Pragmatic Neurorehabilitation Approach for Improving Quality of Life in Duchenne Muscular Dystrophy: A Case Report

This case report provides insights into the physiotherapy management of a 12-year-old male with Duchenne muscular dystrophy (DMD). DMD is a devastating genetic disorder characterized by progressive muscle degeneration and weakness. Skeletal muscle degeneration is induced by a genetic disorder. It is a common X-linked condition that causes hypertrophy of the calves and proximal muscular weakness in children. It frequently results in early mortality, wheelchair confinement, and delays in motor development. Physiotherapy interventions aim to optimize functional abilities and quality of life in individuals with DMD. This case report highlights the effectiveness of physiotherapy in managing DMD progression. This study presents a case exhibiting notable clinical symptoms, highlighting the urgency for advanced treatments to combat this debilitating disease. Outcome measures such as body mass index, spirometry, manual muscle testing, and the World Health Organization Quality-of-Life scale are used to report patient progress. The treatment plan was carried out for six weeks, five times a week. Physiotherapy strategies include diet management, stretching and splinting techniques, and pulmonary training. While current treatments focus on symptom management, ongoing research holds promise for the development of more effective therapies to improve outcomes and quality of life for affected individuals. Multidisciplinary care, including neurophysiotherapy rehabilitation, plays a crucial role in managing the symptoms and complications of DMD, emphasizing the importance of comprehensive support for patients and their families. At the end of our rehabilitation, the patient showed significant improvement in the outcome measures.

An Analysis From a Tertiary Pediatric Hospital: Does Physical Activity Play a Role in the Management of Children and Young Adults With Osteogenesis Imperfecta?

INTRODUCTION

Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by reduced bone density and increased proneness to fractures. It manifests across a varied clinical spectrum of expressions in children and young adults. It is crucial for children with OI to have a multidisciplinary follow-up, including orthopedics, pediatrics, and physical medicine and rehabilitation. Although exercise may have no effect on the disease itself, it might improve the autonomy, self-esteem, and fitness of these children.  Methods: Retrospective cohort analysis of children and young adults aged three or more years old followed-up in a Level III Pediatric Hospital between 1995 and 2020. Demographic and clinical data were obtained from the hospital records and from the caregivers via phone calls. To our knowledge, this is the first national case series published assessing exercise habits in children with this condition.

RESULTS

Among the 21 patients studied, the median age was 14 years, with no gender predominance. Eighteen (86%) practiced regular physical activity, while the remaining three (14%), all of whom were type III OI, were totally dependent. Of the aforementioned 18 children, 12 (67%) considered practicing the same level of physical activity compared to their healthy peers, although most of them needed adaptations. The most reported extracurricular activity was swimming, in 50% of the cases. About 39% engaged in physical activity two times or less per week, and 89% practiced for one hour or less per session.

DISCUSSION

Over the years, it has become clear that physical activity is an important part of OI management. While awareness of the importance of exercise already exists, proper planning, follow-up, and monitoring are essential.

Multimodal Physiotherapy Approach for Autism With Speech Impairment and Attention Deficit: A Case Report

Autism is a disorder distinguished by significant challenges in social interaction and communication coupled with repetitive and stereotypical patterns of behavior and activities. Deficits in social interaction and language development become apparent before age three. In children, this condition is referred to as autism spectrum disorder (ASD). Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Individuals with ADHD may struggle with sustaining attention, organizing tasks, and completing assignments. They may exhibit hyperactive behaviors such as fidgeting, difficulty staying seated, and impulsive actions like interrupting others. ADHD can significantly impact daily functioning and is often diagnosed in childhood, with symptoms potentially persisting into adulthood. The disorder has three main subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation. Treatment typically involves a combination of behavioral interventions, psychoeducation, and, in some cases, medication, aiming to provide support and strategies for individuals to manage their symptoms effectively in various aspects of life. Cognitive impairment in ASD varies, meaning it could be at the sensory perception level of cognitive processing, learning, and memory. The goal of the training intervention was to control physiological arousal, enhance awareness, keep annoyance from getting worse, and encourage self-regulation abilities. In this case report, we discuss the approach of multimodal physiotherapy for autism with speech impairment and attention deficit. Furthermore, physiotherapy needs to find a position in the new mental health care paradigm in order to contribute to mental health care.

The Effect of Amantadine on Agitation in the Pediatric Traumatic Brain Injury Population: A Case Series

In this report, we present a case series involving four pediatric patients who sustained a traumatic brain injury (TBI) and required intensive care unit admission immediately after the injury. In each of the four cases, amantadine was started during the acute care hospital admission to address agitation. Cases were retrieved from the electronic medical record at the Children's Hospital of Philadelphia between July 1, 2020, and October 31, 2022. This case series describes clinical data on TBI presentation, amantadine administration, patient behavior, and hospital course relating to agitation. This is the first publication that reports the effect of amantadine on agitation in the acute phase of recovery in the pediatric TBI population. Improvement in agitation was observed within 48 hours of amantadine initiation in all four cases based on the primary team progress notes, as well as the quantity of pro re nata medications given for agitation. Resolution of agitation was also observed in all cases, though the time scale varied. No adverse events were reported in relation to amantadine use, supporting other reports that the medication may be well tolerated in the pediatric population. More research is needed to determine the optimal dose of amantadine for the pediatric population and whether amantadine hastens agitation resolution compared to the current standard of care.

Effectiveness of Early Physiotherapy Rehabilitation Approach for Split Skin Grafting Post-burn in a Pediatric Patient

Childhood is critical for developing social, physical, and cognitive functioning. Burns in children are very different from burns in adults because it is difficult for them to save themselves. Their skin is more sensitive and less heat-resistant; their exposure may last longer, worsening the burn. When neglected, severe disabling and deforming contractures caused by burns in children can result in substantial impairment. Therefore, burn rehabilitation should not be carried out by one person but rather by a multidisciplinary team to ensure that all of the patients' physical, psychological, and social requirements are met while the child is in the hospital and after discharge. The treatment of young burn victims requires a multidisciplinary approach that begins the day of the accident and lasts for several years. To reduce the consequences of the patient's post-traumatic stress and increase functional independence, a thorough rehabilitation programme is needed. The burn team members' dedication, commitment to the patient's care, and encouragement of patient participation and full engagement in rehabilitation can make a difference to juvenile burn patients' long-term quality of life (QOL). We present a seven-year-old female who suffered from a superficial burn over the lateral aspect of her right thigh. Exercise prescriptions should be thoroughly customized to provide the best possible success in rehabilitation, considering the degree of burns and physical limitations. This case report is intended to serve as a practical manual for the necessary clinical knowledge and therapy intervention approaches for managing burn patients successfully.

Early-Onset Type 2 Diabetes Mellitus

Globally, the prevalence of chronic, non-communicable diseases is increasing at an alarming rate. Amongst it, Type 2 diabetes mellitus (DM) is becoming more prevalent among young individuals due to obesity and sedentary habits. With the advent of COVID-19, there has been an increasing trend for diabetes and its complications. Here we describe a 13-year-old female girl with polyuria, polydipsia for two months with further assessment leading to a diagnosis of Type 2 DM who is now closely monitored by a pediatric endocrinologist. She remains euglycemic with insulin and lifestyle changes. Early-onset DM is complex and requires multidisciplinary care for preventing complications and comorbidities. Hence, early recognition and management are crucial.