Maintaining equal pressure and a precise test area for simultaneous stimulation of both the normal and abnormal part may be challenging. If the patient presents with hyperaesthesia (sensory sensitisation, or an abnormal pain response), or allodynia
over a hypoaesthetic territory ( Spicher 2008), then the scoring (and clinical interpretation) differs: normal sensation = 1 and the test area is scored between 1/10 and 10/10 (10 = hyperaesthesia). Testing contraindications include open wounds or absence of an available normal reference territory. “
“Latest update: 2012. Next update: Not stated. Patient group: Children with respiratory muscle weakness as a result of neuromuscular disease or disorders of the motor unit. Intended audience: Healthcare practitioners who care for children with neuromuscular Z-VAD-FMK solubility dmso Selleck IOX1 weakness, including doctors, nurses, and physiotherapists. Additional versions: Nil. Expert working group: A 13-member group including medical specialists, a physiotherapist, a nurse, and a consumer representative from the United Kingdom comprised the expert working group. Funded
by: Not stated. Consultation with: A draft guideline was circulated to relevant medical society stakeholders, including the Association of Paediatric Chartered Physiotherapists and the British Thoracic Society Standards of Care Committee. It was also made available for public consultation. Approved by: The British Thoracic Society. Location: The guidelines are published
as: Hull J, et al (2012) mafosfamide British Thoracic Society Guideline for respiratory management of children with neuromuscular weakness. Thorax 67: Suppl 1: i1–40. They are available at: http://www.brit-thoracic.org.uk/Guidelines/Children-with-Neuromuscular-Weakness.aspx. Description: This guideline is a 45-page document that outlines potential respiratory complications of neuromuscular weakness in children, then identifies and critically appraises the research evidence underpinning current assessment and management approaches. It begins with a three-page summary of recommendations. The neuromuscular conditions covered by the guideline are detailed in the first appendix, and the most common reasons for respiratory complications in each condition are explained. The complications covered include reduced pulmonary function, retention of airway secretions, aspiration lung disease, sleep-disordered breathing, the influence of scoliosis, and respiratory failure. The evidence underpinning tests to identify children at risk is presented, including recommendations for clinical assessment, spirometry, tests of respiratory muscle strength, and peak flow. Recommendations are made on the use of a variety of chest physiotherapy techniques for airway clearance and respiratory muscle training, in addition to presentation of evidence for several forms of assisted ventilation.