May 2017

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Editor Message


Concussion’s whole-body effects

As I was proofing pages for this month’s LER: Pediatrics, my next-door neighbor called to say her 9-year-old daughter had fallen, hard on her head, while practicing gymnastics. She wanted to me to come and watch her baby while she took her older child to the emergency department. But, after a few minutes of us watching her daughter vomit and not respond to questions, my neighbor asked me to call an ambulance.

The paramedics took daughter and mom to the hospital, and I sat with my neighbor’s baby, eventually returning to my editorial work, which included the story on page 6, “Gait metrics highlight gender differences after concussion.” I now reviewed the work with more gravity, thinking about the seriousness of these injuries, and how effects linger, including those affecting the lower extremities.

Later that day, my young neighbor was admitted to a pediatric intensive care unit, where neurologists diagnosed a concussion.

These head traumas, it turns out, raise risk for lower extremity injury for at least two years after concussion; the opposite is also true, with lower extremity injury upping risk for concussion. (See “Concussion repercussions: Studies explore lower extremity effects,” LER, June 2016, page 13). And, as the news story in this issue reports, after concussion children walk more slowly and take shorter and fewer steps during gait.

Gait and concussion, it seems, are linked—dual-task gait metrics, for example, are good at revealing biomechanical postconcussion deficits, as well as gender differences suggesting girls have more postinjury problems. Luckily, the youth sports community is heeding research about the short- and long-term effects of concussion. US Soccer, for example, in 2016 banned heading the ball for kids younger than 11, and restricted it for those aged 11 to 13.

Lower extremity practitioners have an important role to play in concussion rehabilitation, helping patients improve gait and regain strength losses common with the injuries, and with return-to-sports decisions.

My neighbor’s daughter is home now, and with time, I hope she’ll recover completely, perhaps with help from a lower extremity specialist.

By Emily Delzell, Senior Editor


  • Genetic mutations in CMT help predict phenotypic differences      

    Ankle strength commonly affected – Researchers are inching closer to being able to predict specific symptoms of Charcot-Marie-Tooth disease (CMT) based on a child’s genotype, but the variability found in a recent Australian study suggests that, for now, patients should still be assessed and managed individually.

    By Greg Gargiulo

  • Gait metrics highlight gender differences after concussion

    Girls show more postinjury changes – A recent study’s findings related to dual-task gait analysis in adolescents add to the body of evidence suggesting that concussion effects differ between male and female patients.

    By Hank Black

  • Age-based patterns of patellar maltracking require tailored care      

    PFP etiology differs in adults, kids – Patellar maltracking persists in adolescent girls with patellofemoral pain (PFP) even as symptoms improve, according to a study from Maryland, which suggests the etiology of PFP differs between adolescents and adults and should be managed accordingly.

    By Katie Bell


  • Fine-tuning orthotic device prescription, fitting in CP

    The heterogeneity of cerebral palsy means individual responses to orthotic devices vary widely. Moving beyond standardized  care to match orthotic prescriptions to each child’s unique gait issues, as well as to their individual footwear needs, however, will likely improve outcomes for all.

    By P.K. Daniel

  • Growth-plate injuries: a diagnostic challenge

    Physeal trauma can be hard to spot, and mismanagement can disturb normal development and lead to lower extremity issues,  such as limb-length discrepancy and  abnormal biomechanics. A thorough clinical exam, including details of the moment of injury, is often key to accurate diagnosis.

    By Shalmali Pal