Shriners Hospitals for Children Chicago

Chicago, IL, United States

Shriners Hospitals for Children Chicago

Chicago, IL, United States
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Zhao L.,University of Illinois at Chicago | Zhao L.,University of Illinois at Urbana - Champaign | Zhao L.,Shriners Hospitals for Children Chicago | Patel P.K.,University of Illinois at Chicago | And 4 more authors.
Archives of Plastic Surgery | Year: 2012

Computer aided design and manufacturing (CAD/CAM) technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP) technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons. This article illustrates the components, system and clinical management of the VSP and CAD/CAM technology including: data acquisition, virtual surgical and treatment planning, individual implant design and fabrication, and outcome assessment. It focuses primarily on the technical aspects of the VSP and CAD/CAM system to improve the predictability of the planning and outcome. © 2012 The Korean Society of Plastic and Reconstructive Surgeons.

Albert C.,Marquette University | Albert C.,Orthopaedic and Rehabilitation Engineering Center | Jameson J.,Marquette University | Jameson J.,Orthopaedic and Rehabilitation Engineering Center | And 8 more authors.
Clinical Biomechanics | Year: 2013

Background: Osteogenesis imperfecta is a heterogeneous genetic disorder characterized by bone fragility. Previous research suggests that impaired collagen network and abnormal mineralization affect bone tissue properties, however, little data is yet available to describe bone material properties in individuals with this disorder. Bone material properties have not been characterized in individuals with the most common form of osteogenesis imperfecta, type I. Methods: Bone tissue elastic modulus and hardness were measured by nanoindentation in eleven osteotomy specimens that were harvested from children with osteogenesis imperfecta during routine surgeries. These properties were compared between osteogenesis imperfecta types I (mild, n = 6) and III (severe, n = 5), as well as between interstitial and osteonal microstructural regions using linear mixed model analysis. Findings: Disease severity type had a small but statistically significant effect on modulus (7%, P = 0.02) and hardness (8%, P < 0.01). Individuals with osteogenesis imperfecta type I had higher modulus and hardness than did those with type III. Overall, mean modulus and hardness values were 13% greater in interstitial lamellar bone regions than in osteonal regions (P < 0.001). Interpretation: The current study presents the first dataset describing bone material properties in individuals with the most common form of osteogenesis imperfecta, i.e., type I. Results indicate that intrinsic bone tissue properties are affected by phenotype. Knowledge of the material properties of bones in osteogenesis imperfecta will contribute to the ability to develop models to assist in predicting fracture risk. © 2012 Elsevier Ltd.

Krzak J.J.,Shriners Hospitals for Children Chicago | Krzak J.J.,University of Illinois at Chicago | Corcos D.M.,University of Illinois at Chicago | Graf A.,Shriners Hospitals for Children Chicago | And 3 more authors.
Gait and Posture | Year: 2013

Background: Fine wire electromyography (EMG) is commonly used for surgical decision making in equinovarus foot deformity. However, this invasive technique may have the unwanted effect of altering the gait of children with cerebral palsy (CP). The purpose of this study was to determine if fine wire insertion into the posterior tibialis muscle affects temporal-spatial parameters and hindfoot kinematics during gait in children with equinovarus secondary to hemiplegic CP. Methods: 12 children with hemiplegic CP who presented with an equinovarus foot (mean age 12.5 yrs, four right-sided, eight left-sided) were recruited. Temporal-spatial parameters and 3-D segmental foot and ankle kinematic gait data were collected utilizing standard gait analysis and the Milwaukee Foot Model (MFM). Three representative trials with and without fine wire electrode insertion were compared to determine the effect of electrode placement in the posterior tibialis on temporal spatial-parameters and hindfoot sagittal, coronal and transverse plane kinematic peaks, timing of kinematic peaks, and excursions. Results: No significant differences in any temporal-spatial or kinematic parameters were observed between " with wire" and " without wire" conditions. Strong correlations were observed among the gait parameters, with the exception of cadence, for the two conditions. Discussion: Fine wire insertion into the posterior tibialis had no measurable effect on the gait of individuals with equinovarus secondary to hemiplegic CP. This suggests that the simultaneous collection of segmental foot and ankle kinematics and fine wire EMG data of the posterior tibialis is acceptable for surgical decision making in this patient population. © 2012 Elsevier B.V.

Flanagan A.,Shriners Hospitals for Children Chicago | Gorzkowski M.,Shriners Hospitals for Children Chicago | Altiok H.,Shriners Hospitals for Children Chicago | Hassani S.,Shriners Hospitals for Children Chicago | Ahn K.W.,Medical College of Wisconsin
Clinical Orthopaedics and Related Research | Year: 2011

Background: To provide the best health care for individuals with myelomeningocele (MM), clinicians and researchers need to understand their health and functional status as well as quality of life. The literature is mixed regarding the relationship between motor level and health-related quality of life (HRQOL) for these individuals. Questions/purposes: We compared the HRQOL of children with MM at the L2 and above and L3-5 motor level and to demonstrate how having a shunt, age, and body mass index affect HRQOL instruments for these two motor level groups. Methods: We recruited 50 patients with MM (24 male, 26 female) with a mean age of 11.5 years (range, 5-18 years) and motor levels of L2 and above (n = 15) and L3-5 (n = 35). Guardians were interviewed using standardized functional and HRQOL tools (the Pediatric Quality of Life and the Pediatric Outcomes Data Collection Instrument); height, weight, presence of a shunt, ambulatory level, and body mass index were also collected. Results: We found a decreased HRQOL score for children with MM in the L2 and above motor level compared with those in the L3-5 motor level group. HRQOL had no correlation with body mass index and limited correlation with age. The presence of a shunt correlated with a decreased HRQOL. Conclusions: Children with MM had deficits in HRQOL and that was associated with neurologic level and presence of a shunt. Level of Evidence: Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. © 2011 The Association of Bone and Joint Surgeons®.

PubMed | USA Mobility, Medical College of Wisconsin, University of Wisconsin - Milwaukee and Shriners Hospitals for Children Chicago
Type: | Journal: Frontiers in bioengineering and biotechnology | Year: 2015

Currently, there is limited research of the biomechanics of pediatric manual wheelchair mobility. Specifically, the biomechanics of functional tasks and their relationship to joint pain and health is not well understood. To contribute to this knowledge gap, a quantitative rehabilitation approach was applied for characterizing upper extremity biomechanics of manual wheelchair mobility in children and adolescents during propulsion, starting, and stopping tasks. A Vicon motion analysis system captured movement, while a SmartWheel simultaneously collected three-dimensional forces and moments occurring at the handrim. A custom pediatric inverse dynamics model was used to evaluate three-dimensional upper extremity joint motions, forces, and moments of 14 children with spinal cord injury (SCI) during the functional tasks. Additionally, pain and health-related quality of life outcomes were assessed. This research found that joint demands are significantly different amongst functional tasks, with greatest demands placed on the shoulder during the starting task. Propulsion was significantly different from starting and stopping at all joints. We identified multiple stroke patterns used by the children, some of which are not standard in adults. One subject reported average daily pain, which was minimal. Lower than normal physical health and higher than normal mental health was found in this population. It can be concluded that functional tasks should be considered in addition to propulsion for rehabilitation and SCI treatment planning. This research provides wheelchair users and clinicians with a comprehensive, biomechanical, mobility assessment approach for wheelchair prescription, training, and long-term care of children with SCI.

January A.,Shriners Hospitals for Children Chicago | January A.,Marquette University | Zebracki K.,Shriners Hospitals for Children Chicago | Zebracki K.,Loyola University Chicago | And 3 more authors.
Topics in Spinal Cord Injury Rehabilitation | Year: 2014

Objective: To investigate mental health problems in adults with pediatric-onset spinal cord injury (SCI) and explore how these problems relate to the risk of negative outcomes over time. Method: The study included 466 adults who sustained an SCI prior to age 19 years and had been injured for at least 1 year. Participants were interviewed on an approximately annual basis using a study-specific questionnaire and standardized measures of depression, anxiety, substance use, and community involvement. Generalized estimating equations were used to assess the risk of negative outcomes across time as a function of depression, anxiety, and substance misuse. Results: Of the participants who reported on each domain of mental health, 26% reported misuse of alcohol or drugs (122/466), 21% reported problems with depression (78/360), and 29% reported problems with anxiety (49/168). Depression was associated with increased odds of pressure ulcers, urinary tract infections, hospitalizations, pain, and smoking and lower levels of economic independence and mobility. Anxiety was associated with increased odds of hospitalization, pain, and smoking. Substance misuse predicted an increased risk of pressure ulcers, pain, and smoking and decreased odds of occupational involvement. When examining the effect of mental health with time, results showed that depression accelerated the risk of urinary tract infections, respiratory complications, and hospitalizations and anxiety and depression accelerated risk for lower occupational independence. Conclusions: The added burden that mental health difficulties pose for medical and psychosocial outcomes highlight the importance of monitoring and treating mental health symptoms in pediatric-onset SCI. © 2014 Thomas Land Publishers, Inc.

Albert C.,Shriners Hospitals for Children Chicago | Albert C.,Marquette University | Jameson J.,Marquette University | Jameson J.,Lawrence Berkeley National Laboratory | And 4 more authors.
Bone | Year: 2014

Osteogenesis imperfecta is a genetic disorder resulting in bone fragility. The mechanisms behind this fragility are not well understood. In addition to characteristic bone mass deficiencies, research suggests that bone material properties are compromised in individuals with this disorder. However, little data exists regarding bone properties beyond the microstructural scale in individuals with this disorder.Specimens were obtained from long bone diaphyses of nine children with osteogenesis imperfecta during routine osteotomy procedures. Small rectangular beams, oriented longitudinally and transversely to the diaphyseal axis, were machined from these specimens and elastic modulus, yield strength, and maximum strength were measured in three-point bending. Intracortical vascular porosity, bone volume fraction, osteocyte lacuna density, and volumetric tissue mineral density were determined by synchrotron micro-computed tomography, and relationships among these mechanical properties and structural parameters were explored.Modulus and strength were on average 64-68% lower in the transverse vs. longitudinal beams (P<. 0.001, linear mixed model). Vascular porosity ranged between 3 and 42% of total bone volume. Longitudinal properties were associated negatively with porosity (P≤. 0.006, linear regressions). Mechanical properties, however, were not associated with osteocyte lacuna density or volumetric tissue mineral density (P≥. 0.167). Bone properties and structural parameters were not associated significantly with donor age (P≥. 0.225, linear mixed models).This study presents novel data regarding bone material strength in children with osteogenesis imperfecta. Results confirm that these properties are anisotropic. Elevated vascular porosity was observed in most specimens, and this parameter was associated with reduced bone material strength. These results offer insight toward understanding bone fragility and the role of intracortical porosity on the strength of bone tissue in children with osteogenesis imperfecta. © 2014 Elsevier Inc.

Holbein C.E.,Loyola University Chicago | Lennon J.M.,Loyola University Chicago | Kolbuck V.D.,Loyola University Chicago | Zebracki K.,Loyola University Chicago | And 3 more authors.
Journal of Pediatric Psychology | Year: 2015

Objective To identify differences in social behaviors in observed peer interactions between children with spina bifida (SB) and peers, and to examine neuropsychological correlates of these differences. Method A total of 100 youth (aged 8-15 years) with SB and peers participated in video-recorded interaction tasks, which were coded for interaction style, affect, and collaboration. Children with SB also completed a neuropsychological test battery. Results Children with SB demonstrated less adaptive social behaviors in peer interactions, particularly within the interaction style domain. Observational items found to be different between children with SB and their peers were best predicted by social language and attention abilities. Conclusions Children with SB exhibit a less adaptive interaction style and lower levels of social dominance but are comparable with typically developing peers on other social behaviors. The observed group differences may have a neuropsychological basis.

Riordan A.,Shriners Hospitals for Children Chicago | Kelly E.H.,Shriners Hospitals for Children Chicago | Kelly E.H.,University of Illinois at Chicago | Klaas S.J.,Shriners Hospitals for Children Chicago | And 2 more authors.
Journal of Spinal Cord Medicine | Year: 2015

Objective: Examine psychosocial outcomes of youth with spinal cord injury (SCI) as a function of neurological level (paraplegia/tetraplegia) and severity (American Spinal Injury Association (ASIA) Impairment Scale (AIS)). Design: Survey research. Setting: Three pediatric SCI specialty centers in the USA. Participants: Youth with SCI ages 5-18 with neurological impairment classifications of: tetraplegia AIS ABC (tetraplegia ABC), paraplegia AIS ABC (paraplegia ABC), or AIS D. Outcome Measures: Children's Assessment of Participation and Enjoyment, Pediatric Quality of Life Inventory, Revised Children's Manifest Anxiety Scale, and Children's Depression Inventory. Results: Three hundred and forty youth participated; 57% were male; 60% were Caucasian, 21% Hispanic, 7% African-American, 2% Native American, and 3% reported "other". Their mean age was 8.15 years (standard deviation (SD) = 5.84) at injury and 13.18 years (SD = 3.87) at interview. Ninety-six youth (28%) had tetraplegia ABC injuries, 191 (56%) paraplegia ABC injuries, and 53 (16%) AIS D injuries. Neurological impairment was significantly related to participation and quality of life (QOL). Specifically, youth with paraplegia ABC and AIS D injuries participated in more activities than youth with tetraplegia ABC (P = 0.002; P = 0.018, respectively) and youth with paraplegia ABC participated more often than youth with tetraplegia ABC (P = 0.006). Youth with paraplegia ABC reported higher social QOL than youth with tetraplegia ABC (P = 0.001) and AIS D injuries (P = 0.002). Groups did not differ regarding mental health. Conclusion: Interventions should target youth with tetraplegia ABC, as they may need support in terms of participation, and both youth with tetraplegia ABC and AIS D injuries in terms of social integration. © The Academy of Spinal Cord Injury Professionals, Inc. 2015.

Flanagan A.,Shriners Hospitals for Children Chicago | Kelly E.H.,Shriners Hospitals for Children Chicago | Kelly E.H.,University of Illinois at Chicago | Vogel L.C.,Shriners Hospitals for Children Chicago | Vogel L.C.,Rush University Medical Center
Pediatric Physical Therapy | Year: 2013

PURPOSE: To describe psychosocial outcomes of children and adolescents with early-onset spinal cord injury (SCI) and spina bifida (SB) and identify differences between them. METHODS: Eighty-three participants had acquired SCI before age 3 years (mean age 10.6 ± 3.8 yrs), and 54 had SB (mean age 11.7 ± 4.1 yrs). The participants completed standardized assessments of participation, quality of life (QOL), anxiety, and depression. Independent-sample t tests and Mann-Whitney tests were used to assess group differences. RESULTS: Participants with SCI reported higher school QOL (P = .016) and lower anxiety with social concerns/concentration (P = .037) than did participants with SB. The subgroup of participants with SCI with paraplegia reported higher school (P = .014) and overall (P = .034) QOL, and they participated in more activities (P = .015) than participants with SB. CONCLUSIONS: Children and adolescents with SCI with paraplegia have greater school and overall QOL and participate in more activities than children and adolescents with SB. Children and adolescents with SB would benefit from increased support at school and in social participation. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins and Section on Pediatrics of the American Physical Therapy Association.

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