Judith Gooch - Academia.edu (original) (raw)

Papers by Judith Gooch

Research paper thumbnail of Selective dorsal rhizotomy in children with spastic hemiparesis: Clinical article

Http Dx Doi Org 10 3171 2010 7 Peds09318, Oct 1, 2010

Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe... more Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

Research paper thumbnail of Care provider assessment of intrathecal baclofen in children

Develop Med Child Neurol, 2007

Research paper thumbnail of Muscle powered therapeutic vehicle

Research paper thumbnail of Evaluation of the Hip-Extensor Tricycle in Improving Gait in Children With Cerebral Palsy

Develop Med Child Neurol, 2008

Weakness of the hip extensor muscles contributes to the walking impairment of children with cereb... more Weakness of the hip extensor muscles contributes to the walking impairment of children with cerebral palsy, but it is difficult to strengthen these muscles. This study demonstrates greater activation of the hip extensor muscles when using a tricycle developed for this purpose than when using a traditional tricycle. The hip-extensor tricycle was also found to be more stable than a traditional tricycle. A 10-week field trial of the hip-extensor tricycle showed that visually analysed gait improved, but hip extensor strength did not. However, children used and enjoyed the tricycle, and parental reports were positive. This tricycle could be used to supplement other means of improving gait in children with CP.

Research paper thumbnail of An intensive motor skills treatment program for children with cerebral palsy

Journal of pediatric rehabilitation medicine, 2009

This article describes the development and efficacy of the Intensive Motor Skills Program conduct... more This article describes the development and efficacy of the Intensive Motor Skills Program conducted at Primary Children's Medical Center. The program was designed for children with cerebral palsy who have undergone a medical procedure and were determined to need a "jumpstart" to gain functional skills. Data was collected from parent interviews that determine desired outcomes during the two-week program. Parent ratings of performance and satisfaction were then analyzed to determine parents' perceptions of the program. Information was also collected and analyzed from therapists' short-term objectives and parent satisfaction surveys. The results indicated that parents perceived positive changes in their children's performance on goals addressed during the program. Positive changes in parents' satisfaction with how their child performed on the defined goals were also noted. Therapists documented that children in the program required decreasing levels of ass...

Research paper thumbnail of The contribution of tone to resting energy expenditure in children with moderate to severe cerebral palsy: Evaluation utilizing intrathecal baclofen injection

Journal of pediatric rehabilitation medicine, 2008

The extent to which high muscle tone contributes to the caloric needs of children with cerebral p... more The extent to which high muscle tone contributes to the caloric needs of children with cerebral palsy (CP) is debated. Understanding its contribution is important in predicting calorie needs in this population which frequently experiences under nutrition. Intrathecal baclofen is an innovative therapy now used for treatment of excessive tone. We prospectively studied the changes in resting energy expenditure (REE) observed in 12 children with CP undergoing intrathecal baclofen injection. REE was measured in the fasting state before intrathecal injection of 50 micrograms of baclofen. Patients remained fasting and REE measures were repeated four hours later. Tone changes were assessed using the Modified Ashworth Scale at the same time points. One child was excluded from study because he became increasingly agitated over the observation period and one child demonstrated no tone reduction after the baclofen injection. In the remaining 10 patients, the average REE prior to injection was 1...

Research paper thumbnail of Orthopedic surgery in children with intrathecal baclofen pumps

Journal of pediatric rehabilitation medicine, 2013

Children with cerebral palsy often have severe spasticity leading to deformity that requires mult... more Children with cerebral palsy often have severe spasticity leading to deformity that requires multiple orthopedic surgeries. Intrathecal baclofen pump implantation effectively decreases severe spasticity. The objective of this study was to determine whether children who have a baclofen pump implanted at a young age have fewer orthopedic surgeries than those who have a baclofen pump implanted at later ages. In this retrospective study of 310 children, we compared occurrence of surgery in relation to having or not having the baclofen pump, by using survival analysis with surgery as the outcome, presence of baclofen pump as the exposure of interest, modeled as a time-dependent variable, and age as the time scale. There was no significant effect of pump placement on overall surgery frequency. Analyses by type of surgery showed that those without a pump in place had a 64% lower hazard of scoliosis surgery. No evidence was found to indicate that children who have a baclofen pump implanted ...

Research paper thumbnail of Stereotactic endoscopic placement of third ventricle catheter for long-term infusion of baclofen in patients with secondary generalized dystonia

Journal of neurosurgery. Pediatrics, 2012

Continuous infusion of baclofen is a treatment option for severe generalized dystonia. Catheter i... more Continuous infusion of baclofen is a treatment option for severe generalized dystonia. Catheter insertion within the third ventricle has been described as an alternative to standard intrathecal placement to maximize intracranial concentrations of baclofen. The authors describe their experience with a novel technique for stereotactic endoscopic insertion of baclofen infusion catheters in the third ventricle in 3 patients with severe secondary generalized dystonia. Insertion was successful in all 3 patients, and all of them experienced significant improvement in dystonia scores on the Barry-Albright Dystonia Scale. Follow-up ranged from 5.5 to 7 months (mean 6 months), and no mechanical complications or CSF leaks were observed. The stereotactic endoscopic insertion of a baclofen infusion catheter into the third ventricle appears to be a safe method for continuous intraventricular baclofen infusion in patients with generalized secondary dystonia.

Research paper thumbnail of Prolonged, severe intrathecal baclofen withdrawal syndrome: a case report

Archives of physical medicine and rehabilitation, 2007

Intrathecal baclofen (ITB) withdrawal is a well-recognized complication when drug delivery is dis... more Intrathecal baclofen (ITB) withdrawal is a well-recognized complication when drug delivery is disrupted for any reason. ITB withdrawal varies widely in its severity and poses the very real possibility of death if not promptly managed. Cases of withdrawal lasting greater than 1 or 2 weeks, however, are sparse. We report the case of an 11-year-old girl with spastic quadriplegic cerebral palsy who developed an infected pump and subsequent meningitis, prompting the removal of her pump and catheter. She subsequently developed a severe, prolonged baclofen withdrawal syndrome marked by increased spasticity, agitation, hypertension, and tachycardia that lasted nearly 2 months, requiring intensive care and continuous intravenous sedation with benzodiazepines and opiates. Her pump was eventually replaced on hospital day 56 and within 24 hours her symptoms dramatically improved. She was eventually weaned off sedating medications and returned to baseline functional status. Typical management of...

Research paper thumbnail of Combining botulinum toxin and phenol to manage spasticity in children

Gooch JL, Patton CP. Combining botulinum toxin and phenol to manage spasticity in children. Arch ... more Gooch JL, Patton CP. Combining botulinum toxin and phenol to manage spasticity in children. Arch Phys Med Rehabil 2004;85:1121-4. Objective: To describe the specific techniques and adverse reactions of using concurrent, multiple injections of both botulinum toxin and phenol to manage spasticity in children with cerebral palsy (CP) and other neurologic conditions.

Research paper thumbnail of Selective dorsal rhizotomy in children with spastic hemiparesis

Journal of Neurosurgery: Pediatrics, 2010

Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe... more Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

Research paper thumbnail of Spinal Stenosis after Total Lumbar Laminectomy for Selective Dorsal Rhizotomy

Pediatric Neurosurgery, 1996

Knowledge of long-term outcome and complications of selective dorsal rhizotomy is limited due to ... more Knowledge of long-term outcome and complications of selective dorsal rhizotomy is limited due to the relatively recent introduction of the procedure. We describe 2 patients with cerebral palsy who developed lumbar spinal stenosis several years after selective dorsal rhizotomy. These patients also had substantial lateral trunk sway during gait and walked for several years with limited assistive devices. This abnormal gait pattern in combination with the changes from the selective dorsal rhizotomy may lead to the development of spinal stenosis.

Research paper thumbnail of Intraoperative Monitoring in Selective Dorsal Rhizotomy

Pediatric Neurosurgery, 1991

The method used in the intraoperative portion of the selective dorsal rhizotomy procedure for the... more The method used in the intraoperative portion of the selective dorsal rhizotomy procedure for the selection of abnormal circuits within the central nervous system of children with spasticity due to cerebral palsy is described. The decision to transect dorsal rootlets is made on the basis of electrophysiological, behavioral and medical criteria. In 100 cases the average number of rootlets transected was 64%. Of the total stimulated, 23.3% exhibited normal electrophysiological and behavioral responses. Decision making regarding the preservation or transection of the remaining 12.7% of the segments is described. This information is presented in an effort to increase understanding of this particular portion of the procedure and to encourage standardization of the procedure between centers in the future.

Research paper thumbnail of Complications of Intrathecal Baclofen Pumps in Children

Pediatric Neurosurgery, 2003

Intrathecal baclofen is increasingly being used to manage severe spasticity in children. Although... more Intrathecal baclofen is increasingly being used to manage severe spasticity in children. Although substantial tone reduction with this treatment has been documented, complications also occur. In this study, we describe the device- and major non-device-related complications in a group of 100 consecutive children and young adults who received 117 intrathecal baclofen pumps for the management of severe spasticity. Twenty-four patients (24%) experienced a total of 48 complications. The most common complication was disconnection of the catheter at its connection to the pump, occurring in 9% of pumps implanted. This complication occurred more frequently in pumps with catheter access ports (16%) than in those without ports (2%). Catheter dislodgement from the intrathecal space was the next most common complication, occurring in 8% of pumps implanted (13% of pumps with ports, 4% of pumps without ports). To decrease the occurrence of the most common complications of intrathecal pumps, we now typically implant pumps without catheter access ports, and we use 2-piece catheters. Although the lack of an access port may be a disadvantage for troubleshooting, most complications can be detected in pumps without a port. Patient and family education is critical in preventing serious consequences of baclofen withdrawal resulting from catheter-related complications.

Research paper thumbnail of Motor unit spike counts before and after maximal voluntary contraction

Muscle & Nerve, 1990

Motor unit spike counts in the biceps brachii muscle were evaluated using a monopolar needle elec... more Motor unit spike counts in the biceps brachii muscle were evaluated using a monopolar needle electrode during maintenance of antigravity posture with the elbow flexed to 45" before and afier maximal voluntary contraction (MVC). After MVC, the number of motor unit spikesisecond needed to maintain this posture was about 50% less than prior to MVC. Surface rectified integrated EMG activity declined in parallel to the decline in spike counts. To determine whether different muscles were compensating for the reduction in spike counts, synergistic muscles were examined simultaneously. Similar reductions were noted. In one deafferented subject, EMG activity increased rather than decreased after MVC. Fatigue decreases the contraction-relaxation rate of muscle fibers, which lowers fusion frequency.

Research paper thumbnail of Childhood traumatic brain injury: neuropsychological status at the time of hospital discharge

Developmental Medicine & Child Neurology, 2008

Research paper thumbnail of Care provider assessment of intrathecal baclofen in children

Developmental Medicine & Child Neurology, 2004

Research paper thumbnail of Evaluation of the Hip-Extensor Tricycle in Improving Gait in Children With Cerebral Palsy

Developmental Medicine & Child Neurology, 2008

Weakness of the hip extensor muscles contributes to the walking impairment of children with cereb... more Weakness of the hip extensor muscles contributes to the walking impairment of children with cerebral palsy, but it is difficult to strengthen these muscles. This study demonstrates greater activation of the hip extensor muscles when using a tricycle developed for this purpose than when using a traditional tricycle. The hip-extensor tricycle was also found to be more stable than a traditional tricycle. A 10-week field trial of the hip-extensor tricycle showed that visually analysed gait improved, but hip extensor strength did not. However, children used and enjoyed the tricycle, and parental reports were positive. This tricycle could be used to supplement other means of improving gait in children with CP.

Research paper thumbnail of Intrathecal baclofen withdrawal simulating neuroleptic malignant syndrome in a child with cerebral palsy

Developmental Medicine & Child Neurology, 2000

Research paper thumbnail of Prolonged paralysis after treatment with neuromuscular junction blocking agents

Critical Care Medicine, 1991

Previous reports have described prolonged paralysis after treatment with neuromuscular junction b... more Previous reports have described prolonged paralysis after treatment with neuromuscular junction blocking agents in critically ill patients. The purpose of this study was to further describe a group of patients who developed prolonged weakness after treatment with these agents. Clinical information, electrodiagnostic and muscle pathology results are described in this group of patients. Clinical information includes diagnoses, dosage of neuromuscular junction blocker, other medications affecting the neuromuscular system, and neuromuscular examination and clinical course. All patients were seen in the ICUs of three local hospitals. Included were critically ill patients with a variety of diagnoses, all of whom developed severe weakness after discontinuation of neuromuscular junction blocking agents. Electrodiagnostic studies and muscle biopsies were performed on several of the patients. All patients had pronounced weakness without sensory loss. Electrodiagnostic and muscle pathology findings were consistent with failed neuromuscular transmission. Although many patients had disorders or were taking medications that can injure the neuromuscular system, no disorder or medication was common to all. Recovery of strength often took several months and most patients were slow to wean from mechanical ventilator support. Although alternative explanations cannot be excluded with certainty, the use of neuromuscular junction blocking agents may lead to neurogenic atrophy and care must be taken when using them.

Research paper thumbnail of Selective dorsal rhizotomy in children with spastic hemiparesis: Clinical article

Http Dx Doi Org 10 3171 2010 7 Peds09318, Oct 1, 2010

Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe... more Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

Research paper thumbnail of Care provider assessment of intrathecal baclofen in children

Develop Med Child Neurol, 2007

Research paper thumbnail of Muscle powered therapeutic vehicle

Research paper thumbnail of Evaluation of the Hip-Extensor Tricycle in Improving Gait in Children With Cerebral Palsy

Develop Med Child Neurol, 2008

Weakness of the hip extensor muscles contributes to the walking impairment of children with cereb... more Weakness of the hip extensor muscles contributes to the walking impairment of children with cerebral palsy, but it is difficult to strengthen these muscles. This study demonstrates greater activation of the hip extensor muscles when using a tricycle developed for this purpose than when using a traditional tricycle. The hip-extensor tricycle was also found to be more stable than a traditional tricycle. A 10-week field trial of the hip-extensor tricycle showed that visually analysed gait improved, but hip extensor strength did not. However, children used and enjoyed the tricycle, and parental reports were positive. This tricycle could be used to supplement other means of improving gait in children with CP.

Research paper thumbnail of An intensive motor skills treatment program for children with cerebral palsy

Journal of pediatric rehabilitation medicine, 2009

This article describes the development and efficacy of the Intensive Motor Skills Program conduct... more This article describes the development and efficacy of the Intensive Motor Skills Program conducted at Primary Children's Medical Center. The program was designed for children with cerebral palsy who have undergone a medical procedure and were determined to need a "jumpstart" to gain functional skills. Data was collected from parent interviews that determine desired outcomes during the two-week program. Parent ratings of performance and satisfaction were then analyzed to determine parents' perceptions of the program. Information was also collected and analyzed from therapists' short-term objectives and parent satisfaction surveys. The results indicated that parents perceived positive changes in their children's performance on goals addressed during the program. Positive changes in parents' satisfaction with how their child performed on the defined goals were also noted. Therapists documented that children in the program required decreasing levels of ass...

Research paper thumbnail of The contribution of tone to resting energy expenditure in children with moderate to severe cerebral palsy: Evaluation utilizing intrathecal baclofen injection

Journal of pediatric rehabilitation medicine, 2008

The extent to which high muscle tone contributes to the caloric needs of children with cerebral p... more The extent to which high muscle tone contributes to the caloric needs of children with cerebral palsy (CP) is debated. Understanding its contribution is important in predicting calorie needs in this population which frequently experiences under nutrition. Intrathecal baclofen is an innovative therapy now used for treatment of excessive tone. We prospectively studied the changes in resting energy expenditure (REE) observed in 12 children with CP undergoing intrathecal baclofen injection. REE was measured in the fasting state before intrathecal injection of 50 micrograms of baclofen. Patients remained fasting and REE measures were repeated four hours later. Tone changes were assessed using the Modified Ashworth Scale at the same time points. One child was excluded from study because he became increasingly agitated over the observation period and one child demonstrated no tone reduction after the baclofen injection. In the remaining 10 patients, the average REE prior to injection was 1...

Research paper thumbnail of Orthopedic surgery in children with intrathecal baclofen pumps

Journal of pediatric rehabilitation medicine, 2013

Children with cerebral palsy often have severe spasticity leading to deformity that requires mult... more Children with cerebral palsy often have severe spasticity leading to deformity that requires multiple orthopedic surgeries. Intrathecal baclofen pump implantation effectively decreases severe spasticity. The objective of this study was to determine whether children who have a baclofen pump implanted at a young age have fewer orthopedic surgeries than those who have a baclofen pump implanted at later ages. In this retrospective study of 310 children, we compared occurrence of surgery in relation to having or not having the baclofen pump, by using survival analysis with surgery as the outcome, presence of baclofen pump as the exposure of interest, modeled as a time-dependent variable, and age as the time scale. There was no significant effect of pump placement on overall surgery frequency. Analyses by type of surgery showed that those without a pump in place had a 64% lower hazard of scoliosis surgery. No evidence was found to indicate that children who have a baclofen pump implanted ...

Research paper thumbnail of Stereotactic endoscopic placement of third ventricle catheter for long-term infusion of baclofen in patients with secondary generalized dystonia

Journal of neurosurgery. Pediatrics, 2012

Continuous infusion of baclofen is a treatment option for severe generalized dystonia. Catheter i... more Continuous infusion of baclofen is a treatment option for severe generalized dystonia. Catheter insertion within the third ventricle has been described as an alternative to standard intrathecal placement to maximize intracranial concentrations of baclofen. The authors describe their experience with a novel technique for stereotactic endoscopic insertion of baclofen infusion catheters in the third ventricle in 3 patients with severe secondary generalized dystonia. Insertion was successful in all 3 patients, and all of them experienced significant improvement in dystonia scores on the Barry-Albright Dystonia Scale. Follow-up ranged from 5.5 to 7 months (mean 6 months), and no mechanical complications or CSF leaks were observed. The stereotactic endoscopic insertion of a baclofen infusion catheter into the third ventricle appears to be a safe method for continuous intraventricular baclofen infusion in patients with generalized secondary dystonia.

Research paper thumbnail of Prolonged, severe intrathecal baclofen withdrawal syndrome: a case report

Archives of physical medicine and rehabilitation, 2007

Intrathecal baclofen (ITB) withdrawal is a well-recognized complication when drug delivery is dis... more Intrathecal baclofen (ITB) withdrawal is a well-recognized complication when drug delivery is disrupted for any reason. ITB withdrawal varies widely in its severity and poses the very real possibility of death if not promptly managed. Cases of withdrawal lasting greater than 1 or 2 weeks, however, are sparse. We report the case of an 11-year-old girl with spastic quadriplegic cerebral palsy who developed an infected pump and subsequent meningitis, prompting the removal of her pump and catheter. She subsequently developed a severe, prolonged baclofen withdrawal syndrome marked by increased spasticity, agitation, hypertension, and tachycardia that lasted nearly 2 months, requiring intensive care and continuous intravenous sedation with benzodiazepines and opiates. Her pump was eventually replaced on hospital day 56 and within 24 hours her symptoms dramatically improved. She was eventually weaned off sedating medications and returned to baseline functional status. Typical management of...

Research paper thumbnail of Combining botulinum toxin and phenol to manage spasticity in children

Gooch JL, Patton CP. Combining botulinum toxin and phenol to manage spasticity in children. Arch ... more Gooch JL, Patton CP. Combining botulinum toxin and phenol to manage spasticity in children. Arch Phys Med Rehabil 2004;85:1121-4. Objective: To describe the specific techniques and adverse reactions of using concurrent, multiple injections of both botulinum toxin and phenol to manage spasticity in children with cerebral palsy (CP) and other neurologic conditions.

Research paper thumbnail of Selective dorsal rhizotomy in children with spastic hemiparesis

Journal of Neurosurgery: Pediatrics, 2010

Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe... more Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

Research paper thumbnail of Spinal Stenosis after Total Lumbar Laminectomy for Selective Dorsal Rhizotomy

Pediatric Neurosurgery, 1996

Knowledge of long-term outcome and complications of selective dorsal rhizotomy is limited due to ... more Knowledge of long-term outcome and complications of selective dorsal rhizotomy is limited due to the relatively recent introduction of the procedure. We describe 2 patients with cerebral palsy who developed lumbar spinal stenosis several years after selective dorsal rhizotomy. These patients also had substantial lateral trunk sway during gait and walked for several years with limited assistive devices. This abnormal gait pattern in combination with the changes from the selective dorsal rhizotomy may lead to the development of spinal stenosis.

Research paper thumbnail of Intraoperative Monitoring in Selective Dorsal Rhizotomy

Pediatric Neurosurgery, 1991

The method used in the intraoperative portion of the selective dorsal rhizotomy procedure for the... more The method used in the intraoperative portion of the selective dorsal rhizotomy procedure for the selection of abnormal circuits within the central nervous system of children with spasticity due to cerebral palsy is described. The decision to transect dorsal rootlets is made on the basis of electrophysiological, behavioral and medical criteria. In 100 cases the average number of rootlets transected was 64%. Of the total stimulated, 23.3% exhibited normal electrophysiological and behavioral responses. Decision making regarding the preservation or transection of the remaining 12.7% of the segments is described. This information is presented in an effort to increase understanding of this particular portion of the procedure and to encourage standardization of the procedure between centers in the future.

Research paper thumbnail of Complications of Intrathecal Baclofen Pumps in Children

Pediatric Neurosurgery, 2003

Intrathecal baclofen is increasingly being used to manage severe spasticity in children. Although... more Intrathecal baclofen is increasingly being used to manage severe spasticity in children. Although substantial tone reduction with this treatment has been documented, complications also occur. In this study, we describe the device- and major non-device-related complications in a group of 100 consecutive children and young adults who received 117 intrathecal baclofen pumps for the management of severe spasticity. Twenty-four patients (24%) experienced a total of 48 complications. The most common complication was disconnection of the catheter at its connection to the pump, occurring in 9% of pumps implanted. This complication occurred more frequently in pumps with catheter access ports (16%) than in those without ports (2%). Catheter dislodgement from the intrathecal space was the next most common complication, occurring in 8% of pumps implanted (13% of pumps with ports, 4% of pumps without ports). To decrease the occurrence of the most common complications of intrathecal pumps, we now typically implant pumps without catheter access ports, and we use 2-piece catheters. Although the lack of an access port may be a disadvantage for troubleshooting, most complications can be detected in pumps without a port. Patient and family education is critical in preventing serious consequences of baclofen withdrawal resulting from catheter-related complications.

Research paper thumbnail of Motor unit spike counts before and after maximal voluntary contraction

Muscle & Nerve, 1990

Motor unit spike counts in the biceps brachii muscle were evaluated using a monopolar needle elec... more Motor unit spike counts in the biceps brachii muscle were evaluated using a monopolar needle electrode during maintenance of antigravity posture with the elbow flexed to 45" before and afier maximal voluntary contraction (MVC). After MVC, the number of motor unit spikesisecond needed to maintain this posture was about 50% less than prior to MVC. Surface rectified integrated EMG activity declined in parallel to the decline in spike counts. To determine whether different muscles were compensating for the reduction in spike counts, synergistic muscles were examined simultaneously. Similar reductions were noted. In one deafferented subject, EMG activity increased rather than decreased after MVC. Fatigue decreases the contraction-relaxation rate of muscle fibers, which lowers fusion frequency.

Research paper thumbnail of Childhood traumatic brain injury: neuropsychological status at the time of hospital discharge

Developmental Medicine & Child Neurology, 2008

Research paper thumbnail of Care provider assessment of intrathecal baclofen in children

Developmental Medicine & Child Neurology, 2004

Research paper thumbnail of Evaluation of the Hip-Extensor Tricycle in Improving Gait in Children With Cerebral Palsy

Developmental Medicine & Child Neurology, 2008

Weakness of the hip extensor muscles contributes to the walking impairment of children with cereb... more Weakness of the hip extensor muscles contributes to the walking impairment of children with cerebral palsy, but it is difficult to strengthen these muscles. This study demonstrates greater activation of the hip extensor muscles when using a tricycle developed for this purpose than when using a traditional tricycle. The hip-extensor tricycle was also found to be more stable than a traditional tricycle. A 10-week field trial of the hip-extensor tricycle showed that visually analysed gait improved, but hip extensor strength did not. However, children used and enjoyed the tricycle, and parental reports were positive. This tricycle could be used to supplement other means of improving gait in children with CP.

Research paper thumbnail of Intrathecal baclofen withdrawal simulating neuroleptic malignant syndrome in a child with cerebral palsy

Developmental Medicine & Child Neurology, 2000

Research paper thumbnail of Prolonged paralysis after treatment with neuromuscular junction blocking agents

Critical Care Medicine, 1991

Previous reports have described prolonged paralysis after treatment with neuromuscular junction b... more Previous reports have described prolonged paralysis after treatment with neuromuscular junction blocking agents in critically ill patients. The purpose of this study was to further describe a group of patients who developed prolonged weakness after treatment with these agents. Clinical information, electrodiagnostic and muscle pathology results are described in this group of patients. Clinical information includes diagnoses, dosage of neuromuscular junction blocker, other medications affecting the neuromuscular system, and neuromuscular examination and clinical course. All patients were seen in the ICUs of three local hospitals. Included were critically ill patients with a variety of diagnoses, all of whom developed severe weakness after discontinuation of neuromuscular junction blocking agents. Electrodiagnostic studies and muscle biopsies were performed on several of the patients. All patients had pronounced weakness without sensory loss. Electrodiagnostic and muscle pathology findings were consistent with failed neuromuscular transmission. Although many patients had disorders or were taking medications that can injure the neuromuscular system, no disorder or medication was common to all. Recovery of strength often took several months and most patients were slow to wean from mechanical ventilator support. Although alternative explanations cannot be excluded with certainty, the use of neuromuscular junction blocking agents may lead to neurogenic atrophy and care must be taken when using them.