Effects of Speech Therapy in Children with Specific Language Impairment and Mild Intellectual Disability

OBJECTIVE: To analyze the effects of speech therapy between children with specific language impairment (SLI) and mild intellectual disability (ID). METHOD: Fourteen children with SLI and thirteen children with mild ID who had received speech therapy for more than 1 year were enrolled. The language function and cognitive function of all subjects were assessed before and after speech therapy. RESULTS: Improvement of receptive and expressive language development were shown in 78.5% and 71.4% of children with SLI, respectively. However improvement of receptive and expressive language development was shown in only 30.7% of children with ID. Improvement of verbal intelligence which had appeared in the SLI group was not shown in the ID group. CONCLUSION: Effects of speech therapy were different in children with SLI and mild ID and more favorable outcomes were demonstrated in children with SLI.

Visual-perceptual Function in Children with Spastic Cerebral Palsy

OBJECTIVE: To compare visual-perceptual function between children with bilateral spastic cerebral palsy who have periventricular leukomalacia and unilateral spastic cerebral palsy without periventricular leukomalacia. METHOD: Twenty-one children with spastic cerebral palsy (11 bilateral, 10 unilateral) were enrolled and their visual-perceptual function were assessed using K-DTVP-2 (Korean developmental test of visual perception 2). RESULTS: K-DTVP-2 in the bilateral group showed significant dysfunction when compared with the unilateral group. Among 6 sub-items of K-DTVP-2, scores related to visual closure and copying were particularly reduced in the bilateral group. There was discrepancy of verbal and performance IQ in the bilateral group which was not apparent in the unilateral group. CONCLUSION: In children with spastic cerebral palsy, the bilaterally affected group had characteristic features of visual-perceptual dysfunction.

A Survey on the Health Status of Population with Disability in Goyang City

OBJECTIVE: To improve the quality of life of the disabled population by decreasing the incidence of complications and chronic diseases and improving self-care abilities according to individual diseases through health status evaluation and basic survey. METHOD: The basic clinical information of 1,378 regional severely-disabled patients were collected along with information regarding functional level, activities of daily living, nutritional status, and management of complications which were distinguished into 3 stages (good, moderate, poor), which were correlated into scores (1-3 points) that were used to assess a collaborative score (5-15 points) that represented their health status. Health behavior and blood tests were also done. RESULTS: Health status were evaluated based on sex, grade of disability, age, frequency of exercise and type of disability, which revealed that female sex, brain disorder, 1st grade disability, total lack of exercise, old age disabled patients were relatively poor in terms of health status. CONCLUSION: Health status of the severely-disabled showed differences according to sex, age, grade of disability, type of disability, and frequency of exercise, and health programs designed to screen and follow up the severely-disabled person with poor health status as well as manage their accompanying diseases and complications are needed.

"Trigger Finger at the Wrist" due to Anomalous Flexor Digitorum Superficialis Muscle Belly with Carpal Tunnel Syndrome: A Case Report

"Trigger finger at the wrist" is a rare phenomenon. The main symptom consists in a triggering at the wrist produced by finger motion. Its etiology and presentation may vary. One of etiology, some anomalies of muscle can cause this disease. Triggering finger at the wrist with carpal tunnel syndrome by abnormal the belly of the flexor digitorum superficialis has been reported. But most cases of it have been reported by orthopedic surgeons. We are presenting the case of 28 year old male patient who had abnormal flexor digitorum superficialis in carpal tunnel which was diagnosed by using ultrasonography.

Crossed Transcortical Motor Aphasia, Left Spatial Neglect, and Limb and Magnetic Apraxia Due to Right Anterior Cerebral Artery Infarction

Crossed aphasia refers to language disturbance due to right-hemisphere lesions in right-handed individuals, while magnetic apraxia is described as 'forced grasping and groping' caused by lesions in the contralateral frontal lobe. This is a case report of a 70-year-old right handed woman who suffered from crossed transcortical motor aphasia and left hand magnetic apraxia due to right anterior cerebral artery infarction. The definite mechanism of this disorder is not yet understood, but neurophysiological observations suggest that affected supplementary motor areas may be responsible for this phenomenon.

Clinical Features and Effects of Occupational Therapy in Children with Developmental Coordination Disorder

OBJECTIVE: To assess the clinical features of children with developmental coordination disorder (DCD) and the effects of occupational therapy. METHOD: Seventeen children were diagnosed with DCD using by Bruininks-Osteretsky test of motor proficiency (BOTMP). To investigate the clinical features, neurological examinations such as soft neurological signs, speech evaluation, cognitive assessment, and psychiatric evaluation were performed on the 17 participants. Among the participants, 8 children had occupational therapy. BOTMP and cognitive function were evaluated both prior to and 6 months after the intervention. RESULTS: Children with DCD showed various soft neurological signs and co-morbidities such as attention-deficit hyperactivity disorder (ADHD), developmental language disorder, and emotional problems. The cognitive assessment revealed disproportionately low performance IQ for all subjects. After occupational therapy, scores for BOTMP and performance IQ increased significantly. CONCLUSION: The clinical features of DCD are heterogeneous and occupational therapy focused on motor proficiency was effective. This study supports raising interest in and attention on children with motor coordination difficulties.

Treatment of Synovial Proliferative Subdeltoid Bursitis through Alcohol Installation: A case report

For patients with bursitis, the treatment modality of choice was conservative treatment, and those who did not experience symptom relief usually received surgery. However, we have been able to treat a patient with chronic proliferative subdeltoid bursitis through alcohol instillation. The patient complained of aggravating right shoulder area pain particularly on abduction or flexion of his arm. Ultrasonographic examination revealed that there was notable synovial thickening, fluid collection and proliferative pannus in the subdeltoid bursa. Steroid was injected for treatment but after 9 days, synovial proliferation and synovial fluid collection remained unchanged. After additional 7 days, 70% isopropyl alcohol 5 ml was injected into the subdeltoid bursa via ultrasonograph-guided injection, followed by normal saline 10 ml injection to dilute the previously injected alcohol in order to re-aspirate. On the following check-up 3 weeks after, decrease in synovial proliferation along with normal ultrasonographic results other than slightly thickened bursa wall was noted.

Electrophysiological Changes after Botulinum Toxin Type A in Children with Cerebral Palsy

OBJECTIVE: To investigate the electrophysiological changes after botulinum toxin type A injection in children with cerebral palsy. METHOD: Sixteen children with spastic cerebral palsy enrolled in the study. Botulinum toxin type A (Dysport(R)) was injected into gastrocnemius muscles. Electrophysiological assessments included the compound motor action potential of the tibial nerve, the sensory nerve action potential of the sural nerve, the H-reflex and the T-reflex before injection, and at 2 weeks and 4 weeks after the injection. Modified Ashworth scale was used to evaluate spasticity before, 2 weeks and 4 weeks after the injection. RESULTS: Modified Ashworth scale of the ankle decreased at 2 weeks and 4 weeks after injection. The amplitude of the H-reflex and H(max)/M(max) ratio decreased significantly at 4 weeks. The amplitude of the T-reflex decreased at 2 weeks and 4 weeks. The correlation between changes in modified Ashworth scale of the ankle and the changes in electrophysiological parameters at 4 weeks after injection were not significant. CONCLUSION: The change in T-reflex is faster than the change of H-reflex and H(max)/M(max) ratio after botulinum toxin A injection in children with cerebral palsy. Electrophysiological tests could quantify the change in spasticity after botulinum toxin injection.

The Analysis of Relationship among the Anthropometric Index, the Foot Types and Dynamic Plantar Pressure in Normal Teenagers

OBJECTIVE: To investigate the possible relationship between the anthropometric data, the foot types, sex and the dynamic plantar pressure of normally developed teenagers. METHOD: The height, weight, body mass index and dynamic plantar pressure were measured from 98 teenagers. Foot types were classified to high arch, normal and flat foot groups depending on the value derived by dividing the minimal length of mid foot area by the maximal length of the rear foot area. RESULTS: The area with the highest plantar pressure was the middle metatarsal area at both feet. However the plantar pressure of the right medial metatarsal and lateral calcaneal areas was greater than the left, while the plantar pressure of the left lateral metatarsal and medial calcaneal areas was greater than the right. Therefore, supinating and pronating forces were applied to the right and left feet. There were statistically significant differences in body weight and BMI among three groups. The comparison between men and women in plantar pressure measurements and foot type determinations showed that the number of pronated feet group and plantar pressures was greater in males than in females. CONCLUSION: The dynamic plantar pressure of teenagers showed high correlation to weight and BMI. Just like the hands, there was lateral dominance at the feet, and analysis of dynamic plantar pressure of each foot showed asymmetry and asymmetrical turning forces.

Severity of Disability and Quality of Life in Handicapped Persons in Welfare Facility and Home in Goyang City

OBJECTIVE: To compare severity of disability and quality of life between the handicapped residing in a welfare facility and the handicapped living at home. METHOD: This research conducted a survey for the handicapped persons in Goyang city. The survey consisted of the following items: disability diagnosis, modified Barthel index (MBI), Korean-activities of daily living (K-ADL), 8-item short form health survey instrument (SF-8) and life domain satisfaction measure (LDSM). A total number of 144 handicapped persons participated, and 66 among them lived at home. RESULTS: In regard to the range of activities of daily living MBI, K-ADL and quality of life; SF-8, those who resided in a welfare facility showed higher scores. In terms of satisfaction of life, the two groups did not show significant difference in housing, education and family relationship. However, as for leisure and health, those who resided in a welfare facility showed higher satisfaction. CONCLUSION: The handicapped persons residing in a welfare facility could function more independently in carrying out daily activities, and they showed higher quality and more satisfaction of life compared to those who lived at home. These results support that more attention would be needed for disabled persons at home to make welfare and rehabilitation policies.

Quality of Life and Demands for the Welfare of the Parents with Children in Special School in Goyang City

OBJECTIVE: To investigate the level of quality of life, life satisfaction, depression and demands of parents with children in special school. METHOD: Data were collected through a questionnaire answered by 152 parents whose children were enrolled in four special schools in Goyang City. The quality of life (QOL), life domain satisfaction measure (LDSM), Beck depression inventory (BDI) and the demand for rehabilitation and welfare service were obtained. RESULTS: The average score of QOL was less than 50 and the mental health component in particular was the lowest of all. The average score of LDSM was 3.9+/-0.9, and most notably the score regarding economic status resulted to be the lowest. The average score of BDI was 13.4. The general health screening and medical service related needs of the parents with disabled children were most significant, including the need for the expansion of welfare facilities for disabled people. CONCLUSION: In order to provide better rehabilitation service to disabled children, a policy which could decrease the physical and mental burden of parents with disabled children should be considered.

Emotional and Psychosocial Development in Siblings of Children with Cerebral Palsy

OBJECTIVE: To investigate the psychological development such as emotional and social aspects of typically developing siblings of children with cerebral palsy. METHOD: Eighteen siblings of children with cerebral palsy aged 5 to 12 years and their mothers were included and the interview and psychological assessment were administered by developmental psychologist. All children were asked to complete the Children's Depression Inventory (CDI), State- Trait Anxiety Inventory (STAI), Piers-Harris Children's Self- Concept Scale, Korea Child Behavior Checklist and Korean Educational Developmental Institute-Wechsler Intelligence Scale for Children (KEDI-WISC). All participating mother were asked to complete Minnesota Multiphasic Personality Inventory (MMPI), Beck's Depression Inventory (BDI). For control group, eighteen children with healthy sibling and their mothers were enrolled. RESULTS: Siblings of children with cerebral palsy showed higher mean score of CDI and STAI. And there were no differences in the CDI and STAI according to frequency of treatment, duration of treatment of children with cerebral palsy. There were no significant difference in Piers-Harris children's Self-Concept Scale and Korea Child Behavior Checklist between study group and control group. More than half of mothers of children with cerebral palsy showed depression in BDI and higher score of psychopathic Deviate and psychasthenia in MMPI. Children of mothers with depression in BDI showed higher mean score of CDI and STAI. CONCLUSION: It is necessary to consider extended service to promote psychosocial well-being of children with cerebral palsy and siblings in community-based service organizations.

Biomechanic Analysis of Lower Extremities in Children and Teenagers with Pes Planus

OBJECTIVE: To analyze the biomechanics of young patients with flat foot or malalignment syndrome of lower extremities and to provide some information and strategies in examining and treating them for other researchers or successive studies. METHOD: Between January 2004 and March 2006, 274 patients were engaged who had been diagnosed as flatfoot in 586 patients aged between 0 and 18. All patients were examined physically by one physiatrist to find other biomechanic abnormalities of lower extremities and to measure resting calcaneal stance position (RCSP) angle, bimalleolar angle (BMA). To detect the existence of scoliosis and the difference in leg length, radiographs were taken of the spine and the lower extremities. Flat foot was defined as when either of the feet had lower than -4degrees degrees of RCSP angle. RESULTS: When comparing the value of RCSP angle between right side and left side, the left side was more pronated than the right side. The value of RCSP angle increased in proportion to age but there are other factors that caused the persistence of foot pronation and ligament laxity. The value of BMA tends to increase in proportion to age. The foot was more pronated, the tibia of the same side was more rotated internally and tibia of the other side was more rotated externally. The most common combined biomechanic abnormality of lower extremities was toe-in gait. CONCLUSION: Because the biomechanic effect of a foot could influence the leg, pelvis of the same side and the other side lower extremity, the flat foot should be regarded as an element of malalignment syndrome, anatomical abnormality, and also functional impairment.

Usefulness of tibia counter rotator (TCR) for treatment of tibial internal torsion in children / 소아과

PURPOSE: Tibial internal torsion is prevalent in East Asian countries such as Korea and Japan, where sitting on the floor is common behavior. Tibial internal torsion or excessive lateral tibial torsion may cause esthetical, functional, or psychological problems and also may induce degenerative arthritis in older age. The aim of this study is to evaluate the therapeutic effect of Tibial Counter Rotator (TCR) in patients with tibial internal torsion. Method:One hundred forty nine children (274 limbs) with tibial internal torsion participated in this study. Transmalleolar angle were measured with gravity goniometer. When tibial internal torsion was detected, TCR was applied at least for 3 hours a day during sleep. The patient's progress was followed monthly and transmalleolar angle was reevaluated by the same examiner. RESULTS: Transmalleolar angle was significantly increased in patients with tibial internal torsion during TCR application (P<0.001). CONCLUSION: TCR can be one of the effective methods for correcting tibial internal torsion in children under 12 years old of age.

Treatment of Torsion Dystonia with Motor Point Block Using Phenol : A case report

Dystonia is an abnormal movement characterized by sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. Torsion dystonia is characterized by torsion spasms of muscle contraction, which distorts the limbs and trunk into dystonic postures. We present a case of a patient with torsion dystonia who was recalcitrant to oral medication or even surgical operations. This patient was treated with motor point block using 5% phenol solution. Using electromyographical guidance, phenol was injected into the paraspinal and upper extremity muscles, respectively. He showed reduction of dystonia and improvement of functional abilities. Motor point block using phenol can be considered as a tool of the management for patients with torsion dystonia. MDVAQ@yumc.yonsei.ac.kr

The Effects of Single Event Multi-level Chemoneurolysis on Upper Extremity Function in Children with Cerebral Palsy

OBJECTIVE: To investigate the effects of single event multi-level chemoneurolysis (SEMLC) on the upper extremity function along with the improvement of spasticity in children with cerebral palsy. METHOD: SEMLC using botulinum toxin and 5% phenol solution was done for the upper extremities of 22 children with spastic cerebral palsy. In control group, 17 children with spastic cerebral palsy were enrolled. The assessment of spasticity (modified Ashworth scale) and upper extremity function (quality of upper extremity skills test, QUEST) before and 4 weeks after treatment were examined. RESULTS: The spasticity of upper extremity was significantly reduced in SEMLC group compared with control group (p<0.05). The improvement of upper extremity function was significantly greater in SEMLC group than in control group (p<0.05). Children with spastic triplegia showed the largest change of QUEST compared with other types, but it wasn't statistically significant. In SEMLC group, initial QUEST score and the degree of improvement of QUEST after treatment showed significant negative correlation (p<0.05). CONCLUSION: This study revealed SEMLC of the upper extremity in cerebral palsy was the effective treatment which could improve the upper extremity function as well as reduce the spasticity itself.

The Clinical Features and Outcome of Therapy according to the Subtypes of Torticollis / 대한소아신경학회지

PURPOSE:We performed this study in order to investigate the clinical features and the therapeutic outcome of infants with torticollis according to the classification; congenital muscular torticollis(CMT), postural torticollis(PT) and, ocular torticollis(OT). METHODS:This study was conducted on 80 infants with torticollis who had been treated from March 2000 to July 2004 in the outpatient clinic of the pediatrics and rehabilitation medicine department of NHIC Ilsan Hospital. All the patients were physically and neurologically examined and took cervical X-rays and ultrasonographies. Based on the results the patients were classified into the subtypes of torticollis. Except OT, the patients underwent conservative treatment programs with physical therapy and home treatment programs. RESULTS:Among the three groups, the time of the first visit to the hospital was the fastest in CMT and the latest in OT. The appearance of facial asymmetry and plagiocephaly didn't show any difference between CMT and PT. The presence of asymmetric neck righting reaction was noted similarly between the two groups. The duration of the treatment was longer in the CMT group than that of the PT group. The outcomes of the treatment in CMT were not different from those of PT. CONCLUSIONS:There are no significant differences of the clinical features and the treatment results between the CMT and the PT groups except the duration of treatment. The ophthalmologic assessment is strongly recommended, if the age of an infant with torticollis is older than one year.

Diagnosis and Clinical Features of Children with Language Delay

OBJECTIVE: To determine the diagnosis and investigate the clinical features of children with language delay. METHOD: One hundred seventy-eight children who were referred to the Developmental Delay Clinic for the evaluation of suspected language delay were prospectively enrolled. Multidisciplinary assessment was done by a physiatrist, pediatric neurologist and pediatric psychiatrist. All patients took speech evaluation, full battery of cognitive assessment and hearing test. RESULTS: The common diagnoses of children with language delay were mental retardation (MR), specific language impairment (SLI) and autism spectrum disorder (ASD) in the order of frequency. The early developmental history showed delay of acquisition of motor milestone in MR group. The brain magnetic resonance image (MRI) and single photon emission computerized tomography (SPECT) findings couldn't help to distinguish the brain pathology in SLI, MR and ASD. The result of speech evaluation showed more severely involved in ASD and MR rather than SLI. CONCLUSION: In the clinical assesment and management of the children with language delay, the comprehensive assessment which includes cognition and personal-social area as well as language itself would be helpful for the understanding and setting up the therapeutic plan of these children.

Diagnosis and Clinical Features in Children Referred to Developmental Delay Clinic

OBJECTIVE: To determine the phenomenologic, etiologic diagnosis and clinical features of children with developmental delay. METHOD: One hundred seventy-one children, referred to Developmental Delay Clinic which was multidisciplinary clinic for the evaluation of a suspected developmental delay, were prospectively enrolled. Diagnostic yield was ascertained after the completion of the questionnaire, clinical assessments and laboratory investigations by the physiatrist, pediatric neurologist and pediatric psychiatrist. RESULTS: One hundred fifty-one children met study criteria. The common phenomenologic diagnoses of children with developmental delay were mental retardation, delayed language disorder, autism and cerebral palsy. The etiologic diagnosis was determined in 44 (28.02%) children. The diagnoses were hypoxic-ischemic encephalopathy, malformation of cortical development, dysmorphic syndrome, chromosomal abnormalities, and neuomuscular disorders in the order of frequency. In many cases, the chief complaint of parent was not in accordance with final diagnosis. CONCLUSION: In the clinical assessment and management of children with developmental delay, the most important thing is integrative and comprehensive approach including all the developmental territories. And also, the settlement of paradigm for systematic evaluation of these children with other specialists will be needed.

Causes of the Painful Hemiplegic Shoulder and Comparison of the Results of Radiologic Evaluation

OBJECTIVE: The purposes of this study were to investigate the findings of various diagnostic tools for shoulder pain in hemiplegic patients and to compare the results of each diagnostic tool. METHOD: Sixty shoulders in hemiplegic patients with shoulder pain were evaluated by physical examination, visual analogue scale, plain X-ray, arthrogram, ultrasonography and 3-phasic bone scan. RESULTS: The subluxation of shoulder on X-ray was found in 45 patients. The abnormal findings of arthrogram were 39 patients and the most common finding was adhesive capsulitis. The abnormal findings of ultrasonography were 45 patients and the most common finding was supraspinatus tendinitis. In cases of shoulder subluxation on X-ray, manycases were associated with supraspinatus tendinitis on ultrasonography and with adhesive capsulitis on arthrogram. In comparison with the arthrogram and ultrasonography, partial and complete rotator cuff tear findings show consistency. And patients with adhesive capsulitis on arthrogram show significantly high incidence of biceps tendinitis finding on ultrasonography. CONCLUSION: In hemiplegic patients with shoulder pain, the ultrasonography is more valuable and useful as an invasive diagnositc method for the evaluation of rotator cuff tendinitis especially when there is subluxation in X-ray and adhesive capsulitis in physical examination.