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Idiopathic toe-walking in children : prevalence, neuropsychiatric symptoms and the effect of botulinum toxin A treatment

机译:儿童特发性脚趾行走:患病率,神经精神症状和肉毒毒素A的治疗作用

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摘要

Idiopathic toe-walking (ITW) is a term used to describe a state in which a child, in the absence of a known cause, walks on his or her toes, as compared to the normal heel-toe gait. The diagnosis is thus used when other defined causes are excluded. Problems that may develop with untreated ITW are shortened calf muscles with limited mobility in the ankle, pain, balance and foot problems. It has been shown that impaired ankle mobility is common in patients seeking orthopaedic help for foot problems. It is not uncommon for children with ITW to have problems playing sports or to be bullied.It has thus far been unknown how common it is for children to walk on toes.The first study in this thesis evaluates the prevalence of ITW in children evaluated at their final check-up (aged 5.5 years) at their local Child Welfare Centre (CWC). The result shows that out of 1,436 examined children, 2.09% were still toe-walking and 2.79% had been toe-walking but stopped prior to the final check-up.Neuropsychiatric conditions include among others ADHD, tics and autism. It is known that toe-walking is a common phenomenon in children with autism. The general impression among clinicians working with children and young people with other neuropsychiatric conditions is that toe-walking is more common also among these children. This potential comorbidity had not previously been investigated.The second study in this thesis shows that out of 51 children referred to Astrid Lindgren Children’s Hospital for ITW and evaluated for neuropsychiatric symptoms with a validated screening tool, about 25% are likely to have some sort of neuropsychiatric problem.There are many treatment options for ITW ranging from observation and stretch exercises to cast treatment and surgical procedures. Treatment of ITW with botulinum toxin A (BTX) is increasingly being used in clinical practice despite little scientific evidence as to its effectiveness in children with ITW.Studies 3 & 4 examine whether BTX treatment can improve the walking pattern in children with ITW, wherein Study 3 cautiously suggests that it can. Study 4 is a randomised controlled study that compares two groups of children with one group being treated with casts for 4 weeks and the second group receiving the same type of cast treatment in addition to treatment with BTX injections in the calf muscles. However, the results show that BTX does not improve the treatment outcome compared to cast treatment only.Clinical implications: The prevalence and early spontaneous course of ITW in children aged 5.5 years has been established and will affect the accuracy of the information we can give parents and influence the choice of treatment strategy for these children.We have become aware that children with ITW can have a variety of neuropsychiatric problems and that ITW should not always be seen as an isolated phenomenon.It is furthermore advisable to stop BTX treatment for ITW, thus preventing children from being exposed to ineffective treatment.
机译:特发性脚趾行走(ITW)是一个术语,用于描述与正常的脚趾脚趾步态相比,在没有已知原因的情况下儿童脚趾走路的状态。因此,当排除其他已定义的原因时,将使用诊断。未经治疗的ITW可能引起的问题是小腿肌肉缩短,踝关节活动受限,疼痛,平衡和足部问题。已经显示,脚踝移动性受损是寻求足部矫形手术患者的常见病因。患有ITW的儿童在运动或受到欺凌时并不少见。迄今为止,尚不清楚儿童脚趾走路的普遍性。本论文的第一项研究评估了ITW儿童在被评估的儿童中的患病率。他们在当地的儿童福利中心(CWC)进行了最终检查(年龄5.5岁)。结果显示,在1,436名接受检查的儿童中,有2.09%的儿童仍在脚趾行走,而2.79%的儿童仍在脚趾行走,但在最后检查之前就停止了行走。神经精神疾病包括多动症,抽动和自闭症。众所周知,在自闭症儿童中,脚趾行走是一种普遍现象。在有儿童和其他神经精神疾病的年轻人中工作的临床医生的普遍印象是,在这些儿童中,脚趾行走也更为普遍。这种潜在的合并症以前没有被研究过。本论文的第二项研究表明,在51名转给阿斯特丽德·林格伦儿童医院ITW并通过有效筛查工具评估神经精神症状的儿童中,约25%可能患有某种神经精神疾病.ITW有许多治疗选择,从观察和伸展运动到强制治疗和外科手术。尽管肉毒杆菌毒素A(BTX)在ITW儿童中的有效性尚缺乏科学证据,但在临床实践中仍越来越多地使用肉毒毒素A(BTX)治疗。研究3和4研究了BTX治疗是否可以改善ITW儿童的步行方式,其中研究3谨慎地建议可以。研究4是一项随机对照研究,比较了两组儿童,其中一组接受了石膏模型治疗4周,第二组除了在小腿肌肉中进行了BTX注射治疗外,还接受了相同类型的石膏治疗。然而,结果表明BTX与单纯的石膏疗法相比并不能改善治疗效果。临床意义:已经确定了5.5岁儿童ITW的患病率和早期自发性,将影响我们可以提供给父母的信息的准确性并影响这些儿童的治疗策略选择。我们已经知道,患有ITW的儿童可能会出现多种神经精神疾病,不应将ITW始终视为孤立现象。此外,建议停止对ITW进行BTX治疗,从而防止儿童受到无效治疗。

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    Engström Pähr;

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  • 年度 2012
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