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

Factors Affecting Drooling in Adult Patients with Traumatic Brain Injury

OBJECTIVE: To investigate whether drooling in patients with traumatic brain injury (TBI) is due to hypersalivation or cognitive dysfunction or disability. METHOD: The subjects were 24 TBI patients with drooling and 17 TBI patients without drooling and 20 unaffected healthy volunteers who had no known physical or mental disabilities. All participants had no known history of diabetes mellitus, hypertension, thyroid dysfunction or chronic alcoholism. And, we excluded the subjects who take the anticholinergics, beta-agonist or steroid. Salivary pH and flow rate were compared between the TBI groups and the control group. We also measured Korean mini-mental state examination (K-MMSE) and disability rating scale (DRS) and compared mean values between TBI groups. RESULTS: There was no statistical difference in the mean salivary pH and flow rate between the tested groups. The drooling severity and frequency showed no correlation with salivary flow rate in all groups. The drooling severity and frequency showed significant correlations with K-MMSE, but not with DRS in TBI groups. CONCLUSION: The results of this study suggested that the cause of drooling in patients with TBI may not be the hypersalivation and functional disability, but cognitive dysfunction.

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

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.