basis. Patients with a tracheostomy or ventilator dependence were more likely to be admitted postoperatively. The overall rate of major complications was 3.5% and did not differ based on admission status (2.8% inpatient vs 3.8% outpatient, p = 0.517). On univariate analysis, ventilator dependence (9.5% vs 2.7%, p = 0.002), need for nutritional support (7.1% vs 2.5%, p = 0.006), and ASA class > II (4.8% vs 1.3%, p = 0.04) placed patients at a higher risk for any postoperative complications. Multivariate analysis identified only ventilator dependence as an independent risk factor for any perioperative complication.CONCLUSIONSPostoperative admission status did not affect the rate of 30-day perioperative complications, readmission, or rate of unplanned operations following lengthening of growing spinal instrumentation. Outpatient lengthening appears to be safe; however, consideration for postoperative admission should be given for those who are ventilator dependent.

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“…Our second application example focuses on the assessment of spasticity. Spasticity is a neuromuscular disorder due to brain or nerve damage in patients suffering from cerebral palsy, stroke, etc . Spasticity results in muscle stiffness, painful contractures, and jerky limb movements, affecting a person's motor control in balance, gait, eating, hygiene situation, and more.…”

Section: Applications Of Pressure Sensors In Monitoring Body Motionmentioning

confidence: 99%

Flexible Pressure Sensors for Objective Assessment of Motor Disorders

Amit

Chukoskie

Skalsky

et al. 2019

Adv Funct Materials

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Monitoring body motion is relevant to motor control disorders as well as assessment of fine motor skills in child development. Furthermore, motion tracking is necessary for rehabilitation monitoring and injury prevention and benefits both sick and healthy individuals. Flexible pressure sensors based on resistors, capacitors, inductors, or transistors are reviewed in the context of healthcare measurements, ranging from physiological signals to body movement characteristics such as grip and gait. To demonstrate the use of flexible pressure sensors for motor assessment, a touch sensing glove that evaluates fine motor skills in autism research is developed. The results show that autistic children perform fewer taps per minute compared to typically developing children, with larger variations in tap durations. In a second example, a force and motion sensing glove is developed to assess spasticity, a neuromuscular disorder that causes muscle stiffness/resistance and jerky movement. Analyses of force versus velocity show movement-dependent muscle resistance in a patient with spasticity. Through these flexible sensor systems, the shift from subjective scores to objective measurement will promote better diagnosis and dramatically improve the accuracy in tracking patient response to therapy.patients doing certain movements, and then clinicians rank each patient's level according to qualitative descriptions in benchmark classification scales. [12,13] The subjective scores can be inconsistent between raters and do not capture finelevel changes in a patient's progress in response to therapy. Therefore, there is a critical need to tackle the issue of imprecise assessment of motor disorders.With recent advances in flexible sensors and innovations in tactile sensing, [14][15][16][17][18][19] we have new low-cost technologies that are prime to facilitate quantitative evaluation of motor control. This progress report presents current developments in wearable sensor systems applicable to motor disorders, so that consistent, objective metrics become available to accurately track whether a treatment effectively relieves symptoms. The wearable sensors are not limited to placement on patients but can also be worn by clinicians or caregivers to assist them in taking measurements during patient interactions. [20,21] The point-of-care sensor systems will allow frequent monitoring, which is highly desirable to offer a better understanding of the patient's short and long-term response to therapies, to tailor treatment and improve outcome and quality of life for patients.Other reviews [14][15][16][17][18][19] have already extensively covered the flexible materials and devices used in tracking vital signs and electronic skin applications. In light of that, this progress report focuses on the applications in monitoring motor skills, in particular to implement pressure sensor designs for wearable systems with diverse form factors, for instance, gloves, [20,22,23] epidermal tags tags, [24,25] and shoe insoles. [26,27] We will discuss the mechanis...

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Common Complications of Pediatric Neuromuscular Disorders

Cited by 13 publications

References 29 publications

Gastrostomy Placement and Management in Children: A Single-Center Experience

Gastrostomy Placement and Management in Children: A Single-Center Experience

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

Flexible Pressure Sensors for Objective Assessment of Motor Disorders

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