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

ffect of Clonidine on Spasticity in Patients with Spinal Cord Injury

Objective : Spasticity has been reported to be one of the common complications in patients with spinal cord injury. The purposes of this study were to investigate the proper dosage, the therapeutic and undesirable effects of clonidine with combined used of baclofen for the management of spasticity. Method : A prospective study was performed for 17 patients with spinal cord injury who did not improve spasticity with 80 mg baclofen administration. The degree of spasticity was assessed in the more-affected knee by modified Ashworth scale, pendulum test at pre-treatment and at 7 days after receiving clonidine. We also investigated the complications and subjective satisfaction. Results : Seven of 13 patients with spinal cord injury showed subjective improvement in spasticity. We found significant improvement in the relaxation index by pendulum test after administration of more than 0.3 mg of clonidine. There was no significant difference between the subgroups depending on the extent of spinal cord injury. We didn't find any serious complication in adjuvant clonidine therapy. Conclusion : Adjuvant clonidine therapy can be effective in spasticity of spinal cord injured patients without serious complication.ope

Epidemiologic Study of Spinal Cord Injury

Objective : The purpose of this study is to present epidemiological data on patients with spinal cord lesion admitted to the Rehabilitation Hospital, YUCM. Method : Review of medical records of 590 patients with spinal cord injury admitted to the Rehabilitation Hospital, YUCM from 1987 to 1996 retrospectively. Results : 1) Sex: Males account for 79.6% of the SCI patients. 2) Age: The largest number of injuries occurs in the 20∼29 years of age group (32.5% of patients). 3) Etiology: Trauma accounts for 91.2% of all spinal cord injuries. The leading causes of traumatic spinal cord injury are traffic accidents (57.6%) and falls (26.4%). 4) Level of injury: Complete tetraplegia accounts for 20.5% of all SCI patients, incomplete tetraplegia 23.9%, complete paraplegia 38.8% and incomplete paraplegia 16.5%. In tetraplegics, incomplete injuries increased from 40% in 1987∼1991 to 56.7% in 1992∼1996. 5) Methods : of bladder management: 87% of patients voids by reflex. Intermittent catheterization is practiced by 8% of patients Conclusion : Epidemiologic data of 590 patients admitted to the Rehabilitation Hospital, YUCM, from 1987 to 1996 is presented with changes of epidemiology in each period. The patients suffered SCI from trauma, and traffic accidents and sports as causes were increasing. Female patients and incomplete injuries were also increasing. Mean duration of hospitalization decreased.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

Factors Influencing Activities of Daily Living in thePatients with Spinal Cord Injury

Objective: The purpose of this study was to obtain and access baseline data and factors influencing activities of daily living(ADL) in the patients with spinal cord injury(SCI). Method: 65 complete SCI patients who were admitted to the Wonju Christian and Severance hospital from January 1990 to february 1998 were studied. A questionnaire contained 15 items of ADL and factors such as cause, level, age and sex distribution, duration, employment status, religious status, medical payment, income source and complications. We compared each level of SCI according to each variables. Results: The income source and employment status were associated with adjustment of ADL in patients with SCI. Conclusion: Financial independence was the most important factor to improve adjustment of ADL in patients with SCI.ope

Characteristics of the 3D Gait Analysis in Gait MaturationProcess in Korean Children

Objective: To find out the characteristics of gait maturation process in Korean normal children. Method: Three dimensional kinematic gait analysis using Vicon 370 system from Oxford Metrics Company was performed for 72 children (33 females) without known gait anomalies aging between one and six years old. The data were compared with those from 41 normal adults which were collected previously using the same method, and with those from study by Sutherland et. al. Results: 1. The initial heel contact, initial flexion wave of the knee joint during the early stance phase and reciprocal arm swing were found before the age of 3.5. 2. Pelvic motion in transverse plane, hip joint motion in all the three planes, knee joint motion in coronal plane, and ankle joint motion in transverse plane remained greater than those of Caucasian children of Sutherland et. al. 3. Single stance period remained shorter than that of Caucasian children. 4. Internal rotation of hip joint and varus motion of the knee joint remained greater than those of Caucasian children. Conclusion: The difference between Korean and Caucasian children were 1. Development of muscles' ability which stabilize the large leg joints during gait seems slower among Korean children than Caucasian children. 2. These differences are probably from the anthropometrical characteristics of Korean and Caucasian growing children. Also, the different definition of angle systems between the Korean and Caucasian data might case some erroneous effect on the interpretation of result.ope

The Relationship between Weight-Bearing and Stiff-Knee Gait in Hemiplegic Patients

Objective: To determine whether insufficient weight- bearing on the hemiparetic side has a correlation with the degree of stiff-knee gait in hemiplegic patients. Method: Fifty hemiplegic patients were included. In all patients, 3-dimensonal gait analysis and static and dynamic foot pressure measurements were taken. The degree of stiff-knee gait was evaluated using the peak knee flexion angle and the knee flexion slope at toe-off in hemiplegic limb. The degree of weight-bearing was evaluated using the percentage of hemiplegic foot pressure and pressure-time integration on the non-hemiplegic side. Results: The static and dynamic mean pressure ratios and pressure-time integration ratio were statistically correlated with peak knee flexion angle and knee flexion slope (p＜0.01). Conclusion: As a result, insufficient weight-bearing had a correlation with the degree of stiff-knee gait in hemiplegic patients. Insufficient weight-bearing should be further investigated to determine whether it is one of the characteristic findings of stiff-knee gait, or another cause of stiff-knee gait.ope

Epidemiology of Pressure Sore in Spinal Cord Injured Patients

Objective: To provide epidemiologic data of the pressure sores and to determine the most effective prevention and treatment methods. Method: Seventy patients with pressure sores who were admitted to the Rehabilitation Hospital, Yonsei University College of Medicine from 1991 to 1995 were included in this study. Results: The average age of the patients was 36. Traffic accident was the most common(46 cases) cause of injury, followed by falling injury. Thirty-one patients developed pressure sores at home, while 39 patients in various hospitals. According to Frankel's classification, 51 cases were Frankel A, 13 cases were Frankel B, 5 cases were Frankel C and none was Frankel D. Sacrum was the most common site of the sore followed by buttock, ischial tuberosity, greater trochanter, and coccyx. Among many factors investigated, the anemia and hypotension had a significant correlation with the healing time. The treatment methods were variable among the patients depending on the size and severity of the sores. The severe and larger lesions required more surgical managements. Conclusion: The results support that an intensive prevention is necessary at homes as well as at the hospitals. More educational programs should be provided not only for the patients, but also for the hospital personnels.ope

Factors Affecting Drooling in Adult Patients with Traumatic Brain Injury

Objective: To investigate whether drooling in patients with traumatic brain injury (TBI) is due to hypersalivation or cognitive dysfunction or disability. Method: The subjects were 24 TBI patients with drooling and 17 TBI patients without drooling and 20 unaffected healthy volunteers who had no known physical or mental disabilities. All participants had no known history of diabetes mellitus, hypertension, thyroid dysfunction or chronic alcoholism. And, we excluded the subjects who take the anticholinergics, beta-agonist or steroid. Salivary pH and flow rate were compared between the TBI groups and the control group. We also measured Korean mini-mental state examination (K-MMSE) and disability rating scale (DRS) and compared mean values between TBI groups. Results: There was no statistical difference in the mean salivary pH and flow rate between the tested groups. The drooling severity and frequency showed no correlation with salivary flow rate in all groups. The drooling severity and frequency showed significant correlations with K-MMSE, but not with DRS in TBI groups. Conclusion: The results of this study suggested that the cause of drooling in patients with TBI may not be the hypersalivation and functional disability, but cognitive dysfunction.ope