Korean Database of Cerebral Palsy: A Report on Characteristics of Cerebral Palsy in South Korea

OBJECTIVE: To introduce the Korean Database of Cerebral Palsy (KDCP) and to provide the first report on characteristics of subjects with cerebral palsy (CP). METHODS: The KDCP is a nationwide database of subjects with CP, which includes a total of 773 subjects. Characteristics such as demography, birth history, onset and type of CP, brain magnetic resonance imaging (MRI) findings, functional ability and accompanying impairments, were extracted and analyzed. RESULTS: Preterm delivery and low birth weight were found in 59.51% and 60.28% of subjects, respectively. Postnatally acquired CP was 15.3%. The distribution of CP was 87.32%, 5.17%, and 1.81% for spastic, dyskinetic, and ataxic types, respectively. Functional ability was the worst in dyskinetic CP, as compared to other types of CP. Speech-language disorder (43.9%), ophthalmologic impairment (32.9%), and intellectual disability (30.3%) were the three most common accompanying impairments. The number of accompanying impairments was elevated in subjects with preterm birth and low birth weight. Brain MRI showed normal findings, malformations, and non-malformations in 10.62%, 9.56%, and 77.35% of subjects, respectively. Subjects with normal MRI findings had better functional ability than subjects with other MRI findings. MRI findings of a non-malformation origin, such as periventricular leukomalacia, were more common in subjects with preterm birth and low birth weight. CONCLUSION: The KDCP and its first report are introduced in this report, wherein the KDCP established agreement on terminologies of CP. This study added information on the characteristics of subjects with CP in South Korea, which can now be compared to those of other countries and ethnicities.

An Analysis of Sit-to-Stand Transfer in Normal Children

OBJECTIVE: Rising from a sitting position is a very common, yet essential activity in daily life. The activity to perform the sit-to-stand (STS) transfer is a prerequisite for upright mobility. This study aims to provide fundamental data concerning the execution of the STS, and in particularly the followings: 1) how do the angles of the lower limbs change throughout the process of rising from a chair; 2) how much motion torque and power in each joint are required per kilogram of body weight to complete the STS transfer? METHOD: Twenty-one children who have developed normally and could understand the command requested are involved as subjects. Their age ranged from 3 to 5 years old. Motion analysis of STS transfer were assessed with the Vicon 370 M.A (Oxford Metrics Limited, United Kingdom). The changes in joint angle, maximal moment and power in lower limb were calculated throughout the STS transfer. RESULTS: A series of transition points was observed in the angles of the hip, knee and ankle joints throughout the sit-to-stand movements, which was classified into five stages. The first stage is trunk and hip flexion phase; second stage, buttock take-off; third stage, ankle dorsiflexion and knee extension; forth stage, just-standing; fifth stage, stabilizing phase. The extension moment of each joint is 0.65 Nm/kg on right, 0.71 Nm/kg on left in hip, 0.41 Nm/kg on right, 0.38 Nm/kg on left in knee and 0.21 Nm/kg on right, 0.22 Nm/kg on left in ankle joint. The extension power is 0.60 watt/kg on right, 0.68 watt/kg on left in hip, 0.59 watt/kg on right, 0.50 watt/kg on left in knee and 0.15 watt/kg on right, 0.15 watt/kg on left in ankle joint. CONCLUSION: A consistent pattern was observed throughout the sit-to-stand transfer and six transition points were observed in the angles of the hip, knee and ankle joints throughout the STS transfer. By these 6 points, the movement of the STS transfer was classified into 5 stages. Major changes in angle, moment, and power of each joint were observed in sagittal plane. There were no side to side difference during the STS transfer.

Comparison of Speech-Language, Mental-Motor Development and Brain Radiologic Findings in Children with Cerebral Palsy and Other Delayed Development

OBJECTIVE: To evaluate the characteristics of speech-language development and to find out the relationship between them and radiological findings, and mental/motor developmental quotient in the children with cerebral palsy and other delayed development. METHOD: Fifty-eight children with cerebral palsy or delayed development were evaluated with Bayley scales of infant development, brain magnetic resonance imaging (MRI), and single photon emission computerized tomography (SPECT). At the same time, the speech-language development using several evaluation batteries was assessed. RESULTS: Most of the children with cerebral palsy or delayed development showed delay in speech-language development. There was no relationship between speech-language development and presence of the lesion on brain MRI or SPECT, and mental/motor developmental quotient. CONCLUSION: Speech-language development was delayed in most of the children with cerebral palsy or other delayed development. Therefore, early interventions for speech-language development and comprehensive speech therapy are required for improving functional outcome in these children.

Cardiovascular Responses to Isometric Handgrip Exercise

Isometric contractions of muscles in upper extremities occur frequently during ordinary daily activities. The isometric handgrip exercise can be one of the best methods for the evaluation and treatment of patients with disability of upper extremity. However these isometric contractions can impose sudden and significant high stresses to the cardiovascular system. The purpose of this study was to document the torque patterns and cardiovascular responses of subjects by the isometric handgrip exercises and hopefully to provide a guidance for the safe evaluations and prescriptions of isometric exercises. Eighty healthy male subjects from 21 to 60 years of age performed isometric handgrip exercises using a Baltimore therapeutic equipment work simulator. The peak torque, time to peak torque, and torque at each second were measured by a six-second isometric strength trial program. The blood pressure and heart rate were measured simultaneously at rest and at each minute during isometric exercises at 30%, 50%, and 70% of the peak torque. There were no differences in the peak torque, time to peak torque, and torque at each second between age groups(p>0.05). After the onset of peak torque, the torque gradually decreased and recorded 72.8% of the peak torque at 6 seconds. The mean arterial pressure and heart rate increased significantly during exercise(p<0.001), but returned to the resting state immediately when the exercise stopped. The mean arterial pressures were significantly different when the duration of exercise prolonged at 50% and 70% of the peak torque(p<0.05). And also the mean arterial pressures increased significantly when the strength of exercise increased as well(p<0.001). We have concluded that attentions should be given to patient's cardiovascular state, and duration and strengh of exercise when the isometric handgrip exercises are prescribed for the evaluation and treatment of patients.

Hemodynamic Study of Foot in Diabetic Patient Using Portable Doppler Machine

The importance of neuropathy in the pathogenesis of foot lesions has been well recognized in diabetes. Blood flow in ischemic limbs has been extensively investigated but the circulation of limbs affected by peripheral neu ropathy has received little attention. Some studies on blood flow in peripheral neuropathy have shown a remarkable increase in resting flow, transcutaneous venous oxygen tension, and vascularity, along with loss of the spontaneous variations which occur normally with sympathetic activity of the foot in patients with diabetes. The aim of present study is to find out the effects of somatic and autonomic nervous function in early change of blood flow of foot in diabetic patients, We have studied fifty-one patients of non-insulin-dependent(type II) diabetes with no history of hypertension of diabetic foot ulcers. The evidence of neuropathy was screened by nerve conduction studies and sympathetic skin response of both lower extremities. Blood flow of dorsalis pedls and posterior tibial arteries was measured by portable doppler machine and presented as pressure index(ankle-to-arm systolic pressure ratio). The patients with sympathetic dysfunction showed significant decrease in pressure index compared to normal control and diabetic patients with normal sympathetic function, suggesting that changes of the blood flow occur in diabetic patients with sympathetic dysfunction.