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Romeo DM, Pironi V, Velli C, Sforza E, Rigante D, Giorgio V, Leoni C, De Rose C, Kuczynska EM, Limongelli D, Ruiz R, Agazzi C, Mercuri E, Zampino G, Onesimo R. Ligamentous laxity in children with achondroplasia: Prevalence, joint involvement, and implications for early intervention strategies. Eur J Med Genet 2024; 68:104930. [PMID: 38428804 DOI: 10.1016/j.ejmg.2024.104930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/30/2023] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
Achondroplasia (ACH), the most common form of skeletal dysplasia, is characterized by severe disproportionate short stature, rhizomelia, exaggerated lumbar lordosis, brachydactyly, macrocephaly with frontal bossing and midface hypoplasia. Ligamentous laxity has been reported as a striking feature of ACH, but its prevalence and characteristics have not been systematically evaluated yet. There is growing evidence that ligamentous laxity can be associated with chronic musculoskeletal problems and may affect motor development leading to abnormal developmental trajectories. This study aimed to assess the prevalence of ligamentous laxity in children with ACH through standardized tools, the Beighton scale and its modified version for preschool-age children. A total of 33 children (mean age 6.4 ± 3.2 years; age range 1-12.5 years) diagnosed with ACH by the demonstration of a pathogenic variant in the FGFR3 gene and 33 age- and sex-matched healthy controls were included in the study. Both ligamentous laxity assessment and neurological examinations were performed; medical history was also collected from caregivers. Children with ACH showed a 2 times higher risk of ligamentous laxity than the group without skeletal dysplasia (OR = 2.2; 95% CI = 1.0 to 4.7), with 55% of children meeting the diagnostic criteria for hypermobility. No significant difference in ligamentous laxity was observed between males and females. Joint involvement analysis revealed characteristic patterns, with knee hypermobility observed in 67% of patients, while rare was elbow hypermobility. Longitudinal assessments indicated a decreasing trend in ligamentous laxity scores over time, suggesting a potential decrease in hypermobility issues during adulthood. The findings of this study provide valuable insights into the prevalence and characteristics of ligamentous laxity in ACH. Implementation of standardized ligamentous laxity assessments might guide patients' follow-up and facilitate early interventions, helping to prevent pain and improve outcomes and quality of life for such patients. Further prospective studies are needed to explore the natural history of ligamentous laxity in ACH and investigate the potential impact of emerging pharmacological treatments upon hypermobility.
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Affiliation(s)
- Domenico Marco Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A, Gemelli, IRCCS, 00168, Rome, Italy.
| | - Virginia Pironi
- Child Neurology and Psychiatry Unit, AUSL della Romagna, Ospedale Infermi, Rimini, Italy; Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | - Chiara Velli
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | | | - Donato Rigante
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Valentina Giorgio
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | - Cristina De Rose
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | - Eliza Maria Kuczynska
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | | | - Roberta Ruiz
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | | | - Eugenio Mercuri
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Agostino Gemelli IRCCS, 00168, Rome, Italy.
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
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Romeo DM, Moro M, Pezone M, Venezia I, Mirra F, De Biase M, Polo A, Turrini I, Lala MR, Velli C, Sini F, Dragone D, Mercuri E, Brogna C. Relationship and New Prospectives in Joint Hypermobility in Children with Autism Spectrum Disorder: Preliminary Data. J Pers Med 2023; 13:1723. [PMID: 38138950 PMCID: PMC10744756 DOI: 10.3390/jpm13121723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Autism spectrum disorder (ASD) and joint hypermobility (JH) are considered two different etiological and clinical entities that most often appear in childhood. Despite growing increased research showing a co-occurrence for both conditions, a link between them is rarely established in clinical settings, and the relationship between ASD and JH has not so far been completely investigated in all age groups of ASD children. This preliminary study examined a cohort of 67 non-syndromic ASD children aged 2-18 years (sex ratio M:F = 12:1) showing different degrees of cognitive impairment and autism severity, using the Beighton scale and its revised version. A total of 63% of ASD patients aged 2-4 years and 73% of ASD patients aged ≥5 years presented significant scores of hypermobility. No significant correlation was found comparing total laxity score and cognitive assessments and severity of autistic symptomatology (p > 0.05). The results suggest that JH could be considered as a clinical characteristic of ASD patients and it needs to be assessed in order to schedule a better rehabilitation program.
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Affiliation(s)
- Domenico Marco Romeo
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Marianna Moro
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Mariangela Pezone
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Ilaria Venezia
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Federica Mirra
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Margherita De Biase
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Agnese Polo
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Ida Turrini
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Maria Rosaria Lala
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Chiara Velli
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Francesca Sini
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | | | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Claudia Brogna
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
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Yardımcı-Lokmanoğlu BN, Mutlu A. Assessing Joint Hypermobility, Proprioception, and Developmental Functioning in Toddlers Born Preterm. Turk Arch Pediatr 2023; 58:407-412. [PMID: 37357454 PMCID: PMC10441170 DOI: 10.5152/turkarchpediatr.2023.22263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/07/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE The aims of this study were to explore (i) the joint hypermobility, proprioception, and developmental functioning in toddlers born preterm, (ii) differences in the proprioception and developmental functioning between toddlers with and without joint hypermobility, and (iii) the relationship between them. MATERIALS AND METHODS One hundred twelve toddlers born preterm between 24 and 42 months of age were included in this observational study. Beighton Score for joint hypermobility assess- ment and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) for developmental functioning were applied in all toddlers born preterm; however, propriocep- tion assessment could be applied on 55 of 112 (49.11%) toddlers born preterm due to lack of cooperation. RESULTS Of 112 toddlers, 30 (26.79%) had joint hypermobility. There were no differences in coop- eration rate (P = .629) and success rate (P = .887) in the proprioception assessment between toddlers with and without joint hypermobility (55 toddlers born preterm), which is similar to the cognitive domain (P = .430), language domain (P = .062), and motor domain (P = .619) in the Bayley-III. Additionally, none of them were related to each other (P > .05). CONCLUSION Our study findings showed that joint hypermobility has no effect on propriocep- tion and motor development in toddlers born preterm between 24 and 42 months of age, and there is no relationship between them. The possibility of these results might be that movement repetition and not only proprioception but also other sensory systems could be important in this early period of life.
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Affiliation(s)
- Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Akmer Mutlu
- Hacettepe University Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
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Tran HT, Li YC, Lin HY, Lee SD, Wang PJ. Sensory Processing Impairments in Children with Developmental Coordination Disorder. CHILDREN 2022; 9:children9101443. [PMID: 36291382 PMCID: PMC9600147 DOI: 10.3390/children9101443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022]
Abstract
The two objectives of this systematic review were to examine the following: (1) the difference in sensory processing areas (auditory, visual, vestibular, touch, proprioceptive, and multi-sensory) between children with and without developmental coordination disorder (DCD), and (2) the relationship between sensory processing and motor coordination in DCD. The following databases were comprehensively searched for relevant articles: PubMed, Science Direct, Web of Science, and Cochrane library. There were 1107 articles (published year = 2010 to 2021) found in the initial search. Full-text articles of all possibly relevant citations were obtained and inspected for suitability by two authors. The outcome measures were sensory processing impairments and their relationship with motor coordination. A total of 10 articles met the inclusion criteria. Children with DCD showed significant impairments in visual integration, tactile integration, proprioceptive integration, auditory integration, vestibular integration, and oral integration processes when compared with typically developing children. Evidence also supported that sensory processing impairments were associated with poor motor coordination in DCD. Preliminary support indicated that DCD have sensory processing impairments in visual, tactile, proprioceptive, auditory, and vestibular areas, which might contribute to participation restriction in motor activities. It is important to apply sensory integration therapy in rehabilitation programs for DCD in order to facilitate participation in daily activities.
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Affiliation(s)
- Huynh-Truc Tran
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 40402, Taiwan
| | - Yao-Chuen Li
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 40402, Taiwan
| | - Hung-Yu Lin
- Department of Occupational Therapy, Asia University, Taichung 41354, Taiwan
| | - Shin-Da Lee
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 40402, Taiwan
| | - Pei-Jung Wang
- Department of Physical Therapy, Asia University, Taichung 41354, Taiwan
- Correspondence: ; Tel.: +886-4-2332-3456 (ext. 48039)
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