Botulinum Toxin Treatment on Upper Limb Function in School Age Children With Bilateral Spastic Cerebral Palsy: One Year Follow-up

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Prevalence of Depressive Disorder among the Elderly Attending Community Health Center in a Small City / 신경정신의학

OBJECTIVES: This study was conducted in order to collect data regarding depressive disorder of elderly people at a community health center. METHODS: A total of 109 elderly people participated in this study. Trained examiners evaluated the general characteristics and symptoms of the subjects. Then the doctors conducted interviews with the elderly subjects in person and diagnosed depressive disorder according to the standard of Diagnostic and Statistical Manual of Mental Disorders-IV-TR. RESULTS: The prevalence of depressive disorder was 19.3%, major depressive disorder 10.1%, dysthymic disorder 1.8%, and others 7.3%. According to results of logistic regression analysis, in terms of demographic variables, the odds ratio of elementary school dropout compared with elementary school graduates was 3.60, after adjusting for age and sex. Thus, we found that elementary school dropout was associated with an increased risk of prevalence of depression. CONCLUSION: This is the first study of prevalence of depressive disorder in a primary health care center in Korea. Results of this study confirm that the prevalence of depressive disorder is two times higher among adults in the Chungju community. In addition, the level of education was also highly related. Examiners detected a possible relationship between sex and residence. The results will be helpful in conduct of future studies at the health care center.

Physical Therapists' Recognition about Home-Based Rehabilitation Therapy Services

BACKGROUND: We were interested in getting feedback from physical therapists practicing in individualized home health programs about the present situation and the problems of home-based rehabilitation therapy services. METHODS: We recruited 110 physical therapists practicing in individualized home-visiting health programs offered at health centers. They each completed a 15-item self-administered questionnaire including personal information, therapy environments, characteristics of patients, treatment outcomes and suggestions. RESULTS: Of the 110 respondents, 66 (60%) were engaged in home-based rehabilitation therapy services with other duties. Sixty (54.5%) indicated that >25% of patients improved with home-based therapy and 90% of patients were satisfied with the services they received. Eighty-three (75.5%) respondents indicated that the amount of therapy provided was insufficient, 82 (74.5%) thought that there were no measurement tools to use except for the rehabilitation therapy services records and 27 (24.6%) had evaluation meetings with other medical service members for >50% of their patients. CONCLUSION: The majority of the physical therapists in our study indicated that the home-based rehabilitation therapy services satisfied the needs of patients and improved their functional abilities. However, amount of therapy, use of measurement tools for outcome evaluations and comprehensive team approach were indicated as insufficient. We conclude that increasing the number of physical therapists and systematizing the home-based rehabilitation therapy services would improve the present situation.

Predictive Factors for Cervical Spine Injury in Patients with Minor Head Injury

PURPOSE: This study aimed to determine new criteria for detecting independent factors with high sensitivity in cases of cervical spine injury. We compared the sensitivity, the specificity, and the false negative predictive value (NPV) of plain radiographs with those of computed tomography for cervical spine injury in patients with minor head injury. METHODS: We retrospectively reviewed the cases of 357 patients who underwent both cervical plain radiographs and computer tomography from January 2006, to September 2008. Patients were divided into two groups: the cervical spine injury group and the no cervical spine injury group. New criteria were organized based on variables that had significant differences in the logistic regression test. RESULTS: Among the 357 patients, 78 patients had cervical spine injuries. The average age was 43.9+/-15.2 yrs old, and the male-to-female ratio was 1.90. The most common mechanism of injury was motor vehicle accidents. There was a significant difference in loss of consciousness, Glasgow Coma Scale (GCS)=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs between the two groups on the logistic regression test. New criteria included the above five variables. If a patient has at least variable, the area under the ROC curve of the new criteria was 0.850, and the sensitivity and the false NPV were 87.2% and 5.2%, respectively. CONCLUSION: New criteria included loss of consciousness, GCS=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs. If the patient had at least 1 variable, he or she could have a of cervical spine injury with a sensitivity of 87.2% and a false NPV of 5.2%.

Rehabilitation of Drivers with Brain Injury Using Virtual Reality Based Driving Simulator

OBJECTIVE: To investigate the effect of driving-simulator based training for the persons with brain injury. METHOD: Twenty-seven brain injury patients and 19 healthy volunteers were included in this study. Driving simulator program was composed of an aptitude test (which have 4 items) and simulated road driving. The brain injury patients had 4 sessions of driving simulator training with assessment performed during the first and the last session. Healthy volunteers underwent only one driving simulator session for assessment. To evaluate subjective satisfaction in terms of training effect and the sense for the real, a survey was administered after the training. RESULTS: In brain injury patients, there were significant improvements in both aptitude test and simulated road driving test after training (p <0.01). There were no significant differences between the scores of patients taken at the last session and the scores of healthy volunteers, while the scores of patients taken at the first session were significantly lower than those of healthy volunteers. The patients group reported positively in terms of training effect (81.5%) and the sense for the real (62.9%). CONCLUSION: A driving-simulator based training was effective for brain injury patients to regain driving skill.

Nocturnal Penile Tumescense and Rigidity Testing for Evaluation of Erectile Dysfunction in Men with Spinal Cord Injury

OBJECTIVE: To evaluate erectile dysfunction in patients with spinal cord injury and the relationship between patient's subjective answers and the results of objective tests regarding erectile dysfunction. METHOD: Twenty-one male patients with erectile dysfunction after spinal cord injury were administered with nocturnal penile tumescense and rigidity testing (NPTR) using Rigiscan(R) over 2 consecutive nights. NPTR using Rigiscan(R) at second night was performed after oral administration of sildenafil 50 mg. Answer of the global efficacy question (GEQ) after oral administration of sildenafil 50 mg and the parameters of NPTR were compared. RESULTS: After oral administration of sildenafil 50 mg, number and duration of erectile episodes, and duration of rigidity greater than 60% on NPTR improved significantly (p< 0.05). Sixteen out of seventeen patients (94.1%) who showed improved nocturnal erection after oral administration of sildenafil 50 mg answered that they had an improved erectile function after sildenafil. All four patients (100%) who showed no improvement in nocturnal erection after sildenafil answered that their erectile function was not improved after oral administration of sildenafil 50 mg. CONCLUSION: We expect NPTR using Rigiscan(R) might be useful for the evaluation of erectile dysfunction in men with spinal cord injury.

Effect of the Disability Prevention Program on Students' Self-efficacy and Practice-confidence in Elementary School

OBJECTIVE: To identify the effect of the 'disability prevention program' for elementary school students. 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.

The Selection of Exercise Stress Test in Hemiplegic Patients

OBJECTIVE: To suggest the standard tool for the selection of exercise stress tests (EST) by analysis of the initial evaluation factors affecting EST. METHOD: Twenty-two hemiplegic patients carried out treadmill, arm and bicycle ergometer ESTs. Treadmill EST using modified Harbor protocol was performed without taking off AFO. The velocity of the arm and bicycle ergometer was set in 50 rpm, and the resistance was increased up to 5 W at each stage. Each EST was completed at 80% of maximal heart rate. RESULTS: Brunnstrom stage of lower extrimity, Medical Research Council (MRC) scores [hip flexor, knee extensor, finger flexor] and standing balance of twelve patients completing treadmill EST were superior to those of failed group (p<0.05). Twelve patients completing bicycle ergometer EST showed significant differences in MRC scores [hip flexor, knee extensor] and sitting balance (p<0.05). Brunnstrom stage of lower extremity hip flexor and knee extensor power contributed mostly to the completion of treadmill EST (p<0.01). The completion of bicycle ergometer EST was mostly dependent on hip flexor and knee extensor power (p<0.01). CONCLUSION: For bicycle ergometer EST, hip flexor and knee extensor power should be higher than 3 and 4, respectively. Treadmill EST can be suggested when Brunnstrom stage of lower extremity, hip flexor and knee extensor power are above 4, 4 and 3, respectively. The completion rate of treadmill EST can be increased when standing balance ability and Brunnstrom hand score higher than 4 and 2, respectively.

A Clinical Study on 212 Case of Pelviscopic Surgery / 대한산부인과학회잡지

Two-hundred and twelve cases of pelviscopic operation were performed at Pusan St. Benedict Hospital from November, 1992 to December, 1995. The results were as follows; The common indications were ovarian cyst(32.2%), ectopic pregnancy(16.9%), and endometriosis(14.7%). Frequent types of surgery were salpingo-oophorectomy(22.6%), salpingectomy(10.8%), and oophorectomy(10.0%). The mean age of the patients was 33.4 years. The mean parity of the patients was 1.0. The mean duration of hospitalization was 4.8 days. The most common complication was hemorrhage at the trocar sites. In our conclusions, pelviscopic surgery made minimal postoperative hemorrhage with postoperative discomfort, low incidence of complications, and short duration of hospitalization. Pelviscopic surgery was useful and recommended for the treatment of gynecologic diseases.