Local Botulinum Toxin Type A Injection for the Management of Congenital Muscular Torticollis

OBJECTIVE: To evaluate the effectiveness of local intramuscular botulinum toxin type A injection in patients with congenital muscular torticollis. METHOD: Six patients (mean age, 13.3 months) with congenital muscular torticollis who did not respond to physical therapy were participated with the informed consent of their parents. Twenty-five to fifty Speywood units of Dysport (Beaufour Ipsen, France) were injected into the palpated mass of the sternocleidomastoid muscle. The angle of tilt and range of motion of the neck in sitting position were obtained before and after injection. The size of the mass within the sternocleidomastoid muscle was measured with ultrasonogram. RESULTS: Satisfactory improvement of 3 parameters at post- injection 6-month follow-up was achieved in all patients. The tilting angle and range of motion of the neck to rotation were normalized in 5 patients. The size of the mass within the sternocleidomastoid muscle was decreased significantly with ultrasonographic evaluation. CONCLUSION: Local intramuscular BTA injection might be effective for patients with congenital muscular torticollis who do not respond to conservative management.

A Case Report of Infiltrative Polyneuropathy Associated with Lymphoma

Infiltrative polyneuropathy is an infrequent complication of lymphoma or leukemia. The polyneuropathy can occur in patients with known malignancy, but sometimes it has been initial manifestation of underlying disease. The diagnosis was usually made at autopsy, because more common causes of polyneuropathy were frequently considered during life and many cases showed negative results on sural nerve biopsy. We experienced a case of steroid responsive polyneuropathy due to infiltration of malignant T cell on peripheral nerves prior to lymph node biopsy.

Influences of Primitive Reflex on Infants with Delayed Motor Development

OBJECTIVE: To clarify the relationship of primitive reflexes and motor development during second six months of age. METHOD: All infants were referred to Inha University Hospital Cerebral Palsy Clinic from January 1, 1996 to March 30, 1997. Identical evaluations were performed on 49 risk infants at eight months of age. Their primitive reflexes were graded on a 0~2 scale; 0 being inability to elicit the reponses passively, 1 being intermediate degree, 2 being obligatory. The following primitive reflexes were studied; asymmetric tonic neck reflex (ATNR), tonic labyrinthine reflex on supine (TLS), Moro reflex (Moro). The presence of some voluntary activities (rolling prone to supine, rolling supine to prone, and sitting unsupported) were observed. The Mantal-Haenszel chi-square for trend test was used in order to study the association of primitive reflex and motor development in infants with delayed development. RESULTS: Inability of rolling prone to supine was most significantly associated with presence of ATNR and TLS but not with that of Moro reflex. Inability of rolling supine to prone was significantly associated with presence of TLS and then Moro reflex, ATNR. Inability to Sit independently without support was associated with the presence of TLS, but not with that of ATNR and Moro reflexes. CONCLUSION: This study suggests that the presence of primitive reflexes at second half of age are negatively influenced on motor development of infants.

Protective Effect of Melatonin on Neuropathy in Streptozotocin-Induced Diabetic Rats

OBJECTIVE: The purpose of this study is to prove protective action of melatonin on the development of neuropathy in diabetic rat. METHOD: The experimental rats (Sprague-Dawley) were divided into 3 groups: Group 1, streptozotocin-induced diabetic rats with trial of melatonin; Group 2, streptozotocin-induced diabetic rats without trial of melatonin; Group 3, normal control. Streptozotocin was injected intraperitoneally in group 1 and 2. Melatonin was administered per orally in group 1 from 1 week after the injection of streptozotocin. The melatonin effect on diabetic neuropathy was evaluated by the measurement of conduction velocities and amplitudes of rat tail mixed nerve action potentials. The electrophysiologic examinations were performed before and 2, 4, and 6 weeks after administration of streptozotocin. RESULTS: The rat tail mixed nerve conduction velocities were decreased at 4 weeks in group 1 and 2, and showed significant improvement at 6 weeks in group 1 as compared with those of group 2 (p<0.05). The amplitudes of the compound nerve action potentials did not show difference before and after streptozotocin and melatonin trials, neither among groups. CONCLUSION: In this experimental study, we observed the inhibitory effect of melatonin on the progression of polyneuropathy in early stage of diabetic rat. For the clinical application to human beings, further study is required.

Interrater and Intrarater Reliability Test of Functional Independence Measure (FIM) in Activities of Daily Living (ADL) Evaluation

OBJECTIVE: The purpose of this study is to test interrater & intrarater reliability of FIM. METHOD: We trained 7 members in our rehabilitation team with educational FIM manual and videotape published at State University of New York. After training workshop and several practice of FIM, videotaped FIM of the 10 patients with stroke were evaluated twice at 30 days interval by 7 trained testers. With each FIM data interrater & intrarater correlations were analyzed. RESULTS: Both interrater & intrarater reliability of FIM was significantly high. And the results of intrarater reliability were more reliable than those of interrater reliability. Also motor FIM components were more reliable than cognition FIM components. CONCLUSION: With proper training of the testers, FIM could be used as a standard assessment tool in a rehabilitation unit to quantify patients' disability.