Citations
Citations
Cerebral palsy (CP) was defined as "a permanent, but not unchanging disorder of movement and posture due to a non-progressive defect or lesion of the brain in early life" by the Little Club in 1964. This definition is not universally agreed but it is still widely used. It may be associated with cognitive, sensory and behavioral manifestations.
The prevalence of CP has changed very little over the past 40 years. As a result of improved survival of prematurely born infants with very low birth weight, more individuals have severe motor disability and associated handicaps. The incidence of CP is 2∼5/1,000 live births, but at 7 years of age, the rate is estrmated to be 2/1,000 births.
Management of a child with CP requires a multidisciplinary approach shared with the child and family and should support for them.
Numerous ways have been tried to moderate the abnormalities found in the different varieties of CP. The aim of treatment is to prevent the development of deformity, suppress unwanted or abnormal movements and promote optimal function. The well-known systems of physical therapy include those of the Bobaths, Vojta and the Peto.
Occupational therapy concentrates on eye-hand coordination and upper extremity motor control and other activities of daily life. Orthosis usually is prescribed to correct abnormal posture of the ankle and foot.
Topical injection of phenol, alcohol solution or botulinum toxin into the motor points or motor nerves of a spastic muscle creates a temporary neurolysis and consequent tone reduction lasting 5 to 6 months. Currently intrathecal baclofen is widely used. Where contractures have occurred in the hips and knees, soft tissue surgery around the hip, knee and ankle in a simple operation may be carried out.
The Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) battery provides an initial profile of the cognitive abilities of the brain-injured patient that can be used as a starting point for occupational therapy intervention and as a screening test for further assessment. Reliability and validity for the LOTCA have been reported in the literatures. This study investigated the relationship between LOTCA scores and functional assessments in 34 brain-injured patients, consisting of 21 stroke patients and 13 traumatic brain injury patients.
Subjects were administered the LOTCA and, as functional assessment tools, the Cognitive Capacity Screening Examination(CCSE) and the Modified Barthel Index(MBI) upon referral to occupational therapy initially, and again at discharge.
The initial and the last LOTCA scores were significantly related to the initial and the last CCSE scores and the MBI scores, respectively, in brain-injured patients. Each of the last LOTCA scores, CCSE scores, and MBI scores increased significantly compared to the initial scores. There were no significant differences in the initial and the last LOTCA scores, CCSE scores, and MBI scores between stroke patients and traumatic brain injury patients. Greater LOTCA gain was significantly related to greater MBI gain.
These results suggest that the LOTCA battery for brain-injured patients is related not only to cognitive function, but also to functional evaluation as activities of daily living and functional recovery at discharge.
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