To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities.
Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance.
Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb.
For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.
Citations
Method: Our disability prevention program was a 60 minutes program composed of watching an education video for disability prevention and having a conversation with disabled speakers in wheelchairs. A questionnaire to measure the effect of the education was administered among 5,315 students in the 4th to 6th grades. The questionnaire was administered at 7 days before and after education. The questionnaire was to measure the changes in self-efficacy and in confidence to follow safety regulation. Also the questions on satisfaction about program were asked. Results: The result showed that only 9.7% of bicycle owners, 18.9% of inline skate owners wore helmets, 9.3% of quick board (or skateboard) owners wore helmets, and only 47.6% of students fastened seat-belts in a car. After the program was conducted, there were significant improvements in self-efficacy and practice-confidence to wear protective device and to fasten seat belt in a car (p＜0.01). The most impressive part of the program for students was 'conversation with disabled speaker' and the next was 'watching the video'. After program was conducted, 51.5% of students answered "I will keep safety regulations in mind and practice it" and 10.1% of students answered "I could learn a better understanding of the disabled and I also want to help them". Conclusion: The 'disability prevention program with disabled speakers in wheelchair' was effective in improving the self-efficacy and practice-confidence for safety regulation. (J Korean Acad Rehab Med 2008; 32: 160-168)
Objective: To find out the changes of the plantar pressure distribution of foot and the pathway of center of pressure (COP) in normal preschool children with age.
Method: Thirty-eight normal children aged 1 to 6 were participated in this study. We divided into three groups according to the age. Foot contact area, pressure of the foot and pathway of COP were measured using F-scan in-shoe measuring system (Tekscan Inc.) during the gait.
Results: The ratio of midfoot contact width to forefoot contact width was decreased with age (p＜0.05). And the relative pressure of the medial midfoot was decreased with age (p＜0.05). In the analysis of COP, the ratio of anteroposterior length of COP to total contact length was significantly increased (p＜0.05), and the ratio of mediolateral width of COP to forefoot contact width was tend to decrease.
Conclusion: We can identify the characteristics and changes of the foot pressure distribution and the pathway of COP in preschool children with normal foot using F-scan system. These quantitative data of foot scan are useful for evaluating the foot pathology in preschool children during the gait.
Objective: The main purposes of this study were to understand the correlations among Modified Barthel Index (MBI), Functional Independence Measure (FIM), and ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status) Profile, and to establish the more appropriate assessment standards to check patient's conditions in the hospital and in their homes and society.
Method: Thirty-four patients, who received the rehabilitation treatment and home visiting at the Presbyterian Medical Center, were evaluated for their functions by MBI, FIM, and ESCROW Profile.
Results: The mean scores of assessment measures by home visiting were all higher than in the hospital showing an improvement of the patients' functions after discharge from the hospital. The results of MBI and FIM in the hospital and home visiting showed a significant correlation, while the results of MBI and Cognitive FIM measure indicated a relatively low correlation coefficient. Although each result of MBI, FIM, and ESCROW provided a low correlation when the patients were in the hospital, the result for home visiting revealed very significant correlations. Especially, the items of environment, social support, outlook, and work status of ESCROW showed very significant correlations with MBI and FIM.
Conclusion: The results showed that MBI and FIM measurements were very useful in observing and following up the functional conditions of the patients, while ESCROW profile was more appropriate to evaluate the familial and social rehabilitation status.
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