Multiplanar Humeral Shape Changes from Infancy to Adulthood in Patients with Birth-Related Brachial Plexus Palsy: A Cross-Sectional Analysis.

Background: Birth-related brachial plexus palsy (BRBPP), occurring in up to 1.7% of live births, may have drastic effects on quality of life for those failing to recover shortly after birth. As humeral shape changes correlate with function in older children with BRBPP, the purpose of this study is to evaluate the temporal patterns of humeral shape pathology resulting from unilateral BRBPP spanning the arc from infancy to adulthood, strengthening our knowledge as a basis for clinical intervention.

Delivering Gait Training to Children at Home with a Robotic Knee Exoskeleton: Initial Findings on Feasibility and Patient Satisfaction.

Robotic exoskeletons offer the potential to increase gait training dosage by providing therapy outside the clinic. Exoskeleton use in naturalistic settings has been reported but under researcher supervision and for the purposes of assisting mobility. Here, we examined the feasibility of delivering a resistance-based exoskeleton gait training paradigm in the community setting.

Robotic Knee Exoskeletons as Assistive and Gait Training Tools in Spina Bifida: A Pilot Study Showing Clinical Feasibility of Two Control Strategies.

Robotic exoskeletons are increasingly available to children with movement disorders, most commonly cerebral palsy, as wearable aids to improve mobility, and as rehabilitation tools for gait training with the goal to improve walking when not wearing the device. The focus of this study was to design and evaluate a novel exoskeleton approach for children with crouch gait secondary to weakness caused by spina bifida. Two operational modes were tested: an assistive mode that aids knee extension during stance and late swing, and a gait training mode that assists knee extension in stance and resists it during late swing.

Localization modalities for botulinum neurotoxin injection.

Botulinum toxin is a targeted therapeutic that acts primarily at the site of injection. Various approaches have been taken to guide injection into the selected muscle, gland, organ or other body area. Guidance methodologies that can be used in the office setting for skeletal muscle and salivary gland percutaneous injection include uninstrumented manual needle placement, electromyography (EMG), electromyography with electrical stimulation (e-stim), ultrasound (US) and combined guidance (US + EMG or US + e-stim).

Humeral Development Throughout the Arc of Childhood-A 3D MRI Study.

A quantitative understanding of humeral morphology through the arc of pediatric development is crucial in optimizing the treatment of pediatric shoulder-related orthopedic disorders and athletic overuse injuries. However, data regarding modern normative humeral development are not available. Thus, the aim of this study is to derive biomechanically relevant humeral size and shape measures from a pediatric cohort spanning infancy to adulthood (age 0.

The Relationship Between Stiff Knee Gait Runner's Dystonia and Musculoskeletal Knee Pathology: A Case Series.

Background: Runner's dystonia (RD), a rare task-specific lower-limb dystonia affecting high-mileage runners, presents as abnormal lower-extremity muscle contractions during running. Treatment of RD is challenging and often confounded by significant diagnostic delays due to overlapping symptomatology with other conditions. This case series examines the relationship between stiff knee gait RD and musculoskeletal (MSK) knee pathology.

Unusual delayed and prolonged arm weakness and atrophy following botulinum toxin injection for musician's cramp: case report.

Botulinum toxin is considered first-line treatment for focal hand dystonia in musicians. Mild, temporary weakness is a common accompaniment of effective injection. We present a unique case of delayed-onset, severe, prolonged weakness and atrophy in a patient with musician's dystonia, successfully treated with botulinum toxin for over 10 years, following injection of his usual muscles at his well-established dose.

A call for action: Increasing the pediatric rehabilitation medicine workforce.

Pediatric Rehabilitation Medicine (PRM) is a unique blend of traditional medical rehabilitation knowledge and skills primarily focused on temporary and/or permanent disability conditions of childhood onset throughout the age continuum, with an emphasis on promoting function and participation. Although there are two established pathways to enhance knowledge and skills in PRM, one a combined residency with Pediatrics and the other a PRM fellowship, there has been a relative decline in participants in this training, as has been seen across other subspecialties in Physical Medicine and Rehabilitation (PM&R) and other medical specialties. Based on pediatric rehabilitation physician surveys and the increasing prevalence of children with disabilities, there has been a call to consider opening PRM fellowships to physicians not trained in PM&R.

Comparison of Ultrasound and Electrical Stimulation Guidance for Onabotulinum Toxin-A Injections: A Randomized Crossover Study.

Background: Botulinum neurotoxin (BoNT) injection is an established therapy for limb spasticity and focal limb dystonia. Comparative benefits of injection guidance procedures have not been rigorously studied.

Objectives: We compared 2 targeting techniques for onabotulinumtoxin-A (onabotA) injection for the treatment of focal hand dystonia and upper limb spasticity: electrophysiologic guidance using electrical stimulation (E-stim) and ultrasound (US).

Functional and Structural Brain Connectivity in Children With Bilateral Cerebral Palsy Compared to Age-Related Controls and in Response to Intensive Rapid-Reciprocal Leg Training.

Background: Compared to unilateral cerebral palsy (CP), less is known about brain reorganization and plasticity in bilateral CP especially in relation or response to motor training. The few trials that reported brain imaging results alongside functional outcomes include a handful of studies in unilateral CP, and one pilot trial of three children with bilateral CP. This study is the first locomotor training randomized controlled trial (RCT) in bilateral CP to our knowledge reporting brain imaging outcomes.

Early-Onset and Severe Complex Hereditary Spastic Paraplegia Caused by De Novo Variants in SPAST.

Background: Familial hereditary spastic paraplegia (HSP)-SPAST (SPG4) typically presents with a pure HSP phenotype.

Objective: The aim of this study was to delineate the genotypic and phenotypic spectrum of children with de novo HSP-SPAST.

Methods: This study used a systematic cross-sectional analysis of clinical and molecular features.

A scoping review of methods used in musculoskeletal soft tissue and nerve shear wave elastography studies.

This scoping review of shear wave elastography (SWE) articles in musculoskeletal soft tissue and nerve research demonstrates methodological heterogeneity resulting from a lack of standardized data collection and reporting requirements. Seven literature databases were searched for original articles published in English from 2004-2020 that examine human skeletal muscles, tendons, and nerves in vivo. Although 5,868 records were initially identified, only 375 reports met inclusion criteria.

Adolescents and adults with patellofemoral pain exhibit distinct patellar maltracking patterns.

Background: Chronic idiopathic patellofemoral pain is associated with patellar maltracking in both adolescents and adults. To accurately target the underlying, patient-specific etiology, it is crucial we understand if age-of-pain-onset influences maltracking.

Methods: Twenty adolescents (13.

Efficacy and safety of onabotulinumtoxinA with standardized occupational therapy for treatment of pediatric upper limb spasticity: Phase III placebo-controlled randomized trial.

Background: This is the first large study of onabotulinumtoxinA as treatment for pediatric upper limb spasticity.

Objective: Evaluate efficacy and safety of a single treatment with onabotulinumtoxinA plus occupational therapy (OT).

Methods: In this registrational phase III, multinational study (NCT01603602), participants were randomized 1:1:1 to onabotulinumtoxinA 3 U/kg/OT, 6 U/kg/OT, or placebo/OT.

Ergonomic Recommendations in Ultrasound-Guided Botulinum Neurotoxin Chemodenervation for Spasticity: An International Expert Group Opinion.

Ultrasound (US)-guided botulinum neurotoxin (BoNT) injections are becoming a mainstay in the treatment of muscle spasticity in upper motor neuron syndromes. As a result, there has been a commensurate increase in US-guided BoNT injection for spasticity training courses. However, many of these courses do not emphasize the importance of ergonomics.

Characterizing upper limb function in the context of activities of daily living in CLN3 disease.

In CLN3 disease, impairments in motor function are frequently reported to have later onset compared to visual and cognitive decline, but upper limb motor function has yet to be explored in this population. In a cohort of 22 individuals with CLN3, we used a novel application of multiple measures to (1) characterize motor function, particularly of the upper limbs, in activities of daily living (ADLs), and (2) explore associations between motor function and age as well as visual ability, disease severity, and cognitive function, as evaluated by the Unified Batten Disease Rating Scale (UBDRS), a validated CLN3 disease measure. ADLs that required coordination, speed, and fine motor control were particularly challenging for children with CLN3 based on item-level performance across direct assessments (Jebsen-Taylor Hand Function Test [JTHFT] and MyoSet Tools) and caregiver reports (Pediatric Evaluation of Disability Inventory-Computer Adaptive Testing [PEDI-CAT] and Patient-Reported Outcomes Measurement Information System [PROMIS] Pediatric Upper Extremity).

Botulinum Toxin A for Chronic Exertional Compartment Syndrome Evaluated With Shear Wave Elastography: A Case Report.

This case presentation offers supportive evidence that shear wave elastography may provide an alternative method of diagnosis of chronic exertional compartment syndrome (CECS). A 39-year-old female runner presented with bilateral anterior shin pain on exertion. She initially underwent compartmental pressure testing confirming the diagnosis of CECS but declined fasciotomy.

Functional near-infrared spectroscopy to assess sensorimotor cortical activity during hand squeezing and ankle dorsiflexion in individuals with and without bilateral and unilateral cerebral palsy.

Our study is the first comparison of brain activation patterns during motor tasks across unilateral cerebral palsy (UCP), bilateral cerebral palsy (BCP), and typical development (TD) to elucidate neural mechanisms and inform rehabilitation strategies. Cortical activation patterns were compared for distal upper and lower extremity tasks in UCP, BCP, and TD using functional near-infrared spectroscopy (fNIRS) and related to functional severity. Individuals with UCP ( , ), BCP ( , ), and TD ( , ) participated in this cross-sectional cohort study.

Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis.

Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging.

Self-reported benefit and weakness after botulinum toxin in dystonia.

With this retrospective, single center, chart review study, we investigate the self-reported benefit and weakness after botulinum toxin injections in three different types of dystonia: focal hand dystonia (FHD), blepharospasm and cervical dystonia. We found that the benefit lasts significantly longer in FHD compared to the other two groups.

Hip position influences shear wave elastography measurements of the hamstring muscles in healthy subjects.

Ultrasound shear wave elastography (SWE) has recently emerged as a non-invasive tool for assessing muscle stiffness. The majority of studies utilizing SWE have focused primarily on upper-extremity muscles, with little attention attributed to lower-extremity muscles. In addition, of the studies that have been published, various joint and muscle positions have been examined, rendering it difficult to compare results across studies.