Contra-Lateral Unintended Upper Arm Movement during Unimanual Tasks in Children with Cerebral Palsy

PURPOSE: To characterize associated reactions (ARs) in the contralateral arm across multiple muscles during unimanual tasks and to identify factors related to ARs in children with cerebral palsy (CP). MATERIALS AND METHODS: This was a prospective, cross-sectional study of 35 children with CP. The extent of ARs of the contra-lateral, non-task hand was assessed while performing three unimanual tasks (opening and clenching the fist, a finger opposition task, and tapping fingers). The occurrence of ARs in each trial was evaluated separately for each task using a four-point scale (total scores ranged from 0 to 12). Surface electromyography (SEMG) was used to measure the firing activity of the muscles of the opposite arm during the task. The Manual Ability Classification System and Melbourne Assessment 2 (MA-2) were used to evaluate upper limb function. RESULTS: AR scores were higher in the more-affected limb than in the less-affected limb. SEMG data on the non-task hand showed motor overflow up to the elbow muscles in the more-affected limb. Root mean square ratios of EMG signals were significantly higher in children with ARs than in children without ARs. Multiple regression analysis showed both age and MA-2 to be significant factors related to ARs in the more-affected limb. CONCLUSION: Children with visible ARs showed motor overflow in the non-task limb during unimanual hand tasks. Age and upper limb function were significantly related to the extent of ARs in the more-affected limb of children with CP.ope

Early Treatment Effect in Children with Cerebral Palsy and Delayed Development

Objective : To compare the effects of early and late treatment and to evaluate the contributing factors for the therapeutic outcome in cerebral palsy children. Method : Three hundred twenty four children with delayed development including cerebral palsy who were admitted to the Department of Rehabilitation at Yonsei University Medical Center from January 1992 to December 1995 were studied. They were divided into two groups according to the initiation of treatment: early and late treatment groups. Early treatment was defined as treatment started at or before 6 months and the late treatment was after 6 months. They were also divided into groups according to the diagnosis, responsiveness to treatment and initial motor quotient. And then the motor developments during the follow-up period between each groups were compared as the effects of treatment. Results : The development of the motor milestone was faster in the early treatment group than in the late treatment group. The group which initially showed a higher motor quotient had a higher response rate to the treatment and a faster development of the motor milestone than the group with a lower motor quotient. Conclusion : These results suggest that the initiation of treatment and the severity of delayed development are important contributing factors for an outcome of treatment.ope

Effect of Seizure Disorders on Developmental Disability in Patients with Cerebral Palsy or Delayed Development

Objective : To investigate the effect of epilepsy and neonatal seizure on development in children with cerebral palsy (CP) or delayed development (DD). Method : The subjects were 135 patients with CP or DD. Development was evaluated by Bayley Scale of Infant Development II (BSID II). Epilepsy was diagnosed on the base of clinical features, past history and electroencephalography. Results : The incidence of epilepsy was 18.4% in CP, and 37.8% in DD. Spastic quadriplegia of CP has the highest incidence of epilepsy (38.4%). First seizure attack was occurred before 6 months old of age in 66.7% of CP with epilepsy and in 64.3% of DD with epilepsy. The prevailing type of epilepsy was generalized seizure in DD (57.1%), partial seizure in CP (50.0%). The group with epilepsy had lower psychomotor and mental development quotient on BSID II than the group without epilesy (p＜0.05). Polytherapy was more used to control epilepsy than monotherapy. Valproate (50.0%), phenobarbital (37.5%), carbamazepine (31.3%) were commonly used drugs for controlling epilepsy. Conclusion : The epilpesy has a negative effect on psychomotor and mental development in the children with CP or DD.ope

Effects of Botulinum Toxin A Therapy on Gastrocnemiusin Spastic Cerebral Palsied Children

Objectives: The aim of this study was to assess the changes of the spasticity and gait pattern after botulinum toxin A injection on the gastrocnemius muscle. Method : Thirty five legs of twenty-six ambulatory cerebral palsy children aged from two to sixteen year old were treated. Botulinum toxin A (Allergan, USA) from 2 to 8 U/Kg bodyweight was injected on the gastrocnemius without sedation and electromyographic guidance. The modified Ashworth scale, the reflex excitability test were used for the assessment of spasticity. The changes of gait pattern were collected using 6 camera VICON system. All assessments were measured before and at two weeks after injection. Results : 1) The modified Ashworth scale of ankle plantar flexor improved significantly. 2) The reflex excitability test result decreased significantly in gain. 3) The kinematic data showed significant improvements in sagittal plane of the ankle at two weeks after injection. The children with the genu recurvatum showed improvement in sagittal plane of the knee and those with the crouch gait didn't show aggravation of gait pattern after the injection. Conclusion : The intramuscular botulinum toxin A injection reduced the spasticity and improved the gait pattern in the cerebral palsied children with ankle plantar flexor spasticity.ope

Effect of Seizure Disorders on Developmental Disability in Patients with Cerebral Palsy or Delayed Development

Objective To investigate the effect of epilepsy and neonatal seizure on development in children with cerebral palsy (CP) or delayed development (DD). Method The subjects were 135 patients with CP or DD. Development was evaluated by Bayley Scale of Infant Development II (BSID II). Epilepsy was diagnosed on the base of clinical features, past history and electroencephalography. Results The incidence of epilepsy was 18.4% in CP, and 37.8% in DD. Spastic quadriplegia of CP has the highest incidence of epilepsy (38.4%). First seizure attack was occurred before 6 months old of age in 66.7% of CP with epilepsy and in 64.3% of DD with epilepsy. The prevailing type of epilepsy was generalized seizure in DD (57.1%), partial seizure in CP (50.0%). The group with epilepsy had lower psychomotor and mental development quotient on BSID II than the group without epilesy (p＜0.05). Polytherapy was more used to control epilepsy than monotherapy. Valproate (50.0%), phenobarbital (37.5%), carbamazepine (31.3%) were commonly used drugs for controlling epilepsy. Conclusion The epilpesy has a negative effect on psychomotor and mental development in the children with CP or DD.ope

분양과 재고 아파트가격의 상호작용에 관한 실증분석

학위논문 (박사)-- 서울대학교 환경대학원 : 환경계획학과, 2013. 8. 최막중.본 연구는 분양과 재고 아파트가격의 상호관계에 관한 이론적 매커니즘을 밝히고 이를 근거로 상호작용을 분석하는 것을 목적으로 한다. 이를 위해 본 연구는 지역단위로 세분화된 주택시장의 특성과 가격규제 정책의 영향력을 고려하여 분석대상을 시·군·구의 공간단위와 규제자율기로 한정한다. 주택시장의 공급자 가격결정요인과 대체시장간 가격경쟁 및 교차탄력성에 관한 기존연구 검토를 통해 분석모형과 분석틀을 설정한다. 실증분석은 고정효과 2단계 최소자승법을 이용하여 상대규모(=분양물량/재고거래량)와 주택시장의 구조변화를 중심으로 분석대상을 분양우위시장과 재고우위시장, 가격상승기와 가격안정기로 구분하여 총 4개 그룹에 대해 수행한다. 분양과 재고 아파트가격의 상호작용에 관한 그룹별 분석결과는 다음과 같다. 첫째, 분양과 재고 아파트가격의 대체관계가 시·군·구 지역단위의 주택시장에 존재하는 것이 확인되었다. 둘째, 두 시장 가격의 상호영향력을 상대규모에 따라 살펴보면, 모든 그룹에서 재고가의 영향력이 분양우위시장 보다 재고우위시장에서 높고, 반대로 분양가의 영향력은 재고우위시장 보다 분양우위시장에서 높은 것으로 나타났다. 이를 통해 상대규모가 분양-재고 가격간 상호작용의 기준이 됨을 알 수 있다. 셋째, 모든 그룹에서 재고가의 영향력이 분양가의 영향력 보다 높은 것으로 나타났다. 즉, 분양주택을 판매하는 건설사는 재고소유자의 호가에 민감하게 반응하지만, 재고주택을 판매하는 재고소유자는 건설사가 책정한 신규분양주택가격에 민감하게 반응하지 않음을 의미한다. 이러한 상호작용의 차이로부터 지역주택시장에서 공급자들의 가격 적절성의 판단 기준으로서 재고주택가격이 더 유용한 정보를 가질 것으로 본다. 넷째, 시장간 가격영향이 비교적 대칭적으로 작용하는 그룹은 상호영향계수의 상대비율 값이 1.16으로 1에 근사한 값을 갖고 있는 상대규모의 크기가 0.73인 가격상승기의 분양우위그룹으로 나타났다. 이에 따라 가격의 상호영향력이 대칭적으로 나타날 수 있는 상대규모의 균형값은 0.73보다 더 큰 구간에 있을 것으로 예상된다. 다섯째, 상대규모가 유사한 재고우위그룹을 기준으로 가격상승기와 가격안정기의 가격간 상호영향계수의 비율을 비교하면, 가격상승기의 재고가 영향에 비해 가격안정기의 재고가 영향이 3배(=5.42/1.85)정도 더 큰 것으로 나타났다. 이와 같은 시점간 차이로부터 가격의 기준점효과는 안정적 추세를 가지는 경우에 더 크게 작용하는 것으로 판단된다. 여섯째, 시점간 비교를 종합하면, 보급률의 증가에도 불구하고 재고가 상승이 나타난 시점에는 재고의 상대규모가 낮고, 보급률의 증가에도 불구하고 분양가 상승이 나타난 시점에는 분양의 상대규모가 낮다. 즉, 보급률의 상승에도 불구하고 상대적으로 공급규모가 낮은 부분시장의 가격은 상승할 것으로 예상된다. 따라서 각 부분시장의 주택가격은 매매주택의 총재고가 아닌 각 부분시장의 공급 수준의 영향을 받는 것으로 보인다. 일곱째, 표준화 계수에 따르면 분양과 재고 아파트 가격은 대체시장의 상호 가격의 영향을 가장 크게 받지만 분양가는 전매제한규제와 공사비의 영향을 받고 재고가는 대출금리 영향을 받는 것으로 나타났다. 본 분석을 통해 다음의 시사점 및 정책적 함의를 얻을 수 있다. 첫째, 본 논문은 일반재화시장의 경쟁원리가 주택시장에 동일하게 적용 가능하다는 점에서 기존 주택연구와의 차별성을 갖는다. 둘째, 주택시장에 대한 정책은 전국 및 광역적 차원에서 접근하기 보다는 동질적인 수급권을 형성하는 시·군·구의 지역단위로 검토되어야 한다. 셋째, 주택시장의 가격정책은 가격탄력도가 낮은 재고주택가격을 기준으로 마련되어야 할 것으로 판단된다. 한편, 매매주택시장에 관한 가격 문제는 통합적으로 접근하기 보다는 부분시장의 수급측면에서 접근하는 것이 바람직하다. 즉, 재고주택가격 문제는 재고거래 활성화하고, 분양주택가격 문제는 신규건설을 촉진을 통해 안정화가 가능할 것으로 보인다. 넷째, 분양가에 대한 정책은 직접적인 가격규제 제도를 선택하기 보다는 전매 및 청약제도를 개선하여 투기수요를 사전에 차단하고, 건설사의 분양가 상승 유인을 낮추는 방법으로 비용개선의 검토가 필요하다. 다섯째, 분양가 규제 대상은 「주택법」의 사업계획 승인대상 기준에 따라 일괄적으로 최소 공급세대수 20호 이상에 적용되고 있다. 그러나 본 분석 대상의 최소 재고거래량은 72가구, 평균은 1,000가구를 차지하는 것으로 분석되었다. 이를 상대규모 기준으로 치환하여 본 분석 결과에 적용하면, 재고가에 대한 분양가의 영향력은 미미할 것으로 예상된다. 따라서 분양가규제는 대규모 개발 사업이 발생될 것으로 예상되는 특정 지역과 시기에 사전적으로 시행하는 것이 적합할 것으로 판단된다.제 1 장 서 론 1 제 1 절 연구배경과 목적 1 제 2 절 연구방법과 구성 3 제 2 장 주택정책 및 선행연구 검토 6 제 1 절 주택정책과 시장현황 6 1. 주택정책 변화 6 1) 분양주택 6 2) 재고주택 9 2. 주택시장 특성 11 1) 주택가격 변화 11 2) 주택공급 변화 13 3. 소결 15 제 2 절 선행연구 검토 16 1. 분양-재고주택 연구 16 1) 인과관계 16 2) 상호작용 20 3) 분양-재고가격 결정요인 23 4) 소결 27 2. 경쟁시장간 상호작용 28 1) 상호가격 모형 28 2) 교차탄력성 연구 31 3) 소결 37 제 3 장 모형 및 분석대상 설정 38 제 1 절 이론모형 및 분석틀 38 1. 이론모형 설정 38 2. 분석틀 40 제 2 절 분석방법 41 1. 2단계 최소자승법 41 2. 고정효과모형 43 제 3 절 분석대상 45 1. 패널자료 구성 45 2. 분석대상 설정 49 제 4 절 실증모형 및 변수선정 52 1. 상호가격 실증모형 52 2. 변수선정 55 1) 내생변수 55 2) 외생변수 56 제 4 장 분양-재고 가격간 상호작용 분석 60 제 1 절 기초통계 60 1. 내생변수 60 2. 외생변수 62 1) 비용요인 62 2) 수요요인 63 제 2 절 상호작용 실증분석 67 1. 가격상승기 (`00.1q〜`02.4q) 67 1) 재고우위시장 67 2) 분양우위시장 69 2. 가격안정기 (`03.1q〜`05.4q) 71 1) 재고우위시장 71 2) 분양우위시장 73 제 5 장 결 론 75 참고문헌 79 부 록 91Docto

Efficacy and safety of onabotulinumtoxinA with standardized physiotherapy for the treatment of pediatric lower limb spasticity: A randomized, placebo-controlled, phase III clinical trial

Background: Spasticity is common in cerebral palsy and can result in pain and diminished health-related quality of life. Objective: To evaluate the safety and efficacy of onabotulinumtoxinA for lower limb spasticity treatment in children with cerebral palsy. Methods: In this registrational phase 3, multinational, randomized, double-blind, placebo-controlled trial (NCT01603628), children (2-< 17 years) with cerebral palsy and ankle spasticity (Modified Ashworth Scale-Bohannon [MAS] score≥2) were randomized 1 : 1 : 1 to standardized physical therapy and onabotulinumtoxinA (4 or 8 U/kg), or placebo. Primary endpoint was average change from baseline at weeks 4 and 6 in MAS ankle score. Secondary endpoints included the Modified Tardieu Scale (MTS) and Global Attainment Scale (GAS). Results: 381 participants were randomized. MAS scores averaged at weeks 4 and 6 were significantly reduced with both onabotulinumtoxinA doses (8 U/kg: -1.06, p = 0.010; 4 U/kg: -1.01, p = 0.033) versus placebo (-0.8). Significant improvements in average dynamic component of spasticity, measured by MTS, and in function, measured by GAS, were observed at several time points with both onabotulinumtoxinA doses versus placebo. Most adverse events were mild or moderate. Conclusions: OnabotulinumtoxinA was well tolerated and effective in reducing lower limb spasticity and improving functional outcomes versus placebo in children.ope

Effects of Botulinum Toxin A Therapy on Gastrocnemius in Spastic Cerebral Palsied Children

Objectives: The aim of this study was to assess the changes of the spasticity and gait pattern after botulinum toxin A injection on the gastrocnemius muscle. Method Thirty five legs of twenty-six ambulatory cerebral palsy children aged from two to sixteen year old were treated. Botulinum toxin A (Allergan, USA) from 2 to 8 U/Kg bodyweight was injected on the gastrocnemius without sedation and electromyographic guidance. The modified Ashworth scale, the reflex excitability test were used for the assessment of spasticity. The changes of gait pattern were collected using 6 camera VICON system. All assessments were measured before and at two weeks after injection. Results 1) The modified Ashworth scale of ankle plantar flexor improved significantly. 2) The reflex excitability test result decreased significantly in gain. 3) The kinematic data showed significant improvements in sagittal plane of the ankle at two weeks after injection. The children with the genu recurvatum showed improvement in sagittal plane of the knee and those with the crouch gait didn't show aggravation of gait pattern after the injection. Conclusion The intramuscular botulinum toxin A injection reduced the spasticity and improved the gait pattern in the cerebral palsied children with ankle plantar flexor spasticity.ope

Neuromotor Assessments and Developmental Movement Disorders

Development in motor skills and abnormal movement patterns in developing child are clearly observed and easily identified by the parents. Motor delay and movement disorder are common presentations for children with developmental disorders. Therefore, assessment for motor development and movement disorder become the major developmental focus of early in life. Physical examination has been considered as a key element for identifying developmental motor disorder. Traditionally, development of tone, primitive reflexes, postural reaction and motor milestone are commonly used as the evaluation tools for early identification of children at high risk for developmental disorder. Recently the assessment of the quality of general move-ments was introduced as a new form of neuromotor assessment of young infant. Therefore, clinical usefulness of the assessments for detecting neurological dysfunction was briefly reviewed in this paper. As well, there are a lot of movement disorders shown in child. The movement disorders can be separated into transient, paroxysmal and chronic ones according to their evolution. Since the knowledge of the movement disorders in each category enables us to understand the evolution of movement disorders, avoid unnecessary tests and treatments, and also give the proper information to the parents, the movement disorders were briefly reviewed in this paper.ope

Overground Robot-Assisted Gait Training for Pediatric Cerebral Palsy

The untethered exoskeletal robot provides patients with the freest and realistic walking experience by assisting them based on their intended movement. However, few previous studies have reported the effect of robot-assisted gait training (RAGT) using wearable exoskeleton in children with cerebral palsy (CP). This pilot study evaluated the effect of overground RAGT using an untethered torque-assisted exoskeletal wearable robot for children with CP. Three children with bilateral spastic CP were recruited. The robot generates assistive torques according to gait phases automatically detected by force sensors: flexion torque during the swing phase and extension torque during the stance phase at hip and knee joints. The overground RAGT was conducted for 17~20 sessions (60 min per session) in each child. The evaluation was performed without wearing a robot before and after the training to measure (1) the motor functions using the gross motor function measure and the pediatric balance scale and (2) the gait performance using instrumented gait analysis, the 6-min walk test, and oxygen consumption measurement. All three participants showed improvement in gross motor function measure after training. Spatiotemporal parameters of gait analysis improved in participant P1 (9-year-old girl, GMFCS II) and participant P2 (13-year-old boy, GMFCS III). In addition, they walked faster and farther with lower oxygen consumption during the 6-min walk test after the training. Although participant P3 (16-year-old girl, GMFCS IV) needed the continuous help of a therapist for stepping at baseline, she was able to walk with the platform walker independently after the training. Overground RAGT using a torque-assisted exoskeletal wearable robot seems to be promising for improving gross motor function, walking speed, gait endurance, and gait efficiency in children with CP. In addition, it was safe and feasible even for children with severe motor impairment (GMFCS IV).ope