Effects of Hippotherapy on Psychosocial Aspects in Children With Cerebral Palsy and Their Caregivers: A Pilot Study

OBJECTIVE: To investigate the effects of hippotherapy on psychosocial and emotional parameters in children with cerebral palsy (CP) and their caregivers. METHODS: Eight children with CP were recruited (three males and five females; mean age, 7.3 years; Gross Motor Function Classification System levels 1-3). Hippotherapy sessions were conducted for 30 minutes once weekly for 10 consecutive weeks in an indoor riding arena. The Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), and the Korean version of the Modified Barthel Index were evaluated. All children were evaluated by the Children's Depression Inventory, Trait Anxiety Inventory for Children, State Anxiety Inventory for Children, Rosenberg Self Esteem Scale, and the Korean-Satisfaction with Life Scale (K-SWLS). Their caregivers were evaluated with the Beck Depression Inventory, the Beck Anxiety Inventory, and the K-SWLS. We assessed children and their caregivers with the same parameters immediately after hippotherapy. RESULTS: Significant improvements on the GMFM, dimension E in the GMFM, and the PBS were observed after hippotherapy compared with the baseline assessment (p<0.05). However, no improvements were detected in the psychosocial or emotional parameters in children with CP or their caregivers. None of the participants showed any adverse effects or accidents during the 10 weeks hippotherapy program. CONCLUSIONS: Hippotherapy was safe and effectively improved gross motor and balance domains in children with CP. However, no improvements were observed in psychosocial or emotional parameters.

Effects of Robot-assisted Arm Training in Patients with Subacute Stroke

OBJECTIVE: To investigate the effects of robot-assisted arm training on motor and functional recovery of upper limb in patients with subacute stroke. METHOD: Thirty one subacute stroke patients were randomly divided into 2 groups. Robot-assisted arm training group received robot-assisted therapy using Armeo(R)Spring (Hocoma Inc., Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional arm training with same duration and frequency as robotic group. Outcome measures were used manual muscle test (MMT) for motor strength, Fugl-Meyer assessment (FMA), Manual function test (MFT) for arm function, Korean-modified Barthel index (K-MBI) for activities of daily living, Korean-mini mental state examination (K-MMSE) and Computerized Neuro-Cognitive Function test software-40 (CNT-40) for cognitive function. All recruited patients underwent these evaluations before and after four weeks robot-assisted arm training. RESULTS: Robot-assisted training on upper limb after subacute stroke showed improvement on motor strength, arm function, and activities of daily living. But change values in terms of MMT, FMA, MFT, K-MBI exhibited a no statistically significant difference compared with conventional group (p>0.05). CONCLUSION: In patients with upper limb deficits after subacute stroke, Robot-assisted arm training was considered to facilitate motor and functional recovery of upper limb. But robot-assisted arm training did not significantly improve motor and arm function at 4 weeks compared with conventional arm training group. Further research is required about the comparison of conventional rehabilitation therapy group and the questions about the duration, severity of stroke.

Agreement between Parents and Teachers on School Children's Emotional/Behavioral Problems

OBJECTIVES: In assessing behavioral/emotional problems in school-aged children, the importance of multi-informant reporting has been well documented. However, in clinical settings obtaining multiple informants' opinions has proven difficult. For that reason, we researched the agreement and predictive validity of the Child Problem-Behavior Screening Questionnaire (CPSQ) in order to reveal how accurate parents' assessments reflected teachers' opinions. METHODS: We conducted the first screening for second- and third-grade children from 3 elementary schools in Seoul from 2003 to 2007 using the CPSQ. There were 1178 children included in the analysis. We then administered the Korean version of the Child Behavior Checklist (K-CBCL) as a second screening tool and subsequently, the ADHD Diagnostic System (ADS) and the Korean Educational Development Institute version of the Wechsler Intelligence Scale for Children (KEDI-WISC) was administered by a psychiatrist. We examined each item on the CPSQ and the subscale's agreement between parent and teacher as well as the predictive validity of the CPSQ in children diagnosed with emotional/behavioral problems. RESULTS: The agreement rates between parents and teachers appeared high for questions 18 (0.433), 1 (0.385), and 2 (0.325). Among the subscales, a relatively high correlation was found for externalizing problems, attention deficit hyperactivity disorder, and cognitive problems. For all diagnosed children, their parents revealed a higher sensitivity and lower specificity than teachers. CONCLUSION: From these results, we confirmed that the CPSQ can be useful for sorting out externalizing and cognitive problems. There is a need for further study, however, with a larger sample size.

Change of Tetrodotoxin Sensitive Inhibitory Neural System of the Colon in Spinal Cord Injured Rats

OBJECTIVE: To investigate the effect of spinal cord injury (SCI) on contractions of whole colonic preparation isolated from rats under the inhibition of nitrergic inhibitory neural system using tetrodotoxin (TTX). METHOD: Twenty Sprague-Dawley rats were used. A complete spinal cord transection was performed surgically at the T10 cord level in spinal cord injured group. After 1 week of operation, sensory and motor functions were assessed and colon was removed under anesthesia for in vitro motility study. Whole colon was divided into four segments: proximal, two mid colon and distal colon. Each segment of colon was mounted with longitudinal direction in a 10 ml organ bath. After 1 hour of equilibration, frequency, area under the curve of spontaneous contraction and the response to acetylcholine (Ach), KCl and TTX were measured in each segment. Also the responses to Ach and KCl response under TTX pretreatment were measured. RESULTS: Enhanced contractile response to KCl solution (40 mM), TTX (1 micrometer) and Ach (10(-6) M) was observed in both group. There was no statistical difference in spontaneous, Ach and KCl induced contraction between control and SCI rats, but TTX induced contraction was decreased in SCI group than control group (p<0.05). In addtion, the Ach and KCl responses under the TTX pretreatment were significantly decreased in SCI group than control group (p<0.05). CONCLUSION: These results suggest that the change of colonic contractility after the SCI is caused by at least partly from the change of TTX related inhibitory neural system.