Botulinum Toxin Treatment on Upper Limb Function in School Age Children With Bilateral Spastic Cerebral Palsy: One Year Follow-up

OBJECTIVE: To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities. METHODS: Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance. RESULTS: Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb. CONCLUSION: For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.

Usefulness of Uptake Ratio of Three Phase Bone Scintigraphy in Complex Regional Pain Syndrome after a Stroke

OBJECTIVE: To evaluate usefulness of uptake ratio of three phase bone scintigraphy in assessing the complex regional pain syndrome (CRPS) type I in stroke patients METHOD: Forty three stroke patients were diagnosed as CRPS type I based on their symptoms and confirmed by three phase bone scintigraphy. Uptake ratio was calculated by dividing the radioactivity count on the affected side by that on the unaffected side in each phase. Mean uptake ratio was compared among the groups classified by the clinical diagnosis and by the response to treatment. In addition, uptake ratio was compared before and after treatment. RESULTS: Mean uptake ratio of the wrist in blood pool phase was significantly higher than other parts of the body (p<0.05). However, there was no significant difference among the groups classified by the clinical diagnosis nor by the response to treatment. The changes of uptake ratio were variable after treatment, but only the uptake ratio of the wrist in blood flow phase showed correlation with the degree of swelling. CONCLUSION: Uptake ratio of three phase bone scintigraphy was not correlated with clinical findings.

Quality of Life in Primary Caregivers for the Home-Bound Severe Stroke Patients

OBJECTIVE: To evaluate the level of depression, anxiety and quality of life in primary caregivers for the severe stroke patients. METHOD: We studied a sample of 44 severe stroke patients and their primary caregivers. Functional status of the severe stroke patients was evaluated by Modified Barthel Index (MBI). We collected the data through interviewing the caregivers and using the Beck Depression Inventory (BDI), State- Trait Anxiety Inventory (STAI), Ego-strength scale, Short Form Health Survey-36 (SF-36) and Family APGAR (Adaptation, Partnership, Growth, Affection and Resolve) score. RESULTS: The average level of depression in caregivers was low. The mean socres of STAI were 41.5 for state anxiety and 44.3 for trait anxiety, respectively. Ego-strength scale was significantly inversely related to BDI score and trait anxiety inventory score, but positively related to SF-36 score. The most influencing factor for the SF-36 score was the BDI score. CONCLUSION: Primary caregivers for the home-bound severe stroke patients demonstrated a lower level of quality of life, especially mental health, general health and vitality component. Community based rehabilitation should more focus on the evaluation and support for caregiver's psychologic status and their quality of life.