Physiological characteristics of child athletes

Physiological characteristics of child athletes cannot be examined independently from the changes that occur during growth and maturation. This article reviews changes occurring in aerobic and anaerobic capacities, muscle strength and endurance in parallel with growth and development, and the factors affecting these changes, in particular, training. In addition, a brief evaluation is presented concerning the effects of physical activity, participation in sports, and training on growth and maturation.     

Protection of child human subjects.

Historical evidence indicates that research in child issues often involved institutionalized children, which resulted in the development of federal regulations for the protection of child human subjects. The central problem in research concerning children is that children lack the legal ability to consent. Therefore, federal regulations mandate that for children over 7 parental permission and child assent are required. In the assessment of risks and benefits, investigators and reviewers should consider children's age, maturity, and psychological state. The purpose of this article is to summarize the history on research in children and the development of current federal regulations and ethical principles. Then it focuses on children's involvement in the research participation decision and assesses associated developmental risk factors.     

Burn survivors injured as children exhibit resilience in long-term community integration outcomes: A life impact burn recovery evaluation (LIBRE) study

IntroductionThere is limited understanding of how burn injuries at different ages are associated with normal growth and development as well as the burn recovery process. This study provides new useful insights by comparing social participation outcomes among burn survivors injured in childhood compared with injuries sustained in middle age, and older adulthood.MethodsItems from the development of the LIBRE profile were administered to 601 adult burn survivors with ≥5% TBSA burned or burns to critical areas (hands, feet, face, or genitals). Each item was answered on a 5-point Likert scale with higher scores denoting better outcomes. Mean scores for the 6 LIBRE profile scales (sexual relationships, family and friends, social interactions, social activities, work and employment, and romantic relationships) were compared between those burned as children (<18 years) and those burned as adults (≥18 years). Regression analyses were used to assess differences between groups with adjustment for demographic and clinical characteristics.ResultsOf the 597 burn survivors having complete data on age at injury, 165 (27.6%) sustained burn injuries as a child. Those burned as children were more frequently female than those burned as adults (57% vs 47%) and were also more frequently white non-Hispanic (89% vs 77%). Marital status and education level were similar in the two groups. Those who were burned as children had slightly higher scores on the social activities, work and employment and romantic relationships scales. However, these differences did not persist in adjusted regression analyses.ConclusionsBurn survivors who sustained injuries as a child fared at least as well as those burned as adults in a broad range of long-term social participation outcomes. The impact on long-term social participation outcomes of burn survivors was not significantly different between individuals with burns sustained during important developmental stages at young ages and those injured later in life.     

Nierentransplantation bei Kindern

Kidney transplantation is the first line treatment for children with terminal renal failure. In addition to the survival rate of children and transplanted kidneys, the overall condition of the child with respect to growth and development is particularly important. The aims of pediatric renal transplantation are treatment strategies which minimize the side effects of immunosuppression and permit normal growth and development.     

Measurement of growth in children with renal insufficiency.

The serial measurement of stature, weight, skin-fold thickness, mean arm circumference, skeletal maturity, and where appropriate, stage of sexual development are recommended as suitable indices for assessing growth in children with kidney disease. Methods of expressing the data for evaluating the individual child are generally used methods. Emphasis is given to relating stature to bone age in evaluating growth potential. Methods for comparing growth rates in groups of children are less well-developed. Using standard deviation scores is recommended for comparing stature in two groups of children or in the same child observed at the end of two different regimens. Weight using ideal weight-for-height as reference from a group of children can be treated statistically. Data of skinfold thickness and arm circumference from two groups can be handled statistically only when the groups are comparable in age and sex.     

Should preparation for elite sporting participation be included in the rehabilitation process of war-injured veterans?

Background: Participation in sport and exercise training, while aiding in the reintegration and confidence building of wounded service personnel, also has potential to prepare them for elite sport competition. It is this encouragement of the war injured to use sport and recreational physical activity as a means of rehabilitation back into civilian life, which has become the worldwide phenomenon of Paralympic sport. Objectives: This paper evaluates existing research relating to the incidence of types of war injuries and the use of sport within the rehabilitation process. Study Design: Literature review. Methods: Initial searches were conducted in the electronic databases EBSCOHost, ScienceDirect and Pubmed using the keywords 'veterans' and 'sport' or 'physical activity'. These searches were then supplemented by tracking all key references from the appropriate articles identified. A narrative literature review methodology was employed. Results: Although it is clear from the reported literature that further development of available rehabilitation services is necessary to provide the required level of care for the types of mental and physical injuries and the concept of 'therapeutic recreation' is becoming popular, there is still a need for the development of specific protocols to identify individuals who can participate and excel in a specific sport at an elite level. Conclusions: Drawing on the US military experience it can be argued that sport in the UK and other parts of the world should be more widely recognized as a component of rehabilitation. This is not just for the role that sport can play as a tool for rehabilitation but also for the intrinsic and extrinsic benefits that participation in elite sport can offer. Clinical relevance Based on the findings, a clear protocol for the inclusion of elite sport training within rehabilitation process should be implemented. This protocol development and implementation should encompass a team of multidisciplinary rehabilitation professionals including rehabilitation medicine specialists, bioengineers, prosthetists, orthotists and physiotherapists along with sports and exercise scientists and Paralympic administrators.     

General considerations in the management of paediatric injuries

This report discusses the differences between the paediatric and adult musculoskeletal system. Consideration is given to preventive measures and the epidemiology and aetiology of fractures in relation to the developmental milestones in children. The principles of growth disturbances (overgrowth or growth arrest) and their management are presented. Pitfalls in diagnosis and different treatment options for paediatric fractures are discussed. Doctor-patient communication at different stages of growth and the importance of respecting the opinion of the child in management planning is emphasised.     

Allgemeine Gesichtspunkte zur kindorientierten Behandlung von Verletzungen

This report discusses the differences between the paediatric and adult musculoskeletal system. Consideration is given to preventive measures and the epidemiology and aetiology of fractures in relation to the developmental milestones in children. The principles of growth disturbances (overgrowth or growth arrest) and their management are presented. Pitfalls in diagnosis and different treatment options for paediatric fractures are discussed. Doctor-patient communication at different stages of growth and the importance of respecting the opinion of the child in management planning is emphasised.     

Growth in chronic kidney disease

Poor growth is a common sequela of CKD in childhood. It not only affects the psychosocial development of a child but also has significant effects even in the adult life. The multifactorial etiology and severe consequences of growth failure in CKD warrant evaluation of all the modifiable and nonmodifiable causes. Treatment strategies must be directed toward the specific factors for each child with CKD. Among the various metabolic, nutritional, and hormonal disturbances complicating CKD, disordered growth hormone (GH) and insulin-like growth factor-1 axis are important contributors toward poor growth in children with CKD. CKD is recognized as a state of GH resistance rather than GH deficiency, with multiple mechanisms contributing to this GH resistance. Recombinant GH (rGH) therapy can be used in this population to accelerate growth velocity. Although its use has been shown to be effective and safe in children with CKD, there continues to be some uncertainty and reluctance among practitioners and families regarding its usage, thereby resulting in a surprisingly low use in children with CKD. This review focuses on the pathogenesis of growth failure, its effect, and management strategies in children with CKD.     

Preconditioning principles for preventing sports injuries in adolescents and children

Preseason preconditioning can be accomplished well over a 4-week period with a mandatory period of rest as we have discussed. Athletic participation must be guided by a gradual increase of skills performance in the child assessed after a responsible preconditioning program applying physiologic parameters as outlined. Clearly, designing a preconditioning program is a dynamic process when accounting for all the variables in training discussed so far. Despite the physiologic demands of sport and training, we still need to acknowledge the psychologic maturity and welfare of the child so as to ensure that the sport environment is a wholesome and emotionally rewarding experience.     

Approach to skeletal maturation

Skeletal maturation is marked by an orderly and reproducible sequence of recognizable changes in the appearance of the skeleton during childhood. Such changes include the timing and sequence of the appearance of the centers of ossification, specific alterations in the contours of the bones, and the timing and sequence of the ultimate closure of the growth plates. Radiographically, skeletal maturity can be assessed by comparing the radiographic appearance of portions of an individual child's skeleton with the standardized appearance in a comparable population of children at various stages in their progress toward maturity. Radiographic assessment of skeletal maturity in the child is most frequently based on the appearance of the hand and wrist. Considerable normative data are available for this examination. The Greulich-Pyle atlas is the system which is most frequently used in the United States. Assessment of skeletal maturity can be useful in the evaluation and management of children with various endocrinopathies (especially those involving the pituitary, thyroid, and gonads) and in children with malformation syndromes. Skeletal maturity assessment is also frequently requested as part of the evaluation of children who are either too tall or too short for their chronologic age and can be used to predict height at maturity. Such assessment can also be useful in planning orthopedic procedures in which the outcome may be influenced by subsequent growth of the child (e.g., surgical management of scoliosis or leg-length discrepancy).     

Two cases of big-toe replantation: a ten-year follow-up

It is rare for traumatic amputation of the big toe to occur as a single injury. This trauma is especially significant in children for influencing foot development and for possible psychological impact. Two cases of successful replantation of completely amputated big toes in two girls, 2 years 7 months and 5 years 2 months old, are presented. Follow-up was 10 years. In the younger child, the replanted big toe was 49.2 percent shorter compared to the contralateral side, because growth was limited by the affected growth zone in the proximal phalanx. In the older child, the growth zone of the bone was intact, with consequent bone growth unimpaired, and an initial shortage of 10.4 percent was reduced to 2 percent compared to the contralateral side.     

Structured training of children fitted with myoelectric prostheses

This paper presents an occupational therapy method for training children fitted with myoelectric prostheses. It is based upon a structured way of describing the accomplishments of a child fitted with a myoelectric prosthesis, called the Skill Index Ranking Scale (SIRS). By using the SIRS when designing the training session, the therapist can progressively increase the demands presented to the child. Furthermore, the SIRS facilitates for the therapist the documentation and communication of the childs ability with the myoelectric prosthesis.     

胎儿和少儿皮肤内碱性成纤维细胞生长因子及其受体的基因表达

目的　探讨不同胎龄的胎儿和少儿皮肤中碱性成纤维细胞生长因子 (bFGF)及其两种受体 (bek和flg)基因表达的变化。 方法　提取 18例不同胎龄 ( 13～ 3 2周 )的胎儿皮肤和 6例少儿皮肤的总RNA后 ,分离mRNA ,用逆转录 聚合酶链反应 (RT PCR)方法检测这 3种基因在不同组织中的表达。结果　在早期妊娠胎儿的皮肤中 ,bFGF ,flg和bek基因表达较强 ,随着胎儿的生长和发育 ,皮肤组织内这 3种基因表达逐渐降低 ,在少儿皮肤中 3种基因的表达量分别为晚期妊娠胎儿皮肤的 62 .5 % ,5 9.5 %和 5 2 .9% ,基因表达显著降低 ( P <0 .0 5 )。结论　bFGF及其受体基因可能在皮肤的发生、结构功能的维持以及伤后修复中起重要作用。这 3种基因在胎儿皮肤中表达水平较高可能与胎儿皮肤细胞增殖较快 ,皮肤创面愈合迅速有关。     

The video invasion of rehabilitation

Motivating burned children to participate actively in rehabilitation at the burn unit demands many creative ideas. To avoid resistance from the child towards the exercises, it is important to offer a variety of techniques. A new play technique is outlined here, based on the use of video games, that is capable of motivating and stimulating children of all ages--even the youngest--towards active participation in rehabilitation.     

Sports for the physically challenged child

Participation in sports is important for the physical and emotional health of the physically challenged child. Sports can improve strength, endurance, and cardiopulmonary fitness while providing companionship, a sense of achievement, and heightened self-esteem. With interest in such participation increasing, it is necessary for the physicians, therapists, and families of children with special needs to understand the preparticipation evaluation, athletic options, specialized equipment, and sport-specific risks. Recommendations that provide guidelines for safe, effective participation in sports are currently available for common congenital and developmental disabilities such as Down syndrome, cerebral palsy, myelodysplasia, hemophilia, congenital amputations, and arthritic disorders.     

ENT management of a child with CHARGE association

The acronym CHARGE is used to describe specific congenital birth defects in children: colobomata, heart defect, atresia of the choanae, retarded growth or development, genital hypoplasia, and ear anomalies or deafness. CHARGE association with hearing impairment is a challenge to ENT surgeons. We report the case of a child with CHARGE association who underwent cochlear implantation using an unconventional surgical approach and review the postoperative speech perception results. The benefits of cochlear implantation in children with multiple congenital defects are discussed.     

Rehabilitation and outcome following pediatric traumatic brain injury

The long-term outcome for a child who has sustained a traumatic brain injury must be viewed in the context of ongoing development and maturation. Although neuronal plasticity provides the potential for neuronal reorganization in a child's brain, it is the behavioral demands of the environment that allow the child to take advantage of this potential and to maximize recovery. Pediatric rehabilitation is the setting that provides the necessary experiences for stimulating neuronal reorganization following TBI. However, neuronal reorganization has a cost to long-term development. The ultimate long-term impact of a TBI sustained in childhood depends on the child's ability to achieve developmental milestones following injury. Although injury-related and treatment-related factors are critical during the early stages of recovery, patient-related factors such as age-at-injury, developmental achievement at time of injury, maturation, and family involvement and resources impact the later stages of recovery. The process of pediatric rehabilitation following TBI is to provide an enriched, stimulating environment tailored to the needs of the child and based on real-word experiences. Early in the recovery process, pediatric rehabilitation is the setting that maximizes the potential for neuronal reorganization. Early rehabilitation also prepares the family for the child's long-term recovery and developmental needs. Involvement and training of family members early in the recovery process is critical for successful long-term outcome. Family members are the individuals best equipped to ensure treatment compliance and follow through with treatment recommendations, in maintaining treatment gains, and in generalizing treatment effects beyond the medical settings. Despite the life-long ramifications of childhood TBI, pediatric rehabilitation is the necessary step in promoting recovery and successful long-term outcome.     

Muscle and tendon injuries in children and adolescents

The pediatric athlete with open physeal plates is more susceptible to growth plate injuries and avulsion fractures than to ligament and muscle-tendon injuries that most often occur in adults. Muscle contusions and strains are common injuries in young athletes. Although they are rare in the early and middle stages of childhood, they become quite common during the growth spurt period. Healing of muscle tissues is much more rapid in children than that in adults, but it must be ensured that full motion and full strength are regained before returning to sports activities, because recurrences of injuries may result in more serious complications such as myositis ossificans. On the other hand, acute tendinous injuries are quite rare in children; however, repetitive submaximal stress may lead to overuse syndromes. This article reviews the basic anatomy and function of skeletal muscle and discusses the physiopathology of muscle-tendon injuries, and the methods of treatment and prevention, with particular focus on the growing child.