peadiatrics

Torticollis. 

Ever wonder what that is? Well, its a condition of the neck where it’ll be “naturally” positioned in a rotation and side flexed. Basically, malpositioning of the head during preganancy, causes injury to the sternocleidomastoid (SCM) muscle. When injury happens, naturally our body will act to heal it, however in this case, re-injury happens d/t the sustained posture therefore fibrous tumor would form at the SCM muscles. this stimulates healthy myoblasts to degenerate resulting in production of excessive collagen by the fibroblasts. End result? Contracture of the SCM.

Obvious impairments would be reduced ROM of the neck for the ipsilateral rotation and contralateral lateral flexion and muscle tightness which also affects hyoids, tongue and facial muscle. It is also impossible to maintain midline alignment of the head with the torso. Prolonged or untreated condition could also lead to scoliosis and facial asymmetry. 

As usual, physiotherapy treatment would be stretching of the tightened muscles. Besides that, babies grow up with stimulation. therefore, it is crucial to always stimulate them from the side that they neglected d/t the impairments. Personally, i think that this would also help the baby try to overcome the tightness themselves. Positioning should also be implement and teach to the parents for home -based treatment. Once, full ROM achieved more education and re-training of normal function have to be done as child may adapt to limitations they had. This includes symmetrical movement of the limbs, propping, rolling and symmetrical weight bear.All this treatment are done by stimulation. 

Perhaps on another notice, i’d talk specifically on treatment. :) 

Day 299. A picture of E&O on 25th August, over 2 months ago.
Staying over tonight for the first time since August, Oona is squeaky with a cold and teething so uncomfortable. I feel so guilty, I want to cry. I feel so useless as her Mother, it is really difficult staying over the night because of how odd and impersonal it feels. Out of place like setting up camp in a waiting room at an airport, but without the sensation of cosiness when your headed somewhere with loved ones.
I just want us to be together as a family, living under the same roof.

Contralateral Noise Stimulation Delays P300 Latency in School-Aged Children

by Thalita Ubiali, Milaine Dominici Sanfins, Leticia Reis Borges, Maria Francisca Colella-Santos

Background and Objective

The auditory cortex modulates auditory afferents through the olivocochlear system, which innervates the outer hair cells and the afferent neurons under the inner hair cells in the cochlea. Most of the studies that investigated the efferent activity in humans focused on evaluating the suppression of the otoacoustic emissions by stimulating the contralateral ear with noise, which assesses the activation of the medial olivocochlear bundle. The neurophysiology and the mechanisms involving efferent activity on higher regions of the auditory pathway, however, are still unknown. Also, the lack of studies investigating the effects of noise on human auditory cortex, especially in peadiatric population, points to the need for recording the late auditory potentials in noise conditions. Assessing the auditory efferents in schoolaged children is highly important due to some of its attributed functions such as selective attention and signal detection in noise, which are important abilities related to the development of language and academic skills. For this reason, the aim of the present study was to evaluate the effects of noise on P300 responses of children with normal hearing.

Methods

P300 was recorded in 27 children aged from 8 to 14 years with normal hearing in two conditions: with and whitout contralateral white noise stimulation.

Results

P300 latencies were significantly longer at the presence of contralateral noise. No significant changes were observed for the amplitude values.

Conclusion

Contralateral white noise stimulation delayed P300 latency in a group of school-aged children with normal hearing. These results suggest a possible influence of the medial olivocochlear activation on P300 responses under noise condition.

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4

MORE day 298
6.54 kilos, 14lbs 4oz
Not so keen on food today, struggling to breathe through snot. Bath and sore chest from scratching hickman dressing. Fashioned a vest out of tubey grip. 16ml over 18hrs and 3 hr break attempt.

It’s so cold in Oona’s room that I’m wearing my fleece-lined jacket. Blood sugar 4.4 after 2.5hrs break and 3.2 after 3hrs - not bad oobs!

Day - now I have truly lost count

I feel like Basil Faulty

So I asked the doctor this morning if we could do a gradual reduction in the vamin for the PN break to give her a chance for the body to make up for the sudden reduction in glucose flowing through her veins as her last 4 breaks gave blood sugars of 2, 2.1, 2.8 & 3.1. We want a blood sugar above 4 to be happy and 3.5 to be ok. So the doc said ask the nurse. So I mention to the ward matron about the reduction and she sort of doesn’t give a yay or nay answer. Then I ask the nurse, by this time shakey because I am asking the same question all over the place. I explain that a doctor recommended last week that perhaps we do a gradual reduction in the vamin and was it possible? She says she’ll ask ‘them’ later.. them being the doctors? Anyway so no one will give me a straightforward response or be responsible for saying yes or no or I’ll sort it. So I’m not going to be there when they do the break or able to help put the continuous feed on or give her food to keep her blood sugars high because I’ve got a doctors appointment myself (under-water ear pain agony). I end up expending four times the amount of energy than necessary trying to request a simple thing which was originally suggested by a doctor to get it to happen. Everyone is so resistant to take the responsibility of making a straightforward decision. And I am slumped on bench downstairs with blurred vision myself now hypoglycemic with the attempts just made.
Absurd doesn’t cover it.