Sick Sinus Syndrome Combined with Wallenberg Syndrome: a Case Report

Cardiac arrhythmia is a rare manifestation of the Wallenberg syndrome; lesions are located in the brainstem, especially the lower medulla, which regulates sympathetic and parasympathetic activity. A 55-year-old man was admitted to the university hospital with symptoms including ataxia, left ptosis, decreased sensation of pain and temperature on the right side, left facial numbness, and dizziness. Brain magnetic resonance imaging revealed an infarction in the left dorsolateral medulla. Therefore, he was diagnosed with Wallenberg syndrome. While he underwent conservative treatment for Wallenberg syndrome, he experienced several events of self-limiting heart pounding, which required an evaluation of cardiac function. The 24-hour Holter monitor showed an increased RR interval with bradycardia and prolonged sinus pause. As a result, the diagnosis of sick sinus syndrome combined with Wallenberg syndrome was made. Sick sinus syndrome is a rare cardiac complication of the Wallenberg syndrome, and clinicians could overlook it when the initial electrocardiography shows a normal sinus rhythm. Sick sinus syndrome can cause sudden death without appropriate medical intervention. Therefore, clinicians should consider further evaluation, including a 24-hour Holter monitor, to check for the potential presence of sick sinus syndrome in the acute phase of Wallenberg syndrome.

Epidemiology of Spinal Cord Injury: Changes to Its Cause Amid Aging Population, a Single Center Study

Objective@#To investigate the epidemiologic and demographic characteristics of patients with spinal cord injury (SCI) who were admitted to a department of rehabilitation of a university hospital. @*Methods@#This was a descriptive cross-sectional study. Medical records including sex, age at injury, type of disability, traumatic or non-traumatic etiology and presence of ossification of posterior longitudinal ligament (OPLL) of patients with SCI who were admitted to the department of rehabilitation between 2012 and 2018 were reviewed. @*Results@#Of the 221 cases of SCI, 161 were traumatic and 60 were non-traumatic. The mean age at injury was 52.8 years. People aged 40–49 years showed highest proportion among overall SCI patients (19.0%). The proportion of male patients was higher in traumatic SCI at 4.96:1 than in non-traumatic SCI at 1.30:1. The most common cause of traumatic SCI was falling off (37.3%), followed by motor vehicle crash (35.4%) and tripping over (19.3%). Meanwhile, the most common cause of non-traumatic SCI was neoplasm (35.0%). Tripping over was the leading cause of traumatic SCI in patients aged ≥60 years (42.6%). A high proportion of traumatic SCI patients were found to have underlying OPLL (26.1%), particularly those who were injured by tripping over (64.5%). @*Conclusion@#The mean age of SCI patients was higher than that of previous studies. Falls was the single most common cause of traumatic SCI, and tripping over was the most common cause of injury in the elderly patients. OPLL was prevalent in patients who were injured from tripping over.

Clinical Usefulness of the Korean Developmental Screening Test (K-DST) for Developmental Delays

OBJECTIVE: To evaluate the clinical usefulness of the Korean Developmental Screening Test (K-DST) via comparison with Korean Ages and Stages Questionnaire (K-ASQ) for the diagnosis of developmental delay in pediatric patients. METHODS: The K-DST and K-ASQ were used to screen pediatric patients who visited the hospital for evaluation and diagnosis of delayed development. Korean Bayley Scales of Infant Development-II (K-BSID-II) or Korean Wechsler Preschool and Primary Scale of Intelligence III (K-WPPSI-III) were used for the standardized assessment. Moreover, the final clinical diagnosis was confirmed by three expert physicians (rehabilitation doctor, psychiatrist, and neurologist). The sensitivity and specificity of each screening tool for the final diagnosis were investigated and correlated with standardized assessments. RESULTS: A total of 145 pediatric consultations were conducted, which included 123 developmental disorders (40 autism spectrum disorders, 46 global developmental delay/intellectual disability, and 37 developmental language disorders) and another 22 that were not associated with any such disorders. The sensitivity and specificity of K-DST based on the final clinical diagnosis were 82.9% and 90.9%, respectively, which were not significantly different from that of K-ASQ (83.7% and 77.3%). Both K-DST and K-ASQ showed good correlation with K-BSID-II and K-WPPSI-III. No significant difference was found between the K-DST and K-ASQ measures. CONCLUSION: K-DST is an excellent screening tool and is expected to replace K-ASQ with high validity.

Current Situation of Assistive Devices and Appliances Provision for Persons with Cerebral Palsy in Korea / 보건행정학회지

BACKGROUND: The aim of this study was to investigate the current state of the assistive devices and appliances provision system for cerebral palsy patients registered with brain disability. METHODS: From 2003 to 2013, we analyzed the records of cerebral palsy patients who had assistive devices and appliances provisioned at least once in their lives based on National Health Information Database. Patients with cerebral palsy were divided into three groups: infants and toddlers, school age and adolescence, and adults. RESULTS: Data on short leg plastic orthoses, ankle joint orthoses, and wheelchair were mainly analyzed. The types of ankle joint orthoses divided into three categories: limited, 90° limited, and Klenzac. Limited ankle joint orthoses was most frequently supported of the three in all age groups. Powered wheelchair and scooter were most supported to adult patients. When the re-supply duration was evaluated, the duration was suitable to the duration on guideline of regulation of re-supplement according to the related laws in adult patients but not in infants/toddlers and school age/adolescence as the actual re-supplement duration was much shorter than the reference value. CONCLUSION: This study confirmed the pattern of assistive devices and appliances supply differed depending on the age of cerebral palsy patients.

Long Term Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children with Symptomatic Flexible Flat Feet

OBJECTIVE: To evaluate the long termeffect of custom-molded foot orthoses on foot pain and balance ability in children with symptomatic flexible flat feet after 1 year.METHOD: A total of 35 children over 6 year-old with flexible flat feet and foot pain for at least 6 months were recruited. Individual custom-molded rigid foot orthoses fabricated with the inverted orthotic technique was prescribed. Pain related parameters (pain sites, degree, and frequency) were obtained through questionnaires. Pain assessment was performed prior to application of the foot orthoses, and 1, 3, 6, 12 months after applying the orthoses. Balance ability was tested by computerized posturography. Such measures were evaluated prior to, 3 months, and 12 months after applying the foot orthoses. Additionally, the difference inbalance ability between barefoot and withfoot orthosesat 12 months was assessed to estimate carryover effect.RESULTS: 17 out of 35 children completed the study. Significant improvements were noted upto 12 months in pain parameters and balance ability. The carry over effect of the orthoses was confirmed.CONCLUSION: There were significant improvements offoot pain and balance ability in children with symptomatic flexible flat foot after wearing foot orthoses fabricated with the inverted orthotic technique over 1year period.

Cost of Rehabilitation Treatment of Patients With Cerebral Palsy in Korea

OBJECTIVE: To investigate rehabilitation treatment cost of patients with cerebral palsy (CP) according to age. METHODS: We analyzed the cost of rehabilitation treatment from 2007 to 2013 for patients diagnosed with CP by sourcing data from the National Health Information Database. RESULTS: While the number of recently born children requiring rehabilitation treatment has decreased, the number of patients requiring this treatment in other age groups has gradually increased. In addition, annual physical therapy, occupational therapy, hydrotherapy, and botulinum toxin injection treatment costs per person have increased. On the other hand, the number of orthopedic surgeries and selective dorsal rhizotomy performed has decreased. CONCLUSION: This study investigated trends in the cost of treatment for patients with CP. This study can be used as a basis to provide treatment support for patients with CP.

Disability Registration State of Children With Cerebral Palsy in Korea

OBJECTIVE: To investigate the disability registration state of children with cerebral palsy (CP) in Korea. METHODS: Based on the National Health Information Database, the disability registration state was examined for brain lesion disability and other possible complicated disabilities accompanying brain disorder in children diagnosed with CP aged up to 5 years old who were born between 2002 and 2008. RESULTS: Of children diagnosed with CP, 73.1% were registered as having brain lesion disability for the first time before they turned 2 years old. The younger the children, the more likely they will have 1st and 2nd degree disability. However, when the age of children is increased, such likelihood is decreased. The percentage of children registered as having overlapping disabilities was 7%–20%. CONCLUSION: It is important to establish a more accurate standard to rate disability and provide national support systems for children with CP with various severities and multiple disabilities. By reorganizing the current disability registration system for pediatric brain lesions, the system could serve as a classification standard to provide medical and social welfare services.

Incidence of Cerebral Palsy in Korea and the Effect of Socioeconomic Status: A Population-Based Nationwide Study

PURPOSE: Cerebral palsy (CP) is a neurodevelopmental disorder that causes serious disability. Prematurity and low birth weight (LBW) are known to be the strongest risk factors of CP. While socioeconomic status (SES) has been found to influence the occurrence of CP, prematurity, and LBW, no studies have investigated this effect in Korea. The aim of this study was to evaluate the incidence of CP, prematurity, and LBW in Korea, as well as the effect of SES thereon. MATERIALS AND METHODS: Data were obtained from the National Health Information Database from 2007 to 2013; persons with a history of CP, prematurity, and LBW were investigated by year. SES was defined in accordance with income quintiles, birth regions, and coverage classification. RESULTS: The incidence of CP decreased over the last five years, despite increased rates of prematurity and LBW. CP incidence was significantly lower in affluent groups than in the most deprived group, although this difference disappeared after controlling for confounders. The incidence of CP was significantly higher in medical aid beneficiaries, even after controlling for confounders. CONCLUSION: CP incidence in Korea has decreased over the last five years, despite an increase in high-risk deliveries. Income level had no effect in CP incidence. These results may aid CP management and prevention policies.

Femoral Neuropathy Secondary to Autosomal Dominant Polycystic Kidney Disease: A Case Report

Compressive femoral neuropathy is a disabling condition accompanied by difficulty in hip flexion and knee extension. It may result from retroperitoneal hematoma or bleeding, or from complications associated with pelvic, hip surgery, and renal transplants. A 55-year-old female with autosomal dominant polycystic kidney disease presented with proximal muscle weakness in lower extremities. The patient experienced recurrent renal cyst infection, with aggravated weakness during each event. Electromyography and nerve conduction study revealed bilateral femoral neuropathy. Computed tomography and magnetic resonance images were added to further identify the cause. As a result, a diagnosis of femoral neuropathy caused by enlarged polycystic kidney was made. Cyst infection was managed with antibiotics. Renal function was maintained by frequent regular hemodialysis. While avoiding activities that may increase abdominal pressure, rehabilitation exercises were provided. Motor strength in hip flexion and knee extension improved, and was confirmed via electrodiagnostic studies.

Speech and Linguistic Features of Children With Articulation Disorder

OBJECTIVE: To analyze speech and linguistic features in children with articulation disorder characterized by consonant and vowel phonological errors. METHODS: Between February 2007 and June 2015, 117 children who showed articulation disorder were selected for the study. Based on comprehensive speech and language assessments, the subjects were classified into articulation dysfunction (AD), or AD overlapping with language delay. Detailed information of articulation, including percentage of consonants correct (PCC) and normal percentage of variable consonants derived from the Assessment of Phonology and Articulation for Children test, were compared between the two groups. RESULTS: Totally, 55 children were diagnosed as AD and 62 as AD with language delay. Mean PCC was not significantly different between the two groups. In both groups, the acquisition order of consonants followed the universal developmental sequence. However, differences were observed in the nasal & plosive consonants abnormality between the two groups. When adjusted to their delayed language level in AD with language delay group, 53% of children had appropriate articulation function for their expressive language level. CONCLUSION: Speech and linguistic characteristics in children with articulation disorder were variable. Therefore, comprehensive assessment is required in children with inaccurate pronunciation, and a proper treatment plan based on the results of assessment should be followed.

Motor and Cognitive Developmental Profiles in Children With Down Syndrome

OBJECTIVE: To investigate motor and cognitive developmental profiles and to evaluate the correlation between two developmental areas and assess the influencing factors of the developmental process in children with Down syndrome (DS). METHODS: Seventy-eight children with DS participated in this study. The medical history was taken and motoric milestone achievements recorded. The Korean Wechsler Preschool and Primary Scale of Intelligence (K-WPPSI) and Bayley Scales of Infant Development-II (BSID-II) were administered. Subjects were divided into severe motor delay group (severe group) and typical motor delay group (typical group). RESULTS: Children with DS follow the same sequence of motor development and generally displayed double times of acquisition of developmental milestones compared with healthy children. Furthermore, having surgery for associated complications showed negative influence to the motor development. Almost of all children with DS showed moderate degree of intellectual disability and motor and cognitive development do not seem to correlate one another. CONCLUSION: Surgery of associated complications can be negatively related to motor development. However, early motor development did not have any significant effects on the achievement of later cognitive functioning.

Rehabilitation Treatment of a Child Diagnosed With Duplication of 1q42-q44: A Case Report

Trisomy 1 is a rare chromosomal anomaly and has never been reported in Korea. Clinical features of trisomy 1 include macrocephaly, prominent forehead, flat nasal bridge, low set ears, and micrognathia, all of which result in a very distinguishable facial structure. A child with trisomy 1 also suffers from mental retardation and/or developmental delays. In this case report, the child was diagnosed with de novo trisomy 1 without receiving any treatment until visiting our hospital. The child suffered from foot and ankle deformities, leading her unable to stand independently. Here we report the surgical treatment and rehabilitation treatment that enabled the child to walk independently.

Effect of Shift Work on Worker's Health, Family and Social Life at a Automobile Manufacturing Plant / 대한산업의학회지

Effect of shift work on worker's health, family and social life was investigated at a automobile manufacturing plant in Inchon. In total, 2488 shift workers and 599 non-shift workers completed self administered questionnaire in their sleep pattern, subjective gastrointestinal symptoms, prevalent chronic disease status, general well-being schedule, family and social life. More shift workers complained of sleep disturbance, poor sleep quality, tiredness at awakening, and sleepiness in work than non-shift workers. More shift workers also complained of gastrointestinal disturbance than non-shift workers. Worker's mental health was assessed by General Well-Being Schedule(GWB) questionnaire developed for the U.S. Health and Nutrition Examination Surveys(HANES I). The percentage of severely distressed shift workers was significantly higher than that of non-shift workers(p<0.01). Among subscores in General Well-Being Schedule, anxiety, depression, positive well-being, vitality, and general health subscale of shift workers were lower than those of non-shift workers (p<0.05). In terms of family and social life, there was no significant difference between two groups. Multiple logistic regression analysis was done for discrete variables which showed statistically significant difference between shift and non-shift group. The variables included in analysis were sleep disturbance symptoms, gastrointestinal complaints, and distress level calculated from GWB score. Age, tenure, smoking, alcohol drinking, and exercise were adjusted as confounding factors and odds ratios for above symptoms due to shift work were calculated. Odds ratios (ORs) for sleep disturbance symptoms ranged from 0.52 to 3.59. ORs for gastrointestinal complaints ranged from 1.19 to 1.34. OR for distress level was 1.31. We concluded that shift workers are suffered from physical and psychological ailments due to shift work and interventional methods for preventing worker's health from adverse effects of shift work are needed.