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North Vancouver, Canada

Nadel H.R.,British Columbia Childrens Hospital
Seminars in Nuclear Medicine | Year: 2010

Bone scintigraphy is a sensitive tool to evaluate the musculoskeletal system in children. Hybrid imaging using computed tomography (CT) in combination with conventional bone scan and single photon emission computed tomography improves specificity and diagnostic accuracy. It also improves laboratory efficiency and may save the patient an additional visit to the hospital for a separate cross-sectional imaging study. We have found this technique to be particularly helpful in localizing a cause for pain in children who are nonverbal and to better delineate small bone and soft-tissue lesions that can occur with diagnoses of trauma, infection, and tumor. Special attention to technique of positioning the patient for potential CT examination is an adaptation that must be made by the technologist. Because of radiation concerns of the additional CT, obviously these examinations should be tailored to the individual child and be performed for limited sites directed to the abnormality observed on the associated single photon emission computed tomography examination or directed by the appropriate history. © 2010 Elsevier Inc. All rights reserved. Source


Lyons C.J.,British Columbia Childrens Hospital
Pediatric endocrinology reviews : PER | Year: 2010

Strabismus is a disabling aspect of thyroid orbitopathy. Whilst horizontal deviations can be corrected relatively simply, the propensity for inferior rectus involvement makes vertical deviations common. Because the deviations are usually incomitant, prisms have a limited role in management, and surgery is frequently indicated after stability has been documented for at least 6 months. Careful pre-operative discussion of the goals and limitations of strabismus surgery is of paramount importance since a degree of limitation remains postoperatively, even after two or even three surgeries. Nevertheless, with careful planning and duction-testing, a satisfactory central field of binocular single vision can be achieved in the primary position and downgaze, returning this group of patients to a comfortable binocular status for the majority of their day-to-day life. Source


Houghton K.,British Columbia Childrens Hospital
The Physician and sportsmedicine | Year: 2012

Arthritis in childhood can be associated with low levels of physical activity and poor physical fitness. Children with arthritis may have decreased aerobic and anaerobic fitness, muscle weakness, low bone mass, and low bone strength. Suboptimal physical activity and exercise capacity may contribute to further deconditioning and disability, placing children with arthritis at risk for poor health outcomes. Recent studies suggest that exercise therapy is safe and does not worsen arthritis. Exercise therapy may improve function, quality of life, and physical fitness. However, little is known about the exercise prescription that is most effective to improve clinical outcomes in children with arthritis. This article reviews the current literature on physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis. Source


Slobogean G.P.,University of British Columbia | Slobogean B.L.,British Columbia Childrens Hospital
Injury | Year: 2011

The increasing shift towards patient-centred healthcare has lead to an emergence of patient-reported outcome instruments to quantify functional outcomes in orthopaedic patients. Unfortunately, selecting an instrument for use in a shoulder trauma population is often problematic because most shoulder instruments were initially designed for use with chronic shoulder pathology patients. To ensure an instrument is valid, reliable, and sensitive to clinical changes, it is important to obtain psychometric evidence of its use in the target population. Four commonly used shoulder outcome instruments are reviewed in this paper: American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); Constant-Murley shoulder score (CMS); Disabilities of Arm, Shoulder, and Hand (DASH); Oxford Shoulder Score (OSS). Each instrument was reviewed for floor or ceiling effects, validity, reliability, responsiveness, and interpretability. Additionally, evidence of each instrument's psychometric properties was sought in shoulder fracture populations. Based on the current literature, each instrument has limited amounts of evidence to support their use in shoulder trauma populations. Overall, psychometric evaluations in isolated shoulder fracture populations remain scarce, and clinicians must remember that an instrument's properties are defined for the population tested and not the instrument. Therefore, caution must always be exercised when using an instrument that has not been fully evaluated in trauma populations. © 2010 Elsevier Ltd. Source


Houghton K.,British Columbia Childrens Hospital
Physician and Sportsmedicine | Year: 2012

Arthritis in childhood can be associated with low levels of physical activity and poor physical fitness. Children with arthritis may have decreased aerobic and anaerobic fitness, muscle weakness, low bone mass, and low bone strength. Suboptimal physical activity and exercise capacity may contribute to further deconditioning and disability, placing children with arthritis at risk for poor health outcomes. Recent studies suggest that exercise therapy is safe and does not worsen arthritis. Exercise therapy may improve function, quality of life, and physical fitness. However, little is known about the exercise prescription that is most effective to improve clinical outcomes in children with arthritis. This article reviews the current literature on physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis. Source

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