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History: Fourteen year old male with no significant medical history who presents with acute low back discomfort and progressive bilateral lower extremity weakness during a surfing lesson. The patient and his family were on vacation and were receiving surfing lessons for the first time. During his lesson, he noted an initial "twinge" in his lower back while working with smaller waves but continued on with the lesson. Shortly after, he had attempted to stand and catch a larger wave but felt his lower back and legs give out. He landed onto the surfboard on his buttocks and continued to experience weakness in his legs. He lowered himself back onto the board in a prone position and informed his surfing instructor of his symptoms. The 2 remained in the ocean, and the instructor advised him to remain prone until the discomfort subsided. After 20 minutes, the pain persisted, and the decision was made to stop the lesson and paddle back to shore. The patient was able to stand up but was unable to walk secondary to weakness and pain, requiring the assistance of others. He was taken to his car by his father and remained supine while the rest of his family members finished their lessons for another 40 minutes. Upon return to their hotel, the patient noticed progressive weakness and was now unable to stand on his own. His parents called EMS at this point, and he was brought to the ED. Physical Examination: Vitals unremarkable, BMI 20.3. Gen: lying comfortably on exam bed, in NAD. Normal medical exam. Neurologic exam Motor: 5/5 strength in bilateral extremities throughout, 3/5 in hip flexion bilaterally, 2/5 hip abduction and adduction, 2/5 knee extension and flexion, 0/5 ankle dorsiflexion and plantarflexion bilaterally. Sensory: diminished to light touch from L1 dermatome downwards bilaterally, diminished to pinprick from L2 dermatome downwards bilaterally, vibration and proprioception intact in all 4 extremities. Reflexes: 2+ and symmetric throughout. Differential Diagnosis: Vascular: primary and secondary ischemia of the spinal cord (surfers myelopathy, anterior cord syndrome, posterior cord syndrome), spinal hemorrhage (epidural, subdural, subarachnoid, intraparenchymal), vascular malformations inflammatory: transverse myelitis, multiple sclerosis, abscesses (epidural, subdural); disc prolapse; neoplasm; Guillain- Barre Syndrome. Tests and Results: Laboratory: complete blood count and chemistry unremarkable. CT Lumbar spine without contrast: unremarkable. MRI Thoracic Spine: abnormally increased T2 signal within the central cord from T8 to T11. Suggestion of a small central disc protrusion at C5-C6 level that does not cause mass effect upon the cord. Final/Working Diagnosis: Surfer's Myelopathy. Treatment: The patient was admitted to an inpatient pediatric floor and was managed conservatively without steroids. He was placed on lovenox for DVT prohylaxis and an indwelling urinary catheter was placed for his neurogenic bladder. Medical course was uncomplicated, and he then underwent acute inpatient pediatric rehabilitation at Rusk Rehabilitation. Outcome: On admission to inpatient rehabilitation, he was classified as a T12 ASIA impairment scale (AIS) C. Upon discharge home, he improved to a T12 AIS D and was at an independent or supervision level for his ADLs and ambulation with lofstrand crutches and bilateral AFOs. He has also regained full recovery of his bowel and bladder function. Return to Activity and Follow-Up: He continued with outpatient rehabilitation services and also started hyperbaric oxygen therapy (HBOT) in order to expedite recovery as it can promote angiogenesis and increase neuroprotective factors in the spinal cord. He completed his outpatient therapies and received 20 sessions of HBOT and is currently independent in ADLs, and although he remains with residual foot drop, he is currently ambulating without an assistive device. He has been cleared to return to school but is currently restricted from participation in gym class and sports

Patients or Programs: A 14-year-old boy with lumbosacral plexopathy after gunshot wounds. Program Description: The patient presented to acute care after 2 gunshot wounds to the abdomen, which required multiple procedures, including a laparotomy and left thoracotomy for abdominal aortic repair. He had an L3 fracture and paraspinal hematoma, with paresthesias and left lower extremity (LLE) weakness. He was given a lumbar sacral orthosis and an ankle-foot orthosis. Upon admission to acute rehabilitation, his LLE strength was 2-/5 to 3-/5 except 0/5 for dorsiflexion. He had LLE tingling. Electrodiagnostic testing revealed positive sharp waves in the left tibialis anterior, peroneus longus, tibialis posterior, tensor fascia lata, gastrocnemius, vastus medialis and rectus femoris, and gluteus maximus with reduced recruitment patterns on strong effort. There was no response on sensory nerve action potentials in the left superficial and sural nerves. Findings were consistent with a left lumbosacral plexopathy with the L5 root most severely involved. Setting: A pediatric rehabilitation unit in a tertiary care hospital. Results: The patient made significant functional gains, with improvements in bed mobility, transfers, and ambulation. Upon discharge, he was independent in activities of daily living and ambulated 100 ft modified independent with a cane. He was without further improvement of innervation of LLE or gait pattern as an outpatient. He is pending reimaging and electrodiagnostics and possible plexus exploration for adhesions. Discussion: The patient presented with a lumbosacral plexopathy after trauma, an L3 fracture, paraspinal hematoma, and abdominal surgery. Lumbosacral plexopathy is relatively uncommon because the plexus has a rich blood supply. It presents with motor and sensory deficits in a distribution of multiple nerves that originate from the plexus. Etiologies include pelvic injuries or tumors, hemorrhages, trauma, ischemia, inflammation, and postpartum injury. Conclusions: Lumbosacral plexopathy is rare, has varying etiologies, and may cause severe neurologic deficits. Electrodiagnostic testing can be diagnostic

Central to the longitudinal management of childhood hypertonia are nonsurgical treatments. These include physical and occupational therapy, electrical stimulation, orthotics, botulium toxin, and drugs. This manuscripts reviews these treatment modalities as well as evaluation tools available to assess their impact on a child's hypertonia

An augmented auditory feedback device comprised of a thin membrane switch mini-buzzer, and battery is described as a modification of a previously described feedback device. The membrane switch can be customized for the patient and is designed to fit inside a patient's shoe without altering the heel height. Its appeal lies in its simplicity of construction, low cost, and ease of implementation during a patient's training for weight bearing and gait. An ever-present source of information, it provides performance-relevant cues to both patient and clinician about the occurrence, duration, and location of a force component of motor performance. The report includes suggested applications of the device, instructions to construct it, and a case report in which the device was used to improve weight bearing and gait in a cognitively healthy person with spina bifida

Selective dorsal rhizotomy has shown great promise as a treatment for the functional disabilities and deforming hypertonia of spastic cerebral palsy. At New York University Medical Center, 200 children underwent this procedure between 1986 and 1990. All groups, whether walkers, crawlers, or nonlocomotors, showed improvement in the tone and range of most muscles tested. Half of these patients experienced complications. Thirty-five of these were serious and included bronchospasm (5.5%), aspiration pneumonia (3.5%), urinary retention (7%), and sensory loss (2%). There are, however, clear indications that warn of these complications; monitoring and prophylactic treatment can minimize their effects, and the possibility of such problems is more than offset by the proven benefits of this operative procedure