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  • 1.
    Hagbeg, Bengt
    et al.
    Department of Neuropediatrics, The Queen Silvia Children’s Hospital, Go¨teborg University,.
    Erlandsson, Anna
    Division of Clinical Genetics, Go¨teborg University, Go¨teborg, Sweden.
    Kyllerman, Mårten
    Department of Neuropediatrics, The Queen Silvia Children’s Hospital, Go¨teborg University,.
    Larsson, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. The handicap habilitation center, Skellefteå and Rett center, Östersund.
    Odd MECP2-mutated Rett variant: long-term follow-up profile to age 252003In: European journal of paediatric neurology, ISSN 1090-3798, E-ISSN 1532-2130, Vol. 7, no 6, 417-421 p.Article in journal (Refereed)
    Abstract [en]

    A 25-year-old MECP2-mutated female with odd developmental and dyspraxic/ataxic features, followed up through two decades, is reported. She does not fit either the classical Rett syndrome or the criteria required for any Rett variant phenotypes so far described. Nevertheless, she belongs clinically to the latter group. This case deserves attention in order, among other things, to provide important clues to better understand the puzzling battery of neuroimpairments and behavioural abnormalities met in classical Rett phenotypes and Rett variants defined thus far.

  • 2. Jefferson, Amanda
    et al.
    Leonard, Helen
    Siafarikas, Aris
    Woodhead, Helen
    Fyfe, Sue
    Ward, Leanne M.
    Munns, Craig
    Motil, Kathleen
    Tarquinio, Daniel
    Shapiro, Jay R.
    Brismar, Torkel
    Ben-Zeev, Bruria
    Bisgaard, Anne-Marie
    Coppola, Giangennaro
    Ellaway, Carolyn
    Freilinger, Michael
    Geerts, Suzanne
    Humphreys, Peter
    Jones, Mary
    Lane, Jane
    Larsson, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Swedish National Rett Centre, Frösön, Sweden.
    Lotan, Meir
    Percy, Alan
    Pineda, Mercedes
    Skinner, Steven
    Syhler, Birgit
    Thompson, Sue
    Weiss, Batia
    Witt Engerström, Ingegerd
    Downs, Jenny
    Clinical Guidelines for Management of Bone Health in Rett Syndrome Based on Expert Consensus and Available Evidence2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2, e0146824Article in journal (Refereed)
    Abstract [en]

    ObjectivesWe developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians.

    MethodsAn initial guidelines draft was created which included statements based upon literature review and 11 open-ended questions where literature was lacking. The international expert panel reviewed the draft online using a 2-stage Delphi process to reach consensus agreement. Items describe the clinical assessment of bone health, bone mineral density assessment and technique, and pharmacological and non-pharmacological interventions.

    ResultsAgreement was reached on 39 statements which were formulated from 41 statements and 11 questions. When assessing bone health in Rett syndrome a comprehensive assessment of fracture history, mutation type, prescribed medication, pubertal development, mobility level, dietary intake and biochemical bone markers is recommended. A baseline densitometry assessment should be performed with accommodations made for size, with the frequency of surveillance determined according to individual risk. Lateral spine x-rays are also suggested. Increasing physical activity and initiating calcium and vitamin D supplementation when low are the first approaches to optimizing bone health in Rett syndrome. If individuals with Rett syndrome meet the ISCD criterion for osteoporosis in children, the use of bisphosphonates is recommended.

    ConclusionA clinically significant history of fracture in combination with low bone densitometry findings is necessary for a diagnosis of osteoporosis. These evidence and consensus-based guidelines have the potential to improve bone health in those with Rett syndrome, reduce the frequency of fractures, and stimulate further research that aims to ameliorate the impacts of this serious comorbidity.

  • 3.
    Larsson, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Motor function over time in Rett syndrome-loss, difficulties and possibilities2008Licentiate thesis, monograph (Other academic)
  • 4.
    Larsson, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Rett syndrome, motor development, mobility and orthostatic reactions: loss of function, difficulties and possibilities2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Rett syndrome (RTT) is a rare, severe neurodevelopmental disorder, which partly develops in a predictable way, and influences many bodily functions. Regression, i.e. loss of earlier achieved abilities, is one of the clinical criteria for RTT. Research on motor function has to some extent focused on this loss, and less on the possibility to keep, regain or develop abilities. RTT is mainly verified in girls/women, and the prevalence of classic RTT in Sweden for girls born between 1965 and 1976 was 1 in 10.000-12.000. Clinical criteria are used for diagnosis, but since 1999 RTT can be confirmed by a genetic test. As there is no cure so far, development of clinical intervention and management is important, and with good treatment it is possible to improve quality of life.

    The main aim was to acquire more knowledge about motor development in RTT, both, early development, and development over time. Another aim was to study if there were deviating orthostatic reactions when rising from sitting to standing, and during standing, compared with normally developed, healthy people, matched by sex and age.

    Clinical experience as well as reports from parents showed that some people with RTT had lost abilities, some had been able to keep abilities, and some had been able to learn new abilities after regression. For good results, the person with RTT had to be motivated, and the intervention jointly planned; it was also important to realize that dyspraxia causes dependence on other people’s initiatives. Information about one person with RTT, collected over several years, showed the possibility to develop in some areas over time and the tendency to deteriorate in other areas. Studying orthostatic reactions when rising to standing, and standing for three minutes, revealed that those with RTT mainly had the same reactions as the healthy controls. The quicker initial drop in systolic blood pressure in people with RTT, when rising, has not been documented earlier. 

     In conclusion, this thesis shows that it is possible for some people with RTT to keep abilities, regain abilities, and also learn new abilities after regression. Since those with RTT recovered their blood pressure in the same way as the healthy controls, there is no reason to recommend limitations in standing, though the quicker initial drop in systolic blood pressure should be noted. The deterioration in walking found in our previous studies does not seem to be due to deviation in orthostatic reactions. Individual analysis, as well as good knowledge about the development of the disorder and variation in its expression, is essential. Since many people with RTT live to adulthood, planning for lifelong intervention and care is most important.

  • 5.
    Larsson, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Julu, Peter OO
    Breakspear Medical Group, Hertfordshire, UnitedKingdom.
    Witt Engerström, Ingegerd
    RettCenter, Jämtland CountyCouncil, Östersund, Sweden.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Normal reactions to orthostatic stress in Rett syndrome2013In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 34, no 6, 1897-1905 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate orthostatic reactions in females with Rett syndrome (RTT), and also whether the severity of the syndrome had an impact on autonomic reactions. Based on signs of impaired function of the central autonomic system found in RTT, it could be suspected that orthostatic reactions were affected. The orthostatic reactions in 21 females with RTT and 14 normally developed femalesmatched by age were investigated when they rose from a sitting position, and during standing for 3 min. Reactions of the heart, the blood pressure and the time for recovery of systolic blood pressure, were studied in real time, heartbeat by heartbeat, simultaneously. There was no difference between participants with RTT and the normally developed controls regarding general orthostatic reactions (heart rate, systolic and diastolic blood pressure, and mean arterial pressure) when getting up from a sitting position, and when standing erect for 3min. In the specific immediate response by the heart to standing up, the 30:15 ratio, significantly lower values were found for females with RTT. In the RTT group, the maximum fall of systolic blood pressure showed a tendency to a larger decrease, and the initial decrease in systolic blood pressure was significantly faster. The time for recovery of systolic blood pressure from standing erect did not differ between groups. At baseline the females with RTT had significantly lower systolic blood pressure and a tendency to a higher heart rate. The results do not indicate any autonomic limitations for people with RTT in getting up from a sitting position and standing. The participants with RTT had normal orthostatic reactions indicated by the heart and blood pressure responses when standing erect for 3 min. A faster initial drop in systolic blood pressure in people with RTT was notable.

  • 6.
    Larsson, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Engerström, IW
    Rett syndrome from a family perspective: the Swedish Rett Center survey2005In: Brain & development (Tokyo. 1979), ISSN 0387-7604, E-ISSN 1872-7131, Vol. 27, no Suppl 1, S14-S19 p.Article in journal (Refereed)
  • 7. Larsson, Gunilla
    et al.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Witt Engerström, I
    General development in females with rett syndrome, focusing on abilities, deformities and managmet: The Swedish rett center survey2007Conference paper (Other academic)
  • 8.
    Larsson, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Witt Engerström, Ingegerd
    Rett Center, Frösön, Sweden.
    Gross motor ability in Rett syndrome: the power of expectation, motivation and planning2001In: Brain & development (Tokyo. 1979), ISSN 0387-7604, E-ISSN 1872-7131, Vol. 23, no Suppl. 1, S77-S81 p.Article in journal (Refereed)
    Abstract [en]

    A main task for the physiotherapist at the Swedish Rett Center is to document and report successful treatment. This report shows the possibility to regain function, get variation and avoid contractures for several years. A thorough neurologic, orthopaedic and physiotherapeutic assessment and analysis is essential. We stress the importance of keeping the feet in good position, using surgery and well fitting orthoses when needed, making standing possible and for some persons, walking. For the effect of treatment the following factors were of vital importance: the expectations of the persons treating the girl/woman – what they believed she could do, the motivation of the girl/woman herself, a joint plan for intervention including everyone involved, and well educated personnel, well informed about Rett syndrome – its problems and possibilities.

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