Hand function in children is very important in the development of skills needed for daily childhood activities; therefore, preserving this function warrants special attention. One of the interventions aiming to preserve functionis splinting of the affected wrist joint. The rationale for the use of splinting is to balance rest and activity, therebypreserving wrist function. However, the evidence-based knowledge to support this rationale is scarce. To determine the validity of “balancing rest and activity of the affected wrists to preserve function,” we reviewed ourown data, data in the literature regarding rheumatic wrist problems in children, and data from a 15-year followup study of rheumatic wrist problems in an adult cohort of our adult rheumatology counterpart within the medicalcenter.
Purpose: The purpose of this systematic review was to assess whether LBP patients demonstrate signs of splinting by evaluating the reactions to unexpected mechanical perturbations in terms of (1) trunk muscle activity, (2) kinetic and (3) kinematic trunk responses and (4) estimated mechanical properties of the trunk. Methods: The literature was systematically reviewed to identify studies that compared responses to mechanical trunk perturbations between LBP patients and healthy controls in terms of muscle activation, kinematics, kinetics, and/or mechanical properties. If more than four studies reported an outcome, the results of these studies were pooled. Results: Nineteen studies were included, of which sixteen reported muscle activation, five kinematic responses, two kinetic responses, and two estimated mechanical trunk properties. We found evidence of a longer response time of muscle activation, which would be in line with splinting behaviour in LBP. No signs of splinting behaviour were found in any of the other outcome measures. Conclusions: We conclude that there is currently no convincing evidence for the presence of splinting behaviour in LBP patients, because we found no indications for splinting in terms of kinetic and kinematic responses to perturbation and derived mechanical properties of the trunk. Consistent evidence on delayed onsets of muscle activation in response to perturbations was found, but this may have other causes than splinting behaviour.
Although essential for providing optimal adolescent patient support, knowledge of the impact of Marfan syndrome in adolescence is limited. To explore adolescents’ perceived impact of Marfan syndrome on (physical) functioning (activities, participation), disability (limitations, restrictions), contextual factors and support needs, we interviewed 19 adolescents with Marfan syndrome. Audio-recordings were transcribed, coded and analysed using thematic analysis. Identified themes were “difficulties in keeping up with peers” and “being and feeling different from peers”. Furthermore, an adolescent Marfan syndrome-specific International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) model derived from the data describing the adolescent perceived impact of Marfan syndrome on functioning, disability and its contextual factors. Adolescents perceived problems in keeping up with peers in school, sports, leisure and friendships/relationships, and they could not meet work requirements. Moreover, participants perceived to differ from peers due to their appearance and disability. Contextual factors: coping with Marfan syndrome, self-esteem/image, knowledge about Marfan syndrome, support from family/friends/teachers, ability to express needs and peer-group acceptation acted individually as barrier or facilitator for identified themes.
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