Background: Surgery to achieve long bone lengthening and deformity correction in skeletally immature patients is traditionally performed through external fixators. The incidence of infection during treatment is high. Hydrotherapy is highly beneficial during external fixation management, but the infection rates may impact its utilization. The objective of this paper is to document the incidence and duration of infection in patients who participated in a full hydrotherapy program when performed under medical supervision and in accordance with strict follow-up protocols. Methods: In this retrospective study, we documented the key characteristics of patients who participated in hydrotherapy after lower limb external fixation surgery including age, sex, diagnosis and surgery site, the incidence and duration of pin site infections, and the percentage of cases, which were able to comply with a full hydrotherapy protocol. Results: The hydrotherapy pool met all daily water quality metrics. Thirty-four children (19 males and 15 females) had a mean±SD age of 10.9±4.6 years. Of the cases, 80% were unilateral and 20% were bilateral. Diagnoses included congenital hereditary (eg, achondroplasia), congenital nonhereditary conditions (eg, fibular hemimelia), and acquired conditions (eg, traumatic). The location of osteotomy site was quite evenly spread between the femur and the tibia/fibula. Three out of the 34 patients were unable to receive hydrotherapy due to continuous secretions; 2 patients did not miss any sessions. The mean number of treatments was 3 per week. During the entire period, a total of 1200 treatments were performed for these patients with only 32 cancellations (about 3%) due to secretions or other signs of infection. Spearman correlation coefficients showed significantly high correlations between the duration of external fixation and the duration of hydrotherapy. There are no significant correlations between infections and other factors (sex, age segment, whether the problem is unilateral or /bilateral, diagnosis, and duration of treatment). Conclusions: This is the first report, to our knowledge, that documents the low prevalence of infectious events during hydrotherapy treatment and demonstrates its feasibility. Level of Evidence: Level III; retrospective, comparative study.

Background: Arthrogryposis multiplex congenita patients’ functional abilities vary greatly, depending on the disease severity and treatment. This study aimed to identify and describe associations among physical impairments and long-term functional outcomes of adults with arthrogryposis. Methods: We interviewed 42 adult patients ( M =37 y, SD=12; range 20 to 74; 50% men) with arthrogryposis who were treated between 1988 and 2019 at a pediatric rehabilitation center or major adjacent general hospital. We evaluated their function and quality of life with the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD); Disabilities of the Arm, Shoulder, and Hand (Quick-DASH); and Short Form 36 Health Survey (SF-36) and compared variables using the Fisher exact and Mann-Whitney tests. Results: Participants were more likely than the general population to have graduate degrees and lower physical function, but rated their quality of life as similar. Despite high rates of musculoskeletal pain in the back (60%), hip (50%), shoulder-elbow (25%), and wrist (58%), only 2 participants reported regularly using pain medication. Over 83% had upper-limb involvement; upper-extremity and lower-extremity symptoms limited upper-extremity function. Upper limb function was correlated with shoulder, elbow and wrist symptoms but also with hip, knee and foot symptoms (Quick-DASH; P <0.05). General dysfunction was correlated with shoulder, spine, hip, and foot symptoms (PASIPD; P <0.05). Shoulder and spine symptoms had a grave effect on mobility. Participants who had spine surgery reported better upper-limb function than patients who did not (Quick-DASH; P <0.05). Conclusion: We found a significant discrepancy between the participants’ high quality of life and education levels and their limited mobility and social, physical, and upper-extremity function and high rates of symptoms. Pain management and social rehabilitation remain major aims for this population. Upper-extremity function was not only correlated with upper-extremity joint symptoms but also with lower-extremity joint dysfunction and appears to improve with spine surgery. It is possible that improved posture or seating position will enhance the functional position of the upper extremity. The ramifications of surgery and the correlation between extremity function should be further examined. Level of Evidence: Level 4.

Study Design: Ambispective study. Objectives: To determine the long-term natural history of non-surgically treated patients with myopathy and spinal deformity. Methods: Data were analyzed from 118 files from a children’s rehabilitation hospital. Seventeen patients were operated on; the remaining 101 patients (86%) were managed conservatively. Retrospective data included demographics, medical history, respiratory and mobility status, Cobb angle (CA), and pelvic obliquity (PO). Prospective data were obtained via telephone interviews and included the Scoliosis Research Society (SRS-22r), World Health Organization Quality of Life (QoL) (WHO-QoL) and Functional Independence Measure for Children (WeeFIM). Results: One hundred and one patients with myopathy and scoliosis did not have surgery and were followed for up to 33 years. Their mean age at first visit was 5.45 ± 5.27 years. CA and PO at the first visit were 27.05 ± 27.07 and 7.74 ± 9.81°, worsening to 46.95 ± 39.26 and 15.61 ± 8.57° at last visit. Respiratory data for 67 patients showed 45 who remained stable and 14 who worsened moderately and 5 severely. Mobility status worsened but not significantly. Of the 24 participants who responded to the survey (mean age 17.41 ± 10.84 years), 92% are single or divorced. They reported being generally satisfied with their QoL, although their functional scores indicated limited independence. Conclusions: Despite worsening of scoliosis and limited independence, participants were generally satisfied with their QoL.

To determine whether there was a reduction in fracture incidence amongst children with OI who were treated with both bisphosphonates and orthoses.Was there an additional reduction in fracture incid...

Objective: The study purpose was twofold: (1) to develop the Children’s Amputee Mobility Predictor and establish its content and social validity and (2) to determine its intra and inter-rater reliability. Design: A reliability and validity study. Setting: Pediatric rehabilitation hospital. Participants: Content validity study: 10 clinical experts; Social validity study: 24 stakeholders (i.e., children’s parents); Reliability study: 3 physical therapists. Intervention: Not applicable. Main measure: The functional capability of 30 children with leg length discrepancy was evaluated using the Children’s Amputee Mobility Predictor. The Intraclass Correlation Coefficient, two-way mixed model, and absolute agreement for a single measure were used to establish intra and inter-rater reliability. Results: Experts reached a consensus on the relevancy and clarity of all 26 tasks included in the Children’s Amputee Mobility Predictor. The intra- and inter-rater reliability were excellent, Intraclass Correlation Coefficient (ICC)_2,1= .95, with 95% CI ranging from 0.88–0.98; and ICC_3,1 = 0.96 with 95% CI ranging from 0.93–0.98, respectively. Parent feedback indicated the relevancy of tasks for children with leg length discrepancies. Conclusions: The Children's Amputee Mobility Predictor is a comprehensive outcome measure that requires minimal equipment or space. It appears stable over time when used by the same physical therapist and results suggest that it may be used by multiple physical therapists. The Children's Amputee Mobility Predictor appears to measure important and relevant aspects of functional capability and be a meaningful and relevant assessment tool, helping to guide the determination of medical necessity for specific prosthetic and physical therapy interventions.

Background/Objectives. Patient-Reported Outcome Measures (PROMs) capture patients’ perspectives about their health status, quality of life, and medical care outcomes. LIMB-Q Kids is a validated PROM designed to assess health-related quality of life (HRQL) in children with lower limb differences. It evaluates physical, social, and psychological function; symptoms related to the leg, hip, knee, foot and ankle; leg-related distress, appearance, and school-related concerns. It has now been translated and culturally adapted from English to other languages. The aim of this study was to translate and culturally adapt LIMB-Q Kids to Hebrew. Methods. Following international guidelines, two independent forward translations from English to Hebrew were produced and reconciled into a single version. A backward translation was then compared with the original to identify discrepancies. This draft underwent cognitive debriefing interviews (CDIs) with 11 children (ages 8–15) having lower limb differences to assess comprehension and cultural relevance. Results. CDIs revealed general issues including lengthy or unclear text, high-level language, cultural unfamiliarity and duplication of descriptors. Specific to Hebrew, issues included gender inflections and the need for vowel diacritics to support younger, less proficient readers. Revisions to 14 items were made. Conclusions. A translation and cultural adaption (TCA) process led to a linguistically validated and culturally adapted Hebrew version of LIMB-Q Kids. It can now be used for the clinical follow-up of children with lower limb differences including pre- and post-operatively, and as an aid to decision-making for surgery.