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Penny J Ireland 1
Verity Pacey 2,3
Andreas Zankl 4
Priya Edwards 1
Leanne M Johnston 5
Ravi Savarirayan 6
Queensland Paediatric Rehabilitation
Service, Royal Childrens Hospital,
Herston, Brisbane, Queensland,
2
Physiotherapy Department, The
Childrens Hospital at Westmead,
Sydney, New South Wales,
3
Department of Health Professions,
Macquarie University, Sydney, New
South Wales, 4Genetic Medicine,
Childrens Hospital, Westmead, Sydney,
New South Wales, 5School of Health
and Rehabilitation Sciences, University
of Queensland, Brisbane, Queensland,
6
Victorian Clinical Genetics Service,
Royal Childrens Hospital, Melbourne,
Victoria, Australia
1
Introduction
Achondroplasia is the most common form of nonlethal skeletal dysplasia, affecting
more than 250,000 people worldwide.1,2 It is caused by a mutation in the gene that codes
for fibroblast growth factor receptor 3 (FGFR3) and is transmitted as an autosomal
dominant trait.1,35 The estimated prevalence is currently 0.36 to 0.6 per 10,000 live
births (1/27,7801/16,670 live births).6 The defining characteristics of achondroplasia
are short stature with disproportionately shorter proximal limb bones, narrow trunk,
and macrocephaly.1,7,8 There is contraction at the base of the skull with a prominent
forehead and flattened midface region and short, broad hands with a trident appearance of the fingers.3,8,9
Disproportionate growth between endochondral bone and the underlying organs
leads to a number of orthopedic, neurological, respiratory, ear, nose, and throat (ENT),
and dental issues for individuals with achondroplasia.810 Whilst serious complications
(such as sudden death due to severe compression of the spinal cord at the foramen
magnum) impact on only 5%10% of children,8,10 early monitoring and judicious
medical and surgical interventions are important for reducing morbidity and mortality
rates across the population.1,8,1012 Knowledge regarding the type and timing of medical
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2014 Ireland etal. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution Non Commercial (unported,v3.0)
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further
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http://dx.doi.org/10.2147/TACG.S51485
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Ireland etal
Musculoskeletal impairments
and complications
As seen in Figure 1, there are a number of changes related
to body structures and functions in individuals with achondroplasia, including the musculoskeletal, neurological,
cardiorespiratory, and ENT systems that impact upon overall participation. These will be discussed in more detail in
each of the following sections. The head of the infant with
Achondroplasia
FGFR3 mutation: abnormalities of chondrogenesis and endochondral
bone formation
Environmental factors
Products and technology
Lack of equipment, furniture, toys matching anthropometric limitations
Natural environment and human-made changes to environment
Interaction between body size and environment
Support and relationships
Family, teachers, community groups
Attitudes
Societal attitudes
Services, systems, and policy
Attitudes and beliefs of family and community
Personal factors
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Neurological impairments
and complications
Cervical cord compression at the cervicomedullary junction
is frequently observed radiographically in children with
achondroplasia, but symptomatic cord compression is less
common. Significant compression at the foramen magnum
can lead to severe neurological complications, including sleep
apnea, disordered respiration, myelopathy, hydrocephalus,
and sudden infant death.21,47,48 There continues to be debate
on the optimal assessment and type and timing of intervention
for this problem. Some groups advocate for routine investigation of cervicomedullary compression by magnetic resonance
imaging (MRI) or computer tomography (CT) studies in
the infant with achondroplasia.8,49 These groups believe that
the decision to intervene should not be based on traditional
signs of neurological compression such as hypotonia, poor
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Cardiorespiratory impairments
and complications
Respiratory signs and symptoms occur frequently in
individuals with achondroplasia,59 with a number of contributing mechanisms proposed: i) reduced chest circumference with altered mechanical function, ii) upper airway
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Conclusion
Children and adults with achondroplasia are impacted by a
variety of medical issues created by the unique complexities
associated with a form of disproportionate short stature. The
pictorial presentation of achondroplasia based on the ICF
that is presented in this paper highlights the need for ongoing
commitment to coordinated multidisciplinary care to ensure
that families receive timely service provision from medical
subspecialists and therapists skilled in the management of
Disclosure
The authors report no conflicts of interest in this work. The
authors alone are responsible for the content and writing of
this paper.
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