Nutritional Status of Children with Cerebral Palsy

OBJECTIVE: To determine the nutritional status of children with cerebral palsy (CP) and to compare their anthropometric and functional indices. METHOD: Seventy children with cerebral palsy, were at class I (12), II (17), III (18), IV (9) and V (14) on Gross Motor Function Classification System (GMFCS). They varied by age from 25 to 130 months with a mean of 48 months, and consisted of spastic diplegic cerebral palsy (30), quadriplegia (28), triplegia (3), hemiplegia (4), athetoid (4) and hypotonia (1). Evaluation of weight, height, subcutaneous fat thickness, brachial circumference, Body Mass Index (BMI), level of albumin, lymphocyte and blood ferritn were conducted. To identify the factors affecting nutritional status, dietary status and symptoms of dysphagia were investigated. RESULTS: Low BMI percentile was in 23 children (32.9%) and obese condition in 3 children (4.3%). Low BMI percentile tends to frequently observed in groups III, IV, V of GMFCS. BMI percentile with subcutaneous fat thickness, Gross Motor Function Measure (GMFM) score were significantly related (p<0.05). Seen from the symptom of dysphagia, low BMI percentile was correlated with decreased tongue motion (p<0.05). CONCLUSION: Cerebral palsy children with lower GMFM score, decreased tongue motion were significantly related with low BMI percentile. Subcutaneous fat thickness can be useful tool for evaluation of malnutrition of cerebral palsy children.

The Effects of Modified Low-Dye Taping in the Patient with Heel Pad Atrophy

OBJECTIVE: To evaluate whether the change of heel pad thickness improves the pain after Modified Low-Dye Taping (MLDT) in the patient with heel pad atrophy. METHOD: Thirty-five feet of 20 volunteers with heel pad atrophy were selected for the measurement of heel-pad thickness and compressibility index (CI) of the center of calcaneus bone using ultrasound. The subjects were laid in prone with the knees flexed to 90degrees, and an electronic body weight scale was inserted beneath the anterior surface of their knees to take measurements of both UHPT (unloaded heel pad thickness) and LHPT (6 kg-loaded heel pad thickness), which were repeated 3 times respectively. CI was calculated base on LHPT divided by UHPT. After MLDT, the same method was repeated. visual analogue scale (VAS) score was checked at first visit and followed up at second visit. RESULTS: Prior to MLDT, the average value of UHPT (cm), LHPT (cm) and CI value was 0.92+/-0.11, 0.25+/-0.06 and 0.27+/-0.04 respectively. After MLDT, the average was 1.24+/-0.17 for UHPT (cm) and 0.42+/-0.11, for LHPT (cm) while CI stood at 0.33+/-0.06. VAS before MLDT was 7.35+/-1.27 and after MLDT was 3.50+/-1.36, which presented 54% of decrease than initial. CONCLUSION: It was confirmed that the average values of the heel-pad thickness, CI and VAS of patients with heel pad atrophy were improved for MLDT. Accordingly it is considered that application of MLDT is an efficacious treatment and thus further study is needed to develop foot orthoses for heel pad atrophy using the principle of MLDT.

Change of Ultrasonographic Findings according to the Treatment of Adhesive Capsulitis in Hemiplegic Shoulder

OBJECTIVE: To evaluate the clinical importance of effusion in bicipital tendon sheath and the change of ultrasonographic findings according to the treatment. METHOD: Thirty patients with hemiplegia, clinically diagnosed as adhesive capsulitis in hemiplegic shoulder, were investigated. To confirm the location and existence of effusion and to measure the largest diameter and cross sectional area (CSA) of bicipital tendon sheath, the longitudinal and transverse scan of the shoulder were used. Each patient was treated with a series of three intraarticular injections with triamcinolone under ultrasonographic guidance. After each intraarticular injection, the diameter and CSA of bicipital tendon sheath, and passive range of motion of the affected shoulder were measured and compared to the unaffected side. RESULTS: The initial ultrasonographic examination showed increased amount of effusion in the affected bicipital tendon sheath compared to the unaffected side (p<0.01). After intraarticular injection, the amount of effusion was decreased (p<0.01) and passive range of motion of the shoulder was increased (p<0.05). CONCLUSION: The ultrasonographic evaluation of effusion in the bicipital tendon sheath, and interval change of effusion according to the treatment, can be useful tool for diagnosis and follow-up of adhesive capsulitis in hemiplegic shoulder.