WRITING: Some people think that a sense of competition in children should be encouraged. Others believe that children who are taught to co-operate rather than compete become more useful adults. Discuss both these views and give your own opinion. Before jumping to the conclusion we should encourage a sense of competition in children or teach them to co-operate to make them more useful adults, we should clarify the meaning of competition and co-operation. Initially, what is competition? Who are we and what are we doing when we are in competition? Competition means my success is your failure. If I obtain my goal, then you don’t obtain yours. It is essentially a "zero sums" game. Competition may be best described as a situation in which individuals or teams strive against each other to obtain a goal that only one can ultimately achieve. In a competition, one forces oneself to endure pain in the belief that it is the only way to get faster. On race day, Competition is inevitable; it is human nature, one is fiercely focused. Having trained so hard and made so many sacrifices, one wants to win, not just perform well . so, it’s not just winning that one wants, but the opportunity to prove oneself; the challenge of the competition. In a nutshell, Competition brings out the best in us, builds character and strengthens our esteem. And, what is cooperation? Cooperative learning is an instructional strategy in which students work together in groups that are carefully designed to promote positive interdependence cooperative learning requires students to share ideas, take risks, disagree with and listen to others, and generate and reconcile points of view. The task assignment is the crucial point in the formation of each group, and some tasks (like problem solving and open ended problems) are more easily performed in group than others Specifically, groups work according to implicit or explicit norms that regulate individual contributions. Students need to be taught how to help others in group, and individual accountability is essential to ensure generalized participation to cooperation. A cooperative learning approach may usually emerge when competitive behavior is negatively evaluated by schoolmates, especially when the class is more homogeneous in terms of student’s characteristics. In my point of view, both competition and cooperation should be taught to children on behalf of their usefulness Competition is a valuable experience for children as it can stimulate them to seek personal improvement as well as learn discipline, persistence and chance to assert themselves. Competition can help children to appreciate and value effort and excellence in themselves, their team mates, and their opponents. Whereas, cooperative activity allows for individualized attention for low achieving students, as well as providing an opportunity to high achievers to improve their understanding of the subject while exposing to the group. In addition, they are more inclined to gain recognition of their level of ability through competition in the class In a nutshell, education is a preparation for life and in life presents both competition and cooperation. So, children should be made to be familiar with them (453 words).,. Cerebral Angiography in Children Dr Nguyen Ngoc Pi Doanh Dr Dang Ngoc Dung • Angiography is a minimally invasive medical test that uses x-rays and an iodine-containing contrast material to produce pictures of blood vessels in the brain • Gold standard for imaging cerebral vasculature Neurointervention NeuroAngiography Indications • • • • Diagnosis of primary neurovascular disease Planning for neurointerventional procedure Intra-operative assistance Follow-up Imaging after treatment Procedure Procedure Complications Blood clot Air vasospasm Complications Neurological Complications -Cerebral ischemia -Transient cortical blindness -Amnesia Nonneurological Complications - Hematoma - Allergic reaction - Femoral artery pseudoaneurysm - Nephropathy - Thromboembolisim of the lower extremitries - Pulmonary embolism Complications • 19.826 pts • 1981-2003 • Neurologic complications: 522 (2.63%) – stroke with permanent disability : 27 (0.14%) – Death : 12 (0.06%) • Access-site hematoma : 4.2% - 2000, Denmark - 483 cerebral angiography/ 454 pts • 2001-2006, 2.924 diagnostic Cerebral Angiography, - U.K • Clinical complications: 23 (0.79%) – Puncture-site hematoma: 12 (0.41%) – Transient neurological events: 10 (0.34%) – Nonfatal reaction with contrast agent : – Permanent neurological Complications : http://stroke.ahajournals.org/ Radiographic: vasospasm , intraarterial dissection Complications In our Department • > 100 Diagnostic Cerebral Angiography/ year • complications – Broken catheter  Reuse – Permanent neurological Deficit Conclusion • Gold Standard • Invasive procedure- low complications 0-2% (neurological deficit)  Indication • Anatomy, skill, training Thanks for your attention 12 Management of spasticity in children Rachael Hutchinson and H. Kerr Graham Introduction Spasticity can be defined as a velocity-dependent resistance to passive movement of a joint and its associated musculature (Lance, 1980; Rymer & Pow- ers, 1989; Massagli, 1991). Although spasticity is usu- ally present before contracture in children with cere- bralpalsy, true muscle shortening or contracture also appears at an early stage. The majority of children will have a mixture of spasticity and contracture. Dis- tinguishing spasticity from contracture is important from a management point of view. 1. ‘Dynamic’ shortening is most commonly caused by spasticity but may also be associated with dystonia and mixed movement disorders. Typ- ically, ‘dynamic’ contracture is recognized in younger children with cerebral palsy or spas- ticity of recent onset. Such children are likely to exhibit hyperreflexia, clonus, co-contraction and a velocity-dependent resistance to passive joint motion. Children who exhibit ‘dynamic’ calf shortening may walk on their toes with an equinus gait, but on the examination couch the range of passive ankle dorsiflexion may be full or almost full. 2. ‘Fixed’ shortening or ‘myostatic’ contracture describes the typical stiffness found in mus- cles of older children with cerebral palsy or spasticity of longer duration. The stiffness is much less velocity dependent and is still present during couch examination and under anaesthesia. Causes of spasticity in children With the eradication of poliomyelitis and the dra- matic fall in the prevalence of spina bifida, the most common motor disorder in children in developed countries is cerebral palsy. The incidence of cere- bral palsy in developed countries is static or even ris- ing. The reductions in the prevalence of kernicterus due to neonatal jaundice has been overshadowed by improved survival of very low birth weight and premature infants, many of whom suffer from spas- tic diplegia and quadriplegia (Stanley & Alberman, 1984; Petterson et al., 1993a,b; Pellegrino & Dor- mans, 1998; Marlow et al., 2005). Other common causes of spasticity in children are acquired brain injury and spinal cord injury. Table 12.1 shows the cause of spasticity in a consecutive sample of 341 children seen in a variety of clinics at the Royal Chil- dren’s Hospital in Melbourne in 1998. Spasticity in children will continue to be a com- mon and challenging problem for the foreseeable future. While reduction in the incidence of cerebral palsy would have the most impact in reducing the overall incidence of spasticity in children, preven- tion of traumatic brain injury and spinal cord injury is probably more realistic (Glasgow & Graham, 1997). The pathology of spasticity Given that the most common cause of spasticity in our clinics is cerebral palsy, subsequent discussion 214 Management of spasticity in children 215 Table 12.1. Aetiology of spasticity in 341 children (cerebral palsy, orthopaedic and spasticity clinics) Cerebral palsy 79% Acquired brain injury 6% Spina bifida 5% Spinal cord injury 2% Miscellaneous 8% on pathology and management focuses mainly but not exclusively on spasticity in the context of juve- nile cerebral palsy. The effects of spasticity cannot be separated from the overall effects of the upper motor neurone (UMN) syndrome (Fig. 12.1). The child RESEARC H Open Access Oromotor variability in children with mild spastic cerebral palsy: a kinematic study of speech motor control Chia-ling Chen 1,2* , Hsieh-ching Chen 3 , Wei-hsien Hong 4 , Fan-pei Gloria Yang 5 , Liang-yi Yang 2 , Ching-yi Wu 6 Abstract Background: Treating motor speech dysfunction in children with CP requires an understanding of the mechanism underlying speech motor control. However, there is a lack of literature in quantitative measures of motor control, which may potentially characterize the nature of the speech impairments in these children. This study investigated speech motor control in children with cerebral palsy (CP) using kinematic analysis. Methods: We collected 10 children with mild spastic CP, aged 4.8 to 7.5 years, and 10 ag e-matched children with typical development (TD) from rehabilitation department at a tertiary hospital. All children underwent analysis of percentage of consonants correct (PCC) and kinematic analysis of speech tasks: poly-syllable (PS) and mono-syllable (MS) tasks using the Vicon Motion 370 system integrated with a digital camcorder. Kinematic parameters included spatiotemporal indexes (STIs), and average values and coefficients of variati on (CVs) of utterance duration, peak oral opening displacement and velocity. An ANOVA was conducted to determine whether PCC and kinematic data significantly differed between groups. Results: CP group had relatively lower PCCs (80.0-99.0%) than TD group (p = 0.039). CP group had higher STIs in PS speech tasks, but not in MS tasks, than TD group did (p = 0.001). The CVs of utterance duration for MS and PS tasks of children with CP were at least three times as large as those of TD children (p < 0.01). However, average values of utterance duration, peak oral opening displacement and velocity and CVs of other kinematic data for both tasks did not significantly differ between two groups. Conclusion: High STI values and high variability on utterance durations in children with CP reflect deficits in relative spatial and/or especially temporal control for speech in the CP participants compared to the TD participants. Children with mild spastic CP may have more difficulty in processing increased articulatory demands and resulted in greater oromotor variability than normal children. The kinematic data such as STIs can be used as indices for detection of speech motor control impairments in children with mild CP and assessment of the effectiveness in the treatment. Background Cerebral palsy (CP) refers to a group of developmental disorders in movement and postur e, which ar e attribu- ted to non-progressive disturbances that occurred in the developing fetal or infant brain [1]. Disturbed neuro- muscular control of speech mechanism often result in communication disorders, especially poor speech pro- duction in patients with CP [ 2]. Impaired speech functions such as articulation d isorders are present in 38% children with CP [3]. Reduced intelligibility in chil- dren with CP can adversely impact communication abil- ities and limit their vocational, educational, and social participation [4]. Such limitations may consequently diminish these children’s quality of life [4]. JNER JOURNAL OF NEUROENGINEERING AND REHABILITATION Reduced short term adaptation to robot generated dynamic environment in children affected by Cerebral Palsy Masia et al. Masia et al. Journal of NeuroEngineering and Rehabilitation 2011, 8:28 http://www.jneuroengrehab.com/content/8/1/28 (21 May 2011) RESEARC H Open Access Reduced short term adaptation to robot generated dynamic environment in children affected by Cerebral Palsy Lorenzo Masia 1* , Flaminia Frascarelli 2,5 , Pietro Morasso 1,4 , Giuseppe Di Rosa 2 , Maurizio Petrarca 2 , Enrico Castelli 2 and Paolo Cappa 3 Abstract Background: It is kno wn that healthy adults can quickly adapt to a novel dynamic environment, generated by a robotic manipulandum as a structured disturbing force field. We suggest that it may be of clinical in terest to evaluate to which extent this kind of motor learning capability is impaired in children affected by cerebal palsy. Methods: We adapted the protocol alread y used with adults, which employs a velocity dependant viscous field, and compared the performance of a group of subjects affected by Cerebral Palsy (CP group, 7 subjects) with a Control group of unimpaired age-matched children. The protocol included a familiarization phase (FA), during which no force was applied, a force field adaptation phase (CF), and a wash-out phase (WO) in which the field was removed. During the CF phase the field was shut down in a number of randomly selected “catch” trials, which were used in order to evaluate the “learning index” for each single subject and the two groups. Lateral deviation, speed and acceleration peaks and average speed were evaluated for each trajectory; a directional analysis was performed in order to inspect the role of the limb’s inertial anisotropy in the different experimental phases. Results: During the FA phase the movements of the CP subjects were more curved, displaying greater and variable directional error; over the course of the CF phase both groups showed a decreasing trend in the lateral error and an after-effect at the beginning of the wash-out, but the CP group had a non significant adaptation rate and a lower learning index, suggesting that CP subjects have reduced ability to learn to compensate external force. Moreover, a directional analysis of trajectories confirms that the control group is able to better predict the force field by tuning the kinematic features of the movements along different directions in order to account for the inertial anisotropy of arm. Conclusions: Spatial abnormalities in children affected by cerebral palsy may be related not only to disturbance in motor control signals generating weakness and spasticity, but also to an inefficient control strategy which is not based on a robust knowledge of the dynamical features of their upper limb. This lack of information could be related to the congenital nature of the brain damage and may contribute to a better delineation of therapeutic intervention. Background Cerebral palsy ( CP) is a group of non progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development [1,2]. Although motor impair- ment is the leading factor in CP, sensory disorders have been described [3] and sensorimotor cognitive functions are probably affected due to the complexity of the motor impairments implying primary and secondary deficits [4-6]. The last two decades has brought a BioMed Central Page 1 of 5 (page number not for citation purposes) Clinical and Molecular Allergy Open Access Research Asthma is a risk factor for acute chest syndrome and cerebral vascular accidents in children with sickle cell disease Mark E Nordness 1,2 , John Lynn 3 , Michael C Zacharisen* 4 , Paul J Scott 5 and Kevin J Kelly 6 Address: 1 Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA, 2 Prohealth Care Medical Center, N17 W24100 Riverwood Drive, Suite 150, Waukesha, Wisconsin, 53188, USA, 3 Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA, 4 Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA, 5 Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin, Blood Center of Southeastern Wisconsin, Milwaukee, Wisconsin, USA and 6 Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA Email: Mark E Nordness - mnord@mcw.edu; John Lynn - jlynn@mcw.edu; Michael C Zacharisen* - mzach@mcw.edu; Paul J Scott - jpscott@bcsew.edu; Kevin J Kelly - kkelly@mcw.edu * Corresponding author Abstract Background: Asthma and sickle cell disease are common conditions that both may result in pulmonary complications. We hypothesized that children with sickle cell disease with concomitant asthma have an increased incidence of vaso-occlusive crises that are complicated by episodes of acute chest syndrome. Methods: A 5-year retrospective chart analysis was performed investigating 48 children ages 3– 18 years with asthma and sickle cell disease and 48 children with sickle cell disease alone. Children were matched for age, gender, and type of sickle cell defect. Hospital admissions were recorded for acute chest syndrome, cerebral vascular accident, vaso-occlusive pain crises, and blood transfusions (total, exchange and chronic). Mann-Whitney test and Chi square analysis were used to assess differences between the groups. Results: Children with sickle cell disease and asthma had significantly more episodes of acute chest syndrome (p = 0.03) and cerebral vascular accidents (p = 0.05) compared to children with sickle cell disease without asthma. As expected, these children received more total blood transfusions (p = 0.01) and chronic transfusions (p = 0.04). Admissions for vasoocclusive pain crises and exchange transfusions were not statistically different between cases and controls. SS disease is more severe than SC disease. Conclusions: Children with concomitant asthma and sickle cell disease have increased episodes of acute chest syndrome, cerebral vascular accidents and the need for blood transfusions. Whether aggressive asthma therapy can reduce these complications in this subset of children is unknown and requires further studies. Background Sickle cell disease is a common debilitating hematologic disease occurring in 1 in 650 African Americans. Lung dis- ease is a major cause of cardiopulmonary disability and Published: 21 January 2005 Clinical and Molecular Allergy 2005, 3:2 doi:10.1186/1476-7961-3-2 Received: 20 July 2004 Accepted: 21 January 2005 This article is available from: http://www.clinicalmolecularallergy.com/content/3/1/2 © 2005 Nordness et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinical and Molecular Allergy 2005, 3:2 http://www.clinicalmolecularallergy.com/content/3/1/2 Page 2 of 5 (page number not for citation ...• Angiography is a minimally invasive medical test that uses x-rays and an iodine-containing contrast material to produce pictures of blood vessels in the brain • Gold standard for imaging cerebral. .. vasculature Neurointervention NeuroAngiography Indications • • • • Diagnosis of primary neurovascular disease Planning for neurointerventional procedure Intra-operative assistance Follow-up Imaging after... Access-site hematoma : 4.2% - 2000, Denmark - 483 cerebral angiography/ 454 pts • 2001-2006, 2.924 diagnostic Cerebral Angiography, - U.K • Clinical complications: 23 (0.79%) – Puncture-site hematoma: