Rett syndrome is a genetic disorder primarily affecting females. One of its most disabling features is the severe and rapid progression of scoliosis. So far, only surgical intervention has succeeded in reversing the development of scoliosis in Rett syndrome.The present study describes a new management approach implemented with a girl with Rett syndrome. The core of the management regime was intensive: asymmetrical activation of trunk muscles through equilibrium reactions. The X-rays accompanying the article (evaluated by four experienced orthopedic surgeons blinded to the intervention process) suggested that the intervention was successful in reversing the progress of the scoliosis for the above-mentioned child. Discontinuation of treatment led to severe and rapid deterioration of the spinal curve.Due to the fact that this was a case study, generalization is limited, but we suggest further investigation and studies with this method.

Meir Lotan

Joav Merrick

Eli Carmeli

Managing Scoliosis in a Young Child with Rett Syndrome: A Case Study

People with intellectual disability (ID) require special support in order to achieve independence in their daily life. Persons with ID are less exposed to assistive technology, although studies have shown that the availability of aids afford an opportunity to reach independence and cooperation. The aim of this study was to examine the nature of the relationship between involvement of the physiotherapy (PT) team and the degree to which assistive technology was used. A questionnaire was sent to all PTs employed at all 54 residential care centers for persons with ID of the Division for Mental Retardation at the Ministry of Social Affairs in Israel. A significantly positive correlation was found between the degree of involvement of the PT and the utilization of assistive technology. The study results may be summarized by stating that PTs demonstrated a great deal of involvement, particularly in relation to the extent of their work in the residential care centers. PT's awareness of the importance was indicated as the major reason to use assistive technology.

Carmit Cahana

The Assimilation of Assistive Technology in Residential Care Centers for People with Intellectual Disabilities

In 1997, the European Paediatric Orthopaedic Society (EPOS) initiated an international survey of musculoskeletal problems in individuals with Down syndrome. The goals of the study were far-reaching and ambitious in order to obtain a clear picture of the variety of orthopedic problems associated with Down syndrome, to relate their occurrence to other medical conditions, and to record and compare methods of treatment. The survey was to be international in scope, including orthopedic surgeons and departments across Europe and outside Europe. The study was coordinated from the Tel Aviv University in Israel as a multicenter study using electronic technology. This paper describes the organization and implementation of the EPOS Down Syndrome Survey, with special emphasis on the sophisticated electronic data entry instrument that was developed especially for the survey. It is concluded that computerized data entry forms like the one that we developed for the EPOS Down Syndrome Survey are valuable tools for medical surveys. They are especially important for multicenter and multinational studies.

David M. Steinberg

Moshe Kaplan

Shlomo Wientroub

Design and Implementation of a Multinational Computerized Patient Survey: The European Paediatric Orthopaedic Society Down Syndrome Survey

The Arab family in Israel is still embedded in the traditional society with extended family support systems, but we see a population in transition influenced by the surrounding society. This paper looks at the different religious attitudes toward the exceptional people in our society (i.e., the family reaction to a child born with intellectual or developmental disability), reviews recent studies on the Arab and Bedouin families in Israel, and presents data on the Arab population in residential care centers.Today, out of 57 residential care centers in Israel for persons with intellectual disability, 13 (22.8%) are providing service to the non-Jewish population. The Arab population constitutes 12&#x2013;13% of the total residential care population, lower than the 19&#x2013;20% in the total population. In residential care, the Arab population is characterized by younger children with severe and profound intellectual disability. The informal family support system is still a very important factor in the Arab family in Israel, a fact that we believe should be strengthened by implementing the British and Danish model of nurse home visitation.

Isack Kandel

Mohammed Morad

Gideon Vardi

Joseph Press

The Arab Community in Israel Coping with Intellectual and Developmental Disability

Longer life expectancy is resulting in increasing numbers of elderly adults with intellectual disability (ID). There has been the question whether persons with ID demonstrate early signs of aging before the general population. The aim of this study was to determine if persons with ID (with and without Down syndrome) showed premature aging changes compared with a control group. Elderly persons (n = 24, average age of 61) from one residential care center in Israel and younger adults from another center (n = 37, average age of 45) were compared with elderly residents without ID in an independent living facility. The study considered demographic data, medical data, anthropometric measurements, body fat and body mass index, flexibility, and sensorimotor function tests. The results showed that the persons with ID had basically similar body composition to that of persons without ID, however, the functional performance of elderly adults with ID was more impaired. We postulate that the slower functioning responses may be explained by a less physically active lifestyle, that may accelerate the onset of disease and result in symptoms associated with aging that are detrimental to health. It is therefore important that persons with ID participate in physical activity and exercises in order to promote health and prevent disease.

Shlomo Kessel

Yossef Masharawi

Varda Carmeli

Elderly Persons with Intellectual Disability: A Study of Clinical Characteristics, Functional Status, and Sensory Capacity

Intellectual disability (ID) is a life-long disability characterized by impaired cognitive and adaptive skills. Over the past few decades, a shift has occurred in the conceptualization and treatment of people with ID and research in health policy and health-care delivery has become increasingly global with a notable disparity between the developed and developing world. This review presents a literature overview of global health policy for ID with the intent to focus specifically on the policy and treatment within Israel. The methodology involved sites visits to care centers, discussions with stakeholders in health policy, and a literature review. We believe that Israel is in a unique position between a developed and developing culture. In particular, the distinct problems faced by the Arab and Bedouin community in terms of ID must be formally accounted for in Israel's future policies. Research from the developing world would be instructive to this end. The global approach in this presentation led to certain policy recommendations that take into account the uniqueness of Israel's position from a social, economic, religious, and demographic perspective. It is the hope that this paper will lead to an increased awareness of the challenges faced by persons with ID and their providers in all sectors of Israeli society and that the necessary policy recommendations will ultimately be adopted.

Ilana Halperin

Aliza Shupac

Health Policy for Persons with Intellectual Disability: Experiences from Israel

Epilepsy is a common neurological disorder; however, in Nigeria and other tropical regions, the causes of epileptic seizures differ greatly in etiology. This paper is an attempt to highlight some possible microbiological aspects of epileptic seizures. A literature review was carried out to identify the extent to which microbial infections were involved in the elicitation of epileptic seizures. Data were collected from several clinics in the community and hospitals in Nigeria and correlated with the evidence from the literature review. It was found that different microbial agents including viral, bacterial, protozoa, and fungal agents were involved in several aspects of epileptic seizures. Malaria was found to cause more than 88% of childhood epileptic seizures and 12% of adult seizures. Generalized tonic-clonic seizures occurred in more than 40% of adult patients. Partial seizures were uncommon. Cases of epileptic seizures associated with bacteria (e.g., brucellosis), viral, fungal, and protozoa infections were frequently reported. Malaria, tapeworm, and cysticercosis were some of the common infectious causes of epilepsy; however, in some cases, the cause remained unknown. From these findings, it was evident that microbiological aspects of epilepsies are possible research areas that might be developed. It is believed that the unraveling of the various microbiological factors in epileptic seizures would have important implications for understanding the underlying neurobiology, evaluating treatment strategies, and perhaps planning health-care resources for the affected. It will also help to improve the prognostic factors in initial seizure symptomatic etiology and presence of any structural cerebral abnormalities.

Ijeoma Kanu

Ebere C. Anyanwu

Nkechi C. Nwachukwu

John E. Ehiri

Clinical Microbiological Aspects of Epileptic Seizures in the Tropical Countries with Specific Focus on Nigeria

When a child is born, the life of the family changes significantly and each of its members must adapt to the new situation. When the child is born with a disability, in addition to regular adaptation, the family must cope with stress, grief, disappointments, and challenges, which may lead to a serious crisis or even disruption of family life.Parents must coordinate assessments, evaluations, and various treatments while maintaining contact with many professionals and numerous institutions or services. They find themselves faced with important decisions on behalf of the child, decisions on management of the child with disability, and economic decisions that will affect the whole family.This paper reviews the literature on the topic of coping when a child with disability is born and also studies the question as to whether a connection exists between parental orientation toward feelings of guilt and the family relationships system.  The event of a child born with a disability is always a tragedy for the family, but early intervention and support may help the family to adjust and become positively involved in the care and development of the child, even if that child is different and in need of special treatment.

The Birth of a Child with Disability. Coping by Parents and Siblings

HAIR-AN syndrome (hyperandrogenism, insulin resistance, acanthosis nigricans) is a subset of the polycystic ovary syndrome, where the patients demonstrate severe insulin resistance. It is theorized that both genetic and environmental factors, such as obesity, give rise to the development of HAIR-AN. Diagnosis is primarily clinical, with laboratory values lending further support. Treatment is aimed at decreasing insulin resistance, regulating ovulation, and decreasing acne, acanthosis nigricans, and hirsutism.

Kristin M. Rager

Hatim A. Omar

Androgen Excess Disorders in Women: The Severe Insulin-Resistant Hyperandrogenic Syndrome, HAIR-AN

The effect of 2-week, high-intensity running and a 2-week immobilization on muscle fiber type composition of the plantaris muscle from 18 female, 6-month-old Wistar rats (running, n = 6; immobilization, n = 6; sedentary control, n = 6) was bio- and histochemically investigated. The high-intensity treadmill running began with 20 min (32 m/min, 0% gradient, 75% VO2 max), up to 50 min/day. Right hind limbs were immobilized by an external fixation procedure for 13 days. Muscle mass of the plantaris muscle in the immobilized groups was reduced by 16% in comparison with the sedentary control group. High-intensity running and immobilization increased both mRNA and protein levels of matrix metalloproteinase type 2 (MMP-2) in plantaris. Running and immobilization decreased the percentages of transverse sectional area of fast-twitch glycolytic (FG) type IIb fibers, running increased relative cross-sectional area of fast-twitch oxidative glycolytic (FOG) type IIa muscle fibers, whereas immobilization increased relative cross-sectional area of slow-twitch oxidative (SO) muscle fibers (type I). Our results suggest that both high-intensity running and immobilization are enough to induce overwhelming changes in plantaris.

Tal Gal Haimovitch

The Expression of MMP-2 Following Immobilization and High-Intensity Running in Plantaris Muscle Fiber in Rats

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