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To investigate the relationship between the buttoning test and Jebsen-Taylor Hand Function Test (JTHFT), and to determine the validity of using the buttoning test as a tool to evaluate hand disability in patients with stroke.
This was a retrospective study of the medical records of 151 ischemic stroke patients affecting the dominant hand. Patients underwent the buttoning test and JTHFT for their affected hand. All patients were divided into three groups depending on how quickly they fastened a button (group A, not completed; group B, slowly completed over 18 seconds; and group C, completed within 18 seconds).
The button fastening time was negatively correlated with the total score and subtest scores of the JTHFT. Patients who experienced difficulty during the buttoning test had lower mean scores in the JTHFT (group A, 28.0±23.9; group B, 62.9±21.7; group C, 75.4±13.3; p<0.0001, Jonckheere-Terpstra test). We observed significant differences in JTHFT scores among the three groups (p<0.017, Mann-Whitney U-test), although there were considerable overlaps in JTHFT scores between the groups. Significant differences were also found in the subtest scores of the JTHFT, which include fine hand motor function (writing letters, p=0.009; moving small objects, p=0.003; stacking checkers, p=0.001 between groups B and C), among the three groups.
Considering its relationship with the JTHFT and validity, the buttoning test can be considered appropriate for evaluation of hand disability in patients with stroke.
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To compare the disability level of colorectal cancer survivors with and without stoma by using the Korean version of the 12-item, interview-administered World Health Organization Disability Assessment Schedule 2.0 (Korean version of WHODAS 2.0).
This is a multicenter (five tertiary university hospitals and the Korea Ostomy Association) and cross-sectional survey. Colorectal cancer survivors with and without stoma were interviewed. Survey measured disability level using the Korean version of WHODAS 2.0 and health-related quality of life using the SF-36.
A significant difference was observed between patients with and without a stoma in two subdomains: getting around (31.1 vs. 20.3; p=0.013) and participation in society (32.3 vs. 22.2; p=0.028). After adjusting for age, gender, and time since surgery, having a stoma was associated with severe to extreme disabilities in participation (OR=2.72, p=0.045). The Korean version of WHODAS 2.0 showed satisfactory internal consistency (r=0.96) and convergent validity.
Patients with stoma participated less in society than those without stoma. The Korean version of WHODAS 2.0 is a reliable and valid instrument for measuring disability in Korean colorectal cancer patients.
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Diagnostic exome sequencing (DES) is a powerful tool to analyze the pathogenic variants leading to development delay (DD) and intellectual disability (ID). Recently, heterozygous
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To evaluate the effectiveness of intensive neurodevelopmental treatment (NDT) on gross motor function for the children having developmental delay (DD), with or without cerebral palsy (CP).
Forty-two children had intensive NDT three times weekly, 60 minutes a day, for 3 months, immediately followed by conventional NDT once or twice a week, 30 minutes a day, for another 3 months. We assessed Gross Motor Function Measure (GMFM) over three time points: before conventional NDT, before and after intensive NDT, and after 3 months of additional conventional NDT.
The GMFM score in DD children significantly improved after intensive NDT, and the improvement maintained after 3 months of conventional NDT (p<0.05). The children were further divided into two groups: DD with CP and DD without CP. Both groups showed significant improvement and maintained the improvements, after intensive NDT (p<0.05). Also, there was no significant difference in treatment efficacy between the two groups. When we calculate the absence rate for comparing the compliance between intensive and conventional NDT, the absence rate was lower during the intensive NDT.
Intensive NDT showed significantly improved gross motor function and higher compliance than conventional NDT. Additionally, all improvements were maintained through subsequent short-term conventional NDT. Thus, we recommend the intensive NDT program by day-hospital centers for children with DD, irrespective of accompanying CP.
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Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options
To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head.
Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm2) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm2). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months.
In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05).
Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.
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Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.
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To identify the factors that could predict the functional outcome in patients with the axonal type of Guillain-Barre syndrome (GBS).
Two hundred and two GBS patients admitted to our university hospital between 2003 and 2014 were reviewed retrospectively. We defined a good outcome as being "able to walk independently at 1 month after onset" and a poor outcome as being "unable to walk independently at 1 month after onset". We evaluated the factors that differed between the good and poor outcome groups.
Twenty-four patients were classified into the acute motor axonal neuropathy type. There was a statistically significant difference between the good and poor outcome groups in terms of the GBS disability score at admission, and GBS disability score and Medical Research Council sum score at 1 month after admission. In an electrophysiologic analysis, the good outcome group showed greater amplitude of median, ulnar, deep peroneal, and posterior tibial nerve compound muscle action potentials (CMAP) and greater amplitude of median, ulnar, and superficial peroneal sensory nerve action potentials (SNAP) than the poor outcome group.
A lower GBS disability score at admission, high amplitude of median, ulnar, deep peroneal, and posterior tibial CMAPs, and high amplitude of median, ulnar, and superficial peroneal SNAPs were associated with being able to walk at 1 month in patients with axonal GBS.
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To translate, adapt, and test the reliability, validity, and responsiveness of the Korean version of the Shoulder Disability Questionnaire (SDQ) and the Shoulder Rating Questionnaire (SRQ).
The international guideline for the adaptation of questionnaires was referenced for the translation and adaptation of the original SDQ and SRQ. Correlations of the SDQ-K and SRQ-K with the Shoulder Pain and Disability Index (SPADI) and the Numeric Rating Scale (NRS) were assessed to determine the reliability and validity of the questionnaires. To evaluate reliability, surveys were performed at baseline and a mean of 6 days later in 29 subjects who did not undergo any treatment for shoulder problems. To evaluate responsiveness, assessments were performed at baseline with 4-week intervals in 23 subjects with adhesive capsulitis who were administered triamcinolone injection into the glenohumeral joint.
Fifty-two subjects with shoulder-related problems were surveyed. Cronbach alpha for internal consistency was 0.82 for the summary SDQ-K and 0.75 for the summary SRQ-K. The test-retest reliability of the SDQ-K, SRQ-K, and domains of the SRQ-K ranged from 0.84 to 0.95. The SDQ-K and SRQ-K summary scores correlated well with the SPADI and NRS summary scores. Generally, the effect sizes and standardized response means of the summary scores of the SDQ-K, SRQ-K, and domains of the SRQ-K were large, reflecting their responsiveness to clinical changes after treatment.
The reliability, validity, and responsiveness of the SDQ-K and SRQ-K were excellent. The SDQ-K and SRQ-K are feasible for Korean patients with shoulder pain or disability.
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To evaluate changes in activity of daily living before and after provision of electric-powered indoor/outdoor chair (EPIOC), discuss problems of current activities of daily living (ADL) evaluating tools for EPIOC users, and provide preliminary data to develop ADL evaluation tool for EPIOC user.
A total of 70 users who were prescribed EPIOC and had been using for more than 1 year were recruited in this study. Before and after provision of EPIOC, MBI and FIM scores were measured and a questionnaire consisting of six categories (general socioeconomic states, currently using state, whether EPIOC was helpful for social participation and occupational chances, psychiatric influences, self-reported degrees of independency, and barriers of using EPIOC) was used.
No difference in MBI scores before and after provision of EPIOC was observed. However, the wheelchair ambulation category showed a significant difference. While motor FIM was not significantly different from MBI, FIM score were significantly (p<0.05) higher than MBI. For questions regarding social participation frequency, helpfulness of EPIOC on confidence, refreshing patients' emotions and self-reported degrees of independence, all of them showed positive responses. Especially, EPIOC users' self-reported degree of independency showed favorable results. There was discrepancy in MBI or FIM measured by physicians.
Our study showed that there was a gap between the existing ADL evaluation tool and the ADL level that EPIOC users were actually feeling. Thus, it is necessary to develop an evaluation tool specifically for EPIOC.
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To evaluate the potential feasibility of application of the extended International Classification of Functioning, Disability and Health (ICF) Core Set for stroke.
We retrospectively reviewed the medical records of 40 stroke outpatients (>6 months after onset) admitted to the Department of Rehabilitation Medicine for comprehensive rehabilitation. Clinical information of the patients were respectively evaluated to link to the 166 second-level categories of the extended ICF Core Set for stroke.
Clinical information could be linked to 111 different ICF categories, 58 categories of the body functions component, eight categories of the body structures component, 38 categories of the activities and participation component, and seven categories of the environmental factors component.
The body functions component might be feasible for application of the extended ICF Core Set for stroke to clinical settings. The activities and participation component and environmental factors component may not be directly applied to clinical settings without additional evaluation tools including interview and questionnaire.
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To translate the English version of the Pain Disability Questionnaire (PDQ) into Korean and to investigate the reliability and validity of the Korean version of the PDQ (K-PDQ) in patients suffering chronic disabling musculoskeletal disorders (CDMDs).
The English version of the PDQ was translated into Korean. Ten patients with CDMDs were randomly selected for a pilot study to assess the comprehensibility of the pre-final version. One hundred and thirty-nine patients suffering from CDMDs for more than 3 months were enrolled in this study. Follow-up questionnaires were obtained to examine the test-retest reliability. Concurrent validity was evaluated by comparing the K-PDQ with the visual analogue scale (VAS). Construct validity was evaluated by comparing the K-PDQ with the brief form of the World Health Organization quality of life assessment instrument (WHOQOL-BREF) using Pearson correlation coefficient. Reliability was assessed using the intraclass correlation coefficient (ICC), and internal consistency was determined by Cronbach's alpha.
Test-retest reliability was assessed in 70 patients, with an average time interval of 12 days. The ICC was 0.958 (p<0.001). Internal consistency reached Cronbach's alpha of 0.933 for the functional component and 0.870 for the psychosocial component. The correlation coefficient for the K-PDQ when compared with the VAS was 0.834 in the first assessment and 0.831 in the second assessment. All domains of the WHOQOL-BREF showed a significant negative correlation with the K-PDQ.
The K-PDQ is a reliable and valid instrument for measuring disability and can be used to assess disability and treatment outcomes in Korean patients with CDMD.
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To investigate the relationship between gross motor function and daily functional skill in children with cerebral palsy (CP) and to explore how this relationship is moderated by the Gross Motor Function Classification System, Bimanual Fine Motor Function (BFMF), neuromotor types, and limb distribution of CP.
A cross-sectional survey of 112 children with CP (range, 4 years to 7 years and 7 months) was performed. Gross motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66) and functional skill was assessed with the Pediatric Evaluation of Disability Inventory-Functional Skills Scale (PEDI-FSS).
GMFM-66 scores explained 49.7%, 67.4%, and 26.1% of variance in the PEDI-FSS scores in the self-care, mobility, and social function domains, respectively. Significant moderation by the distribution of palsy and BFMF classification levels II, III, and IV was found in the relationship between GMFM-66 and PEDI-FSS self-care. Further significant moderation by the distribution of palsy was also observable in the relationship between GMFM-66 and PEDI-FSS mobility.
These findings suggest that limb distribution and hand function must be considered when evaluating gross motor function and functional skills in children with CP, especially in unilateral CP.
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Method: From July, 2001 to June, 2002, twelve patients who had calcaneal fractures with persistent foot pain and paresthesia were included in our study. We examined electromyography for medial and lateral plantar nerve, inferior calcaneal nerve, also evaluated types of calcaneal fracture and severity of pain and disability with nerve injury.
Results: The intraarticular types were 13 cases, extraarticular type was 1 case and communited types were 2 cases. In the electromyographic findings, the 9 cases were diagnosed as neuropathy. In a cases with neuropathy, 8 persons complained over moderate degree of pain and all persons complained over moderate degree of walking disability. However one of three persons without neuropathy complained over moderate degree of walking disability. So disability tended to be more severe in cases with neuropathy.
Conclusion: We think that neuropathy associated with calcaneal fracture is a cause of aggravation of pain and walking disability, and electromyography for nerves of foot will be needed in the calcaneal fracture. (J Korean Acad Rehab Med 2003; 27: 928-934)
Method: Thirty-five registered disabled persons after stroke were evaluated by two physiatrists to assess the grades of disability according to CDGG and PDGG, which were in use. The evaluations of disabled persons for the grading were done by the physiatrists through house-visit and at the hospital according to CDGG (hereinafter called CDGG-visit and CDGG-OPD) and PDGG (hereinafter called PDGG-grade). These re-evaluated disability grades were compared with the initial disability grades recorded in their disability registries.
Results: There was a low level of agreement between the registered grade and the re-evaluated grades; however, there has shown a high level of agreement amongst the re-evaluated grades. The degree in the registered grade was evaluated upward compared to the degree in other reevaluated grades.
Conclusion: The difference degree between CDGG and PDGG of established was insignificant; however, a new candidate who wants to be evaluated using CDGG has possibilities of facing unfairness when compared to the disabled people with relatively higher registered degrees. (J Korean Acad Rehab Med 2003; 27: 329-334)
ated disability grades were compared with the initial disability grades recorded in their disability registries.
Results: There was a low level of agreement between the registered grade and the re-evaluated grades; however, there has shown a high level of agreement amongst the re-evaluated grades. The degree in the registered grade was evaluated upward compared to the degree in other reevaluated grades.
Conclusion: The difference degree between CDGG and PDGG of established was insignificant; however, a new candidate who wants to be evaluated using CDGG has possibilities of facing unfairness when compared to the disabled people with relatively higher registered degrees. (J Korean Acad Rehab Med 2003; 27: 329-334)
to achieve a standard living equal to that of their citizens. Non-government organizations can assist Governments by formulating needs, suggesting suitable solutions and providing services complementary to those provided by Governments. This article looks into the current position of the policies for persons with disabilities in our society and reviews the main tasks of disability policies including social, employment, educational and medical security, and the social integration. Especially, as a physiatrist, the policy tasks of medical security for the disabled persons is emphasized. (J Korean Acad Rehab Med 2003; 27: 157-163)
Objective: The purposes of this study were to investigate the factors influencing life satisfaction and quality of life (QOL) of the disabled persons and to help the planning and evaluation of Community Based Rehabilitation (CBR).
Method: Data were collected through personal interviews of 503 registrated disabled persons in Uiwang City. Demographic variables and scores of modified Barthel index (MBI), modified Lambeth disability screening questionnaire (MLDSQ), Craig handicap assessment and reporting technique (CHART) and life domain satisfaction measure (LDSM) were obtained.
Results: The score of LDSM was 4.0⁑1.0. Life satisfaction was related to the age, sex, employment status, severity of disability, educational level, housing and residence, level of instrumental activities of daily living and social integration. MLDSQ score was the most strong predictor of life satisfaction (p=0.00) followed by social integration (p=0.001) and total CHART scores (p=0.017). And the factors influencing the handicap were monthly income, severity of disability, employment, level of education and age.
Conclusion: Based on our study, we suggest that the CBR program of Uiwang City need to focus on improving functional ability and social skill of disabled individual and housing, and also promoting their vocational and educational status. (J Korean Acad Rehab Med 2002; 26: 615-625)
Objective: To investigate the influence of psychologic factors and stress on chronic pain syndrome and predictive factors of chronic pain.
Method: The subjects were 23 patients with chronic pain. The age was ranged from 25 to 66 years with an average of 45. We measured pain with initial visual analogue scale (VAS), one-week total VAS, and tenderness threshold by pressure algometer. We evaluated the degree of depression, anxiety and disability with chronic pain and the impact of stress of major versus minor daily events. Association between degree of pain and psychologic factors was studied by regression and stress of major versus minor daily events by correlation analysis. Predictive factors for chronic pain were determined by multiple regression analysis. Association of daily fluctuation of pain severity and stress from minor life events was also studied.
Results: One-week total VAS was associated with initial VAS (r=0.601, p＜0.05). Initial VAS had association with depression and anxiety. Predictive factors for one-week total VAS were initial VAS, static anxiety, and pain disability (r=0.624, p＜0.05).
Conclusion: Depression, anxiety, pain disability from chronic pain, and stress were major influencing factors in patients with chronic pain.
Objective: The objectives of this study were to evaluate the reliability of the Korean version of Spinal Cord Independence Measure (SCIM) and to compare the sensitivity of the SCIM to functional changes of spinal cord injury (SCI) patients with that of the Functional Independence Measure (FIM).
Method: Seventeen subjects with SCI were studied. The SCIM was translated and modified to convert as SCIM Korean-version. All patients were evaluated with the SCIM and the FIM by two raters every other week. To determine inter-rater reliability, the relationship between the SCIM scores obtained by two raters was evaluated by Kappa coefficient and linear regression. To determine relative sensitivity of the test to functional changes, changes in the scores on the SCIM and FIM were compared by McNemar test.
Results: The Kappa coefficient of the various individual tasks in SCIM ranged between 0.63 and 1.00. High correlations were also found between the total SCIM scores for the paired raters (r=0.99, p＜0.01). The SCIM detected all the functional changes detected by FIM total scoring, but in 3 (14%) of 22 sequential test batteries, the FIM missed changes detected by SCIM total scoring.
Conclusion: These results demonstrated that the SCIM is reliable and more sensitive than the FIM in reflecting the functional changes of SCI patients.
Objective: To evaluate the effect of compensation or secondary gain on the pain behavior and psychometric characteristics.
Method: We examined 88 patients who complained of chronic low back pain by the various pain questionnaires, electrodiagnostic study and magnetic resonance imaging (MRI). Total patients were classified into two groups (46 patients who wanted disability evaluation and 42 patients who did not).
Results: Mean score of visual analogue scale, total sum of McGill pain questionnaire and pain rating index on sensory, affective and miscellaneous dimensions were significantly higher in patients related to disability compensation than those in patients without compensation. Mean scores of pain disability index and symptom checklist-90-revision were significantly higher on various subclass in patients with compensation. Various pain scales were significantly correlated to each other in both group but the severity of electrodiagnostic study and MRI findings were not related with the degree of pain index score in both group.
Conclusion: Compensation or secondary gain affect pain behavior and psychometric characteristics in chronic low back patients. So when we evaluate or treat the patients with chronic low back pain, we should consider above results.
Objective: Aims of this study are to assess the activities of daily living (ADL) for disabled persons in some rural communities using an appropriately developed ADL scale and to analyse the relationship between severity of impairment and ADL score.
Method: ADLs of 98 disabled persons in two myeons of Kyunggido were assessed from May 1996 to August 1997. The newly developed ADL index composed of eight basic ADL (B-ADL) and two instrumental ADL (I-ADL) parameters were used. Impairment defined by the National Reparation Law was divided into a severely disabled group, grades 1 to 6 and a mildly disabled group, graded 7 to 14. Correlations between the impairment grade of each body part and the assessed ADL score were studied.
Results: 1) The most dependent ADL item of ten ADL parameters was performance in the public office (37.8%) and, the most independent ADL item was feeding (98.0%). 2) With severe impairment of the upper or lower limb, all ADL scores except for feeding were significantly low (p＜0.05). In addition, with severe hearing impairment, scores of performance in public office were accessed low (p＜0.05). 3)With severe lower limb impairment, average scores of I-ADL and B-ADL were low (p＜0.05). 4) With severe language impairment, the average I-ADL score was also low (p＜0.05).
Conclusion: The task of performance in the public office was the most difficult ADL item for disabled persons. All ADL parameters except feeding were affected for disabled persons with lower or upper limb impairment. We think this pilot study may be used to develop more appropriate ADL scales for community based rehabilitation in the future.
Objective: To investigate the correlation between magnetic resonance imaging (MRI) findings for children with cerebral palsy (CP) and the severity of their developmental disability.
Method: MRI and Münchener Funktionelle Entwicklungs Diagnostik (MFED) were used for the evaluation of 52 children with CP. MFED quotient (MFED age/corrected age⁓100) was compared to the MRI findings.
Results: Of the 52 MRIs, no abnormalities were found in 7 cases (13%), periventricular leukomalacias (PVLs) in 37 cases (71.2%), corpus callosum abnormalities in 33 cases (63.5%), delayed myelinations in 8 cases (15.4%), congenital brain abnormalities in 6 cases (11.5%), and central sulcus abnormalities in 3 cases (5.8%). Among 27 patients who were born preterm, the major MRI finding was PVL (100%), indicative of a hypoxic brain injury. All patients with a normal MRI were born at term. There were significant correlations between the MFED quotient and the severity of PVL. The ratio of corpus callosum length/brain anteroposterior diameter was correlated with a developmental disability.
Conclusion: MRI findings for the patients with CP are well correlated with the developmental disabilities and the timing of brain insult.
The purpose of this study was to collect the informations on the current status and the needs of the physically disabled elderlies in the rural community along with the prevalence rate of these population. One study group for the study of disability status evaluation was 139 physically disabled elderlies living in the main island of Kangwha, and the other group for the study on prevalence of disability was 542 elderlies living in Songhae myun. The prevalence of physical disability was 6.5% in Songhae myun. The neurologic disorder was the most frequent diagnosis among the physically disabled elderlies followed by the musculoskeletal disorder. The time for the medical service delivery was delayed; 45.3% of the subjects received medical service more than one month after the onset of disability. Only 18.0% of the disabled elderlies received the public disability service, and 15.8% of the subjects was waiting for further service. The most common need from the subjects was the medical service, followed by the service from the institution such as a nursing home and the financial support. Registration rate of the disabled was very low(7.7%). There were only three physical therapists for the rehabilitation services in studies areas.
This study revealed that the public concepts for the disability and the rehabiltation service were inadequate. We hope that this basic data can be used for the planning of rehabilitation services in this community.
According to the World Health Organization(WHO), handicaps exist when individual is unable to fulfill expected social roles. The purposes of this study were to assess the handicap in spinal cord injury(SCI) outpatients, and to investigate the correlation of handicaps, impairments, disabilities and depression.
Eighty-five SCI outpatients were evaluated by the Craig Handicap Assessment and Reporting Technique(CHART), Katz scale, neurologic level and Frankel classification and Beck Depression Inventory (BDI). Seventy(82.4%) were male and 15(17.6%) were female. Average age of the subjects was 34.5 years with the age range of 18 to 63. The subjects were devided into four groups: complete quadriplegics (9), incomplete quadriplegics(12), complete paraplegics(41) and incomplete paraplegics(23). There was no significant statistical difference in total CHART scores between male and female subjects. However, male subjects had higher mobility and social integration scores than female subjects. The occupation score was low and the social integration score was high in all groups. No correlation was found between sex, severity and the level of injury, time since injury and the CHART scores. However, significant correlation was noted between the CHART scores and BDI scores.
We can carefully conclude that the CHART can be a valuable tool in the assessment of handicaps of disabled people. Futher extensive studies are recommended to identify the factors which might influence the handicaps of spinal cord injury persons.
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