Method26 cerebral palsy children with spastic hip adductor muscles went under inhalation general anesthesia by anesthesiologist for phenol block of obturator nerve. After induction with thiopental sodium and sustained with sevoflurane by face mask without the use of muscle relaxant, the vital signs including heart rate, blood pressure and oxygen saturation were closely monitored throughout the procedure. The obturator nerve block was carried out with 5% phenol using a stimulator. Modified Ashworth scale (MAS) and range of motion of hip were measured before and after the procedure to compare the effects of nerve block.

ResultsNo significant differences were observed from the vital signs before, during and after the procedure. The MAS score improved from average 2.50±0.71 to 1.12±0.32. The range of motion increased from 24.31±12.32^o and 25.88±12.28^o right and left relatively to 39.62±10.10^o and 40.96±11.14^o.

ConclusionBoth spasticity and range of motion of hip adductor muscles improved significantly after obturator nerve block with 5% phenol under inhalation general anesthesia in the operating room with face mask, and no adverse effects or complications were seen in all 26 cerebral palsy children. Therefore phenol nerve block under inhalation general anesthesia in operation room for cerebral palsy children with poor cooperation or positioning difficulty due to spasticity should be considered as a useful method.

Objective: To evaluate the clinical utility of the dynamic gastrocnemius length, calculated with gait analysis after phenol or botulinum toxin block in spastic cerebral palsy.

Method: Gastrocnemius muscles were injected with phenol or botulinum toxin. Kinematic gait parameters including dynamic gastrocnemius length were surveyed with 3-dimensional gait analysis system before and after the procedure.

Results: The dynamic gastrocnemius lengths improved significantly after block of calf muscles, except 3 cases which showed severe genu recurvatum. The vertical displacement of the center of gravities and the maximal ankle dorsiflexion angles after the block were not significantly different from those before the block.

Conclusion: Dynamic gastrocnemius length calculated with gait analysis can be used as a tool to determine the efficacy of spastic calf muscle block, in the absence of severe genu recurvatum. In case of associated severe genu recurvatum, other parameters may be substituted.

Objective: The purpose of this study is to evaluate gait characteristics using kinematic analysis in children with hemiplegic spastic cerebral palsy.

Method: Fifty-seven non-operated spastic hemiplegic children who were able to walk independently without any walking aid were recruited as subjects. Three-dimensional kinematic gait analysis using a motion analyzer (Vicon 370 M. A. with 6 infrared cameras) were performed in all patients. Changes in joint angle of hip, knee and ankle in sagittal plane were evaluated to classify gait pattern and also the temporospatial values were measured to determine any differences between groups.

Results: Gait patterns were able to be classified into 6 groups. Group I had a minimal gait disturbance, a drop foot pattern. Group II showed hip and knee flexed, with normal ankle range. Group III showed hip, knee, and ankle flexed. Group IV showed genu recurvatum with tibia progression, Group V showed genu recurvatum with tibia arrest. Group VI showed stiff crouch gait. However, the temporospatial values between groups were not significantly different.

Conclusion: This classification system would be useful for converting the vast quantitative information of gait analysis into descriptive and clinically relevant patterns. Therefore, it would be helpful for the clinician to understand underlying pathology and plan appropriate treatment.

Objective: The purposes of this study are to find out the long-term effect of motor point block using phenol on spasticity and gait pattern of spastic cerebral palsy children and to examine contributing factors for success of phenol block in functional implication of cerebral palsy.

Method: We injected 5% phenol into muscles of 35 cases with spastic cerebral palsy under the electromyographic monitoring. Pre, immediate post, and follow-up evaluations for type and severity, grade of spasticity, range of motion, and gait patterns by locomotion rating scale (LRS) were analyzed.

Results: The degree of spasticity was reduced dramatically by block, but this effect returned back to the level of pre-block state on follow-up evaluation. There was much improvement in pes equinus, genu recurvatum and scissoring tendency, while little change was observed in crouch gait and hind foot instability. These effects have been sustained on follow-up evaluation. The gait speed, deviation to normal gait, and instability in walking were significantly improved after block and on follow-up. Maintenance of adequate range of motion and good standing balance were the most important contributing factors determining the success in phenol block. Initial spasticity, initial and post LRS score were not significant.

Conclusion: After phenol block, spasticity returned back to the level of pre-block state but improvement in locomotion activity was maintained over 8 months on follow-up evaluation. The maintenance of adequate range of motion and good standing balance were the most important contributing factors determining the success in motor point block for improving locomotion activity.

Purpose: The purpose of this study is to find out the immediate effect of motor point block using phenol on the degree of spasticity and the gait patterns of children with spastic cerebral palsy and then to ascertain the cases to which these findings are most beneficial.

Subjects & Methods: We injected 5% phenol into spastic muscles of 33 cases with spastic cerebral palsy under the electromyographic monitoring. The clinical evaluation for type and severity of cerebral palsy was performed before the block and then, observations on both the degree of spasticity using `modified Ashworth scale' and the range of motion were made before and after the procedures. Finally, the gait patterns before and after block were analyzed by using locomotion rating scale for gait analysis.

Results: The degree of spasticity, which was measured with modified Ashworth scale, was reduced dramatically through our phenol block - i.e. from 2.8 to 1.2 -. The limited range of motion in some cases was not increased significantly after block. The constant pes equinus state resulted in the state that heel contact is occasionally possible. There was also much improvement in genu recurvatum and scissoring tendency, while little change was observed in crouch gait and hind foot instability. The speed of gait, deviation to normal gait and instability in walking were improved significantly after block, but their locomotion state was still moderately incomplete. When comparing the different outcomes of motor point block with one another according to the severity, the cases in moderately disabled state improved most dramatically. The group with both high degree of spasticity and the full range of motion in their joints improved by far the better after motor point block.

Conclusion: The immediate effect of motor point block with phenol solution can be best described as a dramatic relief of spasticity and tip toeing. but other problems such as other abnormal gait patterns and locomotion activity or state improved little, if any. The moderately disabled children with both high degree of spasticity and the full range of motion in their joint could get the best of our findings.