Secondary Effects of Botulinum Toxin Injections Into Salivary Glands for the Management of Pediatric Drooling.

Secondary effects of botulinum toxin injections into salivary glands for the management of pediatric drooling.

Filed under: Rehab Centers

J Craniofac Surg. 2013 Jan; 24(1): 28-33
Reid SM, Walstab JE, Chong D, Westbury C, Reddihough DS

ABSTRACT: This study aimed to assess the secondary benefits and adverse effects of botulinum toxin A injections into the parotid and submandibular glands in children with developmental disability and to determine whether these effects are related to reduction in drooling. Twenty-six children were injected (14 boys and 12 girls; mean age, 11 years 3 months). The Drooling Impact Scale and a secondary effects questionnaire covering aspects of eating, speech, saliva management, and sleep, were administered to the main carer at specific times before and after injection. Group mean preinjection and postinjection item and domain scores were compared using paired t tests. Change scores were calculated; individually categorized as improvement, no change, or deterioration; and related to change in drooling scores using linear regression analysis. Over 4 weeks, evidence of improvement was seen for the entire group with respect to drooling (P < 0.001), eating (P = 0.05), speech (P = 0.04), and sleep (P = 0.01), but not saliva management. Conversely, a minority of families reported worsening of eating skills after the injections that was directly related to lack of improvement in drooling. Because a minority of children unpredictably experience temporary adverse effects after botulinum toxin A injections into the salivary glands, swallowing function and nutritional status should be taken into account before proceeding with treatment. HubMed – rehab


The analysis of factors associated with improved glycemic con- trol in patients with insulin- requiring type 2 diabetes mellitus after treatment.

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Med Glas Ljek komore Zenicko-doboj kantona. 2013 Feb; 10(1): 86-92
Lazarevi? P, Stanojevi? D, Duki? A, Bubanja I, Bubanja D, Mladenovi? V, Krsti? V

Aim To observe the effect of standardized ten-day diabetes prevention and control program on glycemic control, and to analyze factors contributing signiicantly to improvement of glycemic control after the program/intervention. Methods A cross-sectional nested case-control study on 91 adult patients with insulin-requiring type 2 diabetes mellitus who underwent a standardized ten-day diabetes program in the Specialized Hospital “Merkur” in Vrnja?ka Banja, Serbia, from June the 1st to August 1st 2010 was performed. All necessary data were obtained from patients’ medical iles archived in this institution. Cases (n=32) and controls (n=32) were matched for age and sex. Results Diabetes program led to a signiicant decrease in mean daily blood glucose (p=0.039), achieved at the expense of the reduction of postprandial hyperglycemia (p=0.013). Male patients, patients with mean daily glycemia above the acceptable range before the intervention, and patients who were receiving combined therapy (insulin plus oral antidiabetics) before the intervention, were signiicantly more likely to achieve such positive outcome (ORadjusted = 344.48, 12.83, and 25.44 respectively, with 95%CIs that not included 1). Conclusion Standardized ten-day diabetes educational and rehabilitation program in the Specialized Hospital “Merkur” could be eficient in improving glycemic control, especially for male patients whose glucoregulation was poor despite the combined therapy with insulin and oral antidiabetic agents. Further investigation on determinants of eficiency of this program are necessary to understand better how to facilitate and support improvements in diabetes control at the population level.
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Knee and Elbow 3D Strength Surfaces: Peak Torque-Angle-Velocity Relationships.

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J Appl Biomech. 2012 Dec; 28(6): 726-37
Frey-Law LA, Laake A, Avin KG, Heitsman J, Marler T, Abdel-Malek K

Recognizing the importance of both the torque-angle and torque-velocity relations, three-dimensional (3D) human strength capabilities (i.e., peak torque as a function of both joint angle and movement velocity) have been increasingly reported. It is not clear, however, the degree to which these surfaces vary between joints, particularly between joints with similar biomechanical configurations. Thus, our goal was to compare 3D strength surfaces between the muscles about the elbow and knee hinge joints in men and women. Peak isometric and isokinetic strength was assessed in 54 participants (30 men) using the Biodex System 3 isokinetic dynamometer. Normalized peak torque surfaces varied significantly between flexion and extension (within each joint) and between joints; however, the normalized 3D torque surfaces did not differ between men and women. These findings suggest the underlying joint biomechanics are the primary influences on these strength surface profiles. Therefore, in applications such as digital human modeling, torque-velocity-angle relationships for each joint and torque direction must be uniquely represented to most accurately estimate human strength capability.
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Estimated force and moment of shoulder external rotation muscles: differences between transverse and sagittal planes.

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J Appl Biomech. 2012 Dec; 28(6): 701-7
de Castro MP, Ribeiro DC, de Camargo Forte F, de Toledo JM, Krug RC, Loss JF

The aim of this study was to compare shoulder muscle force and moment production during external rotation performed in the transverse and sagittal planes. An optimization model was used for estimating shoulder muscle force production of infraspinatus, teres minor, supraspinatus, anterior deltoid, middle deltoid and posterior deltoid muscles. The model uses as input data the external rotation moment, muscle moment arm magnitude, muscle physiologic cross-sectional area and muscle specific tension. The external rotation moment data were gathered from eight subjects in transverse and six subjects in sagittal plane using an isokinetic dynamometer. In the sagittal plane, all studied muscles presented larger estimated force in comparison with the transverse plane. The infraspinatus, teres minor, supraspinatus and posterior deltoid muscles presented larger moment in sagittal when compared with transverse plane. When prescribing shoulder rehabilitation exercises, therapists should bear in mind the described changes in muscle force production.
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Participation after Multidisciplinary Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults: A Systematic Review.

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Arch Phys Med Rehabil. 2013 Jan 21;
Brasure M, Lamberty GJ, Sayer NA, Nelson NW, Macdonald R, Ouellette J, Wilt TJ

OBJECTIVE: To determine effectiveness and comparative effectiveness of multidisciplinary rehabilitation programs for moderate to severe TBI in improving participation-related outcomes in adults. This manuscript presents results of select key questions from a recent Agency for Healthcare Quality and Research (AHRQ) comparative effectiveness review. DATA SOURCES: MEDLINE(®), Cochrane Central Register of Controlled Trials, and PsycINFO; hand searches of previous relevant reviews. STUDY SELECTION: We included prospective controlled studies that evaluated effectiveness or comparative effectiveness of multidisciplinary rehabilitation programs delivered to adults with moderate to severe TBI on their participation in life and community. DATA EXTRACTION: We extracted data, assessed risk of bias, and evaluated strength of evidence. Participation was selected as our primary outcome and included measures of productivity (e.g., return to employment or military service) and select scales measuring community integration. Only studies with a low or moderate risk of bias were synthesized. DATA SYNTHESIS: Twelve studies met our inclusion criteria; of these, 8 were of low or moderate risk of bias (4 randomized controlled trials of 680 patients and 4 cohort studies of 190 patients, sample size 36 to 366). Heterogeneous populations, interventions, and outcomes precluded pooled analysis. Evidence was insufficient to draw conclusions about effectiveness. Evidence on comparative effectiveness often demonstrated that improvements were not different between groups; however, this evidence was low strength and may have limited generalizability. CONCLUSIONS: Our review used a rigorous systematic review methodology and focused on participation after multidisciplinary rehabilitation programs for impairments from moderate to severe TBI. The available evidence did not demonstrate superiority of one approach over another. This conclusion is consistent with previous reviews that examined other patient-centered outcomes. While these findings will have little clinical impact, they do point out the limited evidence available to assess effectiveness and comparative effectiveness while highlighting important issues to consider in future comparative effectiveness research on this topic.
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