Citations
Citations
To clarify the relationship of the initial radiologic and a biomechanical parameter at first clinical visit, and define the effectiveness of modified insole, following insole fitting in children with flexible flatfoot.
Children aged less than 13 years with flexible flatfoot were enrolled. The total number of subjects was 66 (33 boys, 33 girls). The subjects were divided into 5 subgroups, based on age: 1–2, 3–4, 5–6, 7–9, and 10–12 years. The mean time period between the initial & final examination for their resting calcaneal stance position angle (RCSPA) was 24 months. Radiography quantified the deformity by measuring angles, including the talometatarsal angle, the metatarsal angle, and the calcaneal pitch angle.
From the angles measured on radiographs, only the talometatarsal angle showed a statistically significant correlation to the initial RCSPA (r=-0.578 for right side, r=-0.524 for left side; p<0.01). The mean RCSPA improved in all subgroups of subjects following insole fitting. Moreover, in children younger than 7 years, the improvement in RCSPA from the insole fitting was greater compared to children aged 7 years and older.
The insole has additionally beneficial effects in all populations younger than 13 years. However, there might exist a hidden effect of normal structural pedal alignment during growth accompanied with bony maturation and developmental process. To date, it is controversial whether the treatment of flexible flatfoot is necessary in the vast majority of cases, or simple observation and advice to parents would suffice.
Citations
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.
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.
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.
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.
Citations
To determine the 9 month period effect of botulinum toxin A (BoNT-A) injection into the salivary gland in children with neurologic disorders and sialorrhea by qualified parent/caregiver-administered questionnaires.
A total of 17 patients (age 7.6±4.24 years) were enrolled in this study. The degree of sialorrhea was assessed at the baseline, 2 weeks, 1, 2, 4, 6 and 9 months after injection. The Drooling Count (DC) was assessed as an objective measurement. The Drooling Frequency and Severity Scale (DFS) and the Teacher Drooling Scale (TDS) were evaluated as a subjective measurement. BoNT-A (0.5 unit/kg) was injected into each submandibular and parotid gland under ultrasonography-guidance.
DC, DFS and TDS showed significant improvement at 2 weeks, 1, 2, 4, 6, and 9 months follow-up (p<0.05). Twelve of 17 cases (70.5%) showed more than 50% reduction in DC from the baseline value.
Ultrasonography-guided BoNT-A injection into the submandibular and parotid gland was a safe and effective method to treat sialorrhea in children with neurologic disorders.
Citations
Objective: We performed to obtain the normal values of Gross Motor Function Measure (GMFM) in normally developed children. We designed this study to inform the degree of gross motor functional disability or delay in children with cerebral palsy, comparing with score values of GMFM in normal children.
Method: One hundred-sixteen normally developed children who were in the age of 12 to 47 months were recruited. Their GMFM tests were performed by a pediatric physical therapist. They were grouped by age of 6 months and the scores were compared with all of each groups.
Results: The GMFM scores in normal children increased with ages. The rates of increment in scores were fast till 35 months of age and inter-individual differences of GMFM scores were greater in younger age groups (less than 36 months of age) than older groups. Even the means of GMFM scores were higher in the girls than boys, the differences between sexes were insignificant statistically.
Conclusion: Norms of GMFM obtained in normally developed children who were in the age of 12 to 47 months. It would be helpful to assess the degree of motor functional disabilities or delay in children with physical disabilities. (J Korean Acad Rehab Med 2002; 26: 398-402)
Objective: To investigate the prevalence and contributing factor of musculoskeletal pain in preadolescent children.
Method: Four hundreds and four primary school students without history of trauma or serious medical conditions were investigated. Self-reported questionnaire and physical examination were done.
Results: One-week and 1-year overall pain prevalence were 25.9% and 33.7%, respectively. Prevalence of wide spread pain (WSP) was 7.2% and that of myofascial pain syndrome (MPS) was 7.9%. Prevalence of overall pain and MPS was
higher in the 6th grade students than the 4th grade. WSP was more frequent in girls than boys. Joint hypermobility, physical fitness, body mass index and life style including computer use, regular exercise and satisfaction to desk-chair did not affect pain prevalence.
Conclusion: Musculoskeletal pain was common in preadolescent children. Age and sex rather than physical state or life style seem to be the contributing factors to pain prev- alence. (J Korean Acad Rehab Med 2002; 26: 26-31)
Objective: To find out the changes of the plantar pressure distribution of foot and the pathway of center of pressure (COP) in normal preschool children with age.
Method: Thirty-eight normal children aged 1 to 6 were participated in this study. We divided into three groups according to the age. Foot contact area, pressure of the foot and pathway of COP were measured using F-scan in-shoe measuring system (Tekscan Inc.) during the gait.
Results: The ratio of midfoot contact width to forefoot contact width was decreased with age (p＜0.05). And the relative pressure of the medial midfoot was decreased with age (p＜0.05). In the analysis of COP, the ratio of anteroposterior length of COP to total contact length was significantly increased (p＜0.05), and the ratio of mediolateral width of COP to forefoot contact width was tend to decrease.
Conclusion: We can identify the characteristics and changes of the foot pressure distribution and the pathway of COP in preschool children with normal foot using F-scan system. These quantitative data of foot scan are useful for evaluating the foot pathology in preschool children during the gait.
Objective: The purpose of this study was to determine prevalence of flatfoot and to investigate relationship between flatfoot and the practice of wearing footwear.
Method: Four hundred-one subjects were interviewed and evaluated with foot printing for flatfoot and measured with foot and shoe tracing for foot and shoe size.
Results: The prevalence of flatfoot in the subject was 18.7%, and flatfoot was significantly associated with weight, body mass index, and obesity. Only parental parameter significantly associated with flatfoot. There was no significant relation between flatfoot and the other parameters such as footwear type before entrance into a primary school, present footwear type, duration of wearing footwear each day, and age when footwear first worn.
Conclusion: The flatfoot was related with obesity, body mass index, weight, and parent parameter.
Objective: To evaluate the efficacy of botulinum toxin type A in the treatment of spasticitc and dystonic upper limbs in a group of cerebral palsy children
Method: Eighteen children with cerebral palsy who did not have fixed contractures in the wrist and hand were enrolled (mean age 9.0 years; range 6∼15). Measurements were obtained before and at 1 and 3 months after botulinum toxin A injections. Assessments included spasticity (modified Ashworth scale), range of motion of thumb and functional assessments including Melbourne assessment of unilateral upper limb function and Jebsen Taylor hand function test. Hand and forearm muscles were injected with 1∼3 u/kg botulinum toxin.
Results: Spasticity measured by modified Ashworth scale decreased by 1 month and diminished spasticity continued for 3 months. Range of motion of thumb increased by 1 and 3 months. In Jebsen hand function test, patients showed functional improvements in item 6 (lifting light weight object) and item 7 (lifting heavy object). Melbourne assessment of unilateral upper limb function scores improved from a mean value of 92 at baseline to a mean value of 101 at 1 month and a mean value of 105 at 3 months.
Conclusion: Botulinum toxin A would be helpful in some selected cerebral palsy patients with upper limb dysfunction. But further research including randomized controlled study is needed on the use of botulinum toxin A to improve function.
Objective: To determine the characteristic pattern of information processing in the children with specific language impairment (SLI) using the Kaufman-Assessment Battery (K-ABC) for children.
Method: Thirty patients were responded to K-ABC. Twenty-three of them were diagnosed as SLI without any abnormalities in other developmental areas, visual or auditory system. Seven patients showed language delay with other developmental abnormalities. Mean chronological age of SLI patients was 61.0 months. Patterns of information processing was measured using K-ABC. Sequential processing, simultaneous processing, mental processing, and achievement scales were obtained and compared between two groups.
Results: In SLI patients, sequential processing, simultaneous processing, mental processing, and achievement scales were 32.9⁑34.2, 54.3⁑26.9, 42.5⁑31.1, and 33.8⁑28.7, respectively. The SLI patients showed significantly poor scales in sequential than in simultaneous processing (p＜0.01).
Conclusion: The patients with SLI exhibited significant deficits in sequential processing, whereas simultaneous processing was better than that of the other group in this study. This characteristics of SLI patients will be useful for understanding and establishing proper therapeutic strategies for these patients.
Objective: To find out the characteristics of gait maturation process in Korean normal children.
Method: Three dimensional kinematic gait analysis using Vicon 370 system from Oxford Metrics Company was performed for 72 children (33 females) without known gait anomalies aging between one and six years old. The data were compared with those from 41 normal adults which were collected previously using the same method, and with those from study by Sutherland et. al.
Results:
1. The initial heel contact, initial flexion wave of the knee joint during the early stance phase and reciprocal arm swing were found before the age of 3.5.
2. Pelvic motion in transverse plane, hip joint motion in all the three planes, knee joint motion in coronal plane, and ankle joint motion in transverse plane remained greater than those of Caucasian children of Sutherland et. al.
3. Single stance period remained shorter than that of Caucasian children.
4. Internal rotation of hip joint and varus motion of the knee joint remained greater than those of Caucasian children.
Conclusion: The difference between Korean and Caucasian children were
1. Development of muscles' ability which stabilize the large leg joints during gait seems slower among Korean children than Caucasian children.
2. These differences are probably from the anthropometrical characteristics of Korean and Caucasian growing children. Also, the different definition of angle systems between the Korean and Caucasian data might case some erroneous effect on the interpretation of result.
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