Changes of Musculoskeletal Deformity in Severely Disabled Children Using the Custom Molded Fitting Chair

OBJECTIVE: To know the effectiveness of a custom molded fitting chair between pre- and post-chair status through comparison of musculoskeletal indices in severely disabled children. METHODS: We researched 34 severely disabled patients who had used a custom molded fitting chair continuously for more than a year. There were 27 cerebral palsy patients and 7 patients with other kinds of diseases that affect the brain such as chromosomal disease or metabolic disease. By radiographic studies, Cobb's angle, the femoral neck-shaft angle of the femur, and Reimers migration percentage were measured. The indices are analyzed before and after application. RESULTS: The average period of application was 24 months. There was a significant reduction in the angles of femur neck-shaft, 163.4 degree before and 158.2 degree after the use of the chair (p<0.05), and 23 of 34 had demonstrated a reduced angle. Cobb's angle and Reimers migration percentage increased but the difference of pre- and post-chair status was not statistically significant. Seventeen of 33 children showed reduced Cobb's angle. Also, 19 of 37 showed a reduced degree of dislocation of the hip joints. CONCLUSION: In spite of the use of a custom molded fitting chair, a significant improvement did not emerge for musculoskeletal deformity indices in severely disabled children. However, there was no significant aggravation of Cobb's angle or Reimers migration percentage in developing children. Therefore, it is thought be helpful to prevent rapid aggravation of musculoskeletal deformities.

An Objective Assessment Scale for "Come-to-Sit" Using a Specifically Designed Jacket in Stroke Patients

OBJECTIVE: To compare an objective assessment scale for "come-to-sit" in stroke patients with the previously established subjective assessment scales of "performance-based assessment" and the "ability for basic movement scale". METHOD: A specifically designed jacket was used to determine the objective degree of assistance needed for patients to perform the task. While patients were sitting up, the investigator evaluated the amount of assistance needed in a fully dependent state (A) and with maximal effort (B). Using this measure, we obtained an objective scale, {(A-B)/A} x100. In addition, patients were tested in two starting positions: hemiplegic-side lying and sound-side lying. We then compared the objective scale with subjective scales and other parameters related to functional outcomes. RESULTS: For both starting positions, the objective assessment scale showed high correlation with the previously established subjective scales (p<0.01). Only the hemiplegic-side lying-to-sit objective scale showed a significant correlation with the parameters used to assess functional outcomes (p<0.05). In terms of Brunnstrom stages, only the leg stage showed a significant correlation with the objective "come-to-sit" scale (p<0.01). CONCLUSION: The objective scale was comparable to established subjective assessment scales when used by an expert. The hemiplegic-side lying-to-sit maneuver had a high correlation with patient's functional recovery. Specifically, balance and lower extremity function appear to be important factors in the "come-to-sit" activity.