In Young Sung

Prediction of treatment outcome with bioimpedance measurements in breast cancer related lymphedema patients.

Objective To investigate the usefulness of bioimpedance measurement for predicting the treatment outcome in breast cancer related lymphedema (BCRL) patients. Method Unilateral BCRL patients who received complex decongestive therapy (CDT) for 2 weeks (5 days per week) were enrolled in this study. We measured the ratio of extracellular fluid (ECF) volume by using bioelectrical impedance spectroscopy (BIS), and single frequency bioimpedance analysis (SFBIA) at a 5 kHz frequency before treatment. Arm circumferences were measured at 10 cm above and below the elbow before and after treatment. We also investigated whether there is correlation between ECF ratio and SFBIA ratio with the change of arm circumference after CDT. Results A total of 73 patients were enrolled in this study. The higher ECF ratio was significantly correlated with higher reduction of arm circumference at both above and below the elbow after treatment, but the higher SFBIA ratio was correlated only with the higher reduction of arm circumference below the elbow. Conclusion These results show that ECF volume measurements and SFBIA before treatment are useful tools for predicting the outcome of patients with lymphedema. We concluded that ECF volume measure can be used as a screening tool for predicting treatment outcome of BCRL patients.

The Effect and Complication of Botulinum Toxin Type A Injection with Serial Casting for the Treatment of Spastic Equinus Foot

Objective To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot. Method Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physicians rating scale (PRS). Results The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (p<0.001), while the BTX-A injection-only group improved until 6 weeks following injection (p<0.05). The combined group showed a significantly greater increase in the degree of dorsiflexion compared to the BTX-A injection-only group at post-injection weeks 6 and 12 (p<0.05). Three children (11.5%) suffered from foot ulcers as a complication caused by the serial casting. Conclusion Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.

Usefulness of the tendon reflex for assessing spasticity after botulinum toxin-a injection in children with cerebral palsy.

This study sought to investigate the relationships between clinical and neurophysiologic assessments of spasticity after injection of botulinum toxin-A in children with cerebral palsy. A total of 40 children were recruited. Clinical assessments included the modified Ashworth scale and modified Tardieu scale parameters R1, R2, and D. Neurophysiologic assessment included compound motor action potential, Hoffmann, and tendon reflex. Children showed significant decreases in modified Ashworth scale, R1, and R2 at 2, 4, and 12 weeks and in D at 2 and 4 weeks. Amplitude of compound motor action potential decreased at 2 weeks, Hoffmann reflex amplitude decreased at 4 weeks, and tendon reflex amplitude decreased at 2 and 4 weeks. At 12 weeks, none of the neurophysiologic parameters differed from baseline. The correlations among R2, D, and the amplitude of tendon reflex were significant. Neurophysiologic tests could be used to evaluate reduced spasticity after botulinum toxin-A injection. The amplitude of tendon reflex showed the highest correlation with severity of spasticity.

Neurodevelopmental Outcomes in Very Low-Birth-Weight Infants in Korea 1998-2007 vs 1989-1997

The authors reviewed the medical records of very low-birth-weight infants admitted from 1998 to 2007 and compared neurodevelopmental outcomes with their previously reported data from 1989 to 1997. The recent group included 824 infants, and the previous group included 471 infants. Neurodevelopmental outcomes were classified into cerebral palsy and non–cerebral palsy neurodevelopmental impairment. In the recent group, the survival rate was significantly higher (79.4% vs 66.2%), the rate of cerebral palsy was lower (7.9% vs 10.5%), and the rate of non–cerebral palsy neurodevelopmental impairment was higher (6.0% vs 4.5%) but not significant. The survival rate increased significantly over time, but there was no significant change in neurodevelopmental outcomes over time. Multivariate analysis indicated that abnormal neurosonographic findings, using assisted ventilation, vaginal delivery, and abnormal brainstem auditory evoked potential, were associated with increased risk for cerebral palsy.

Long-term outcomes in children with swallowing dysfunction.

Purpose: To evaluate swallowing function using a videofluoroscopic swallow study (VFSS), and to identify factors related to long-term swallowing function in children with swallowing dysfunction. Methods: Ninety children, aged 1–120 months (mean 27.5 months) were randomly selected from among children referred for the evaluation of swallowing dysfunction. We retrospectively reviewed the charts, and long-term outcomes were tracked up to 5 years. Results: Baseline American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale was 3.4 ± 2.5. Supraglottic penetration and subglottic aspiration comfirmed by VFSS were detected in 30 children. After follow-up, oral feeding was possible in 74 patients, and the ASHA NOMS swallowing scale improved significantly, from 3.4 ± 2.5 to 5.8 ± 2.0. Baseline VFSS severity, serum albumin concentration, baseline weight percentile and neurologic conditions were significantly correlated with long-term swallowing function. Conclusions: The long-term outcomes in children with swallowing dysfunction were favorable, and baseline videofluoroscopic severity was significantly correlated with long-term swallowing function.

Korean Database of Cerebral Palsy: A Report on Characteristics of Cerebral Palsy in South Korea

Objective To introduce the Korean Database of Cerebral Palsy (KDCP) and to provide the first report on characteristics of subjects with cerebral palsy (CP). Methods The KDCP is a nationwide database of subjects with CP, which includes a total of 773 subjects. Characteristics such as demography, birth history, onset and type of CP, brain magnetic resonance imaging (MRI) findings, functional ability and accompanying impairments, were extracted and analyzed. Results Preterm delivery and low birth weight were found in 59.51% and 60.28% of subjects, respectively. Postnatally acquired CP was 15.3%. The distribution of CP was 87.32%, 5.17%, and 1.81% for spastic, dyskinetic, and ataxic types, respectively. Functional ability was the worst in dyskinetic CP, as compared to other types of CP. Speech-language disorder (43.9%), ophthalmologic impairment (32.9%), and intellectual disability (30.3%) were the three most common accompanying impairments. The number of accompanying impairments was elevated in subjects with preterm birth and low birth weight. Brain MRI showed normal findings, malformations, and non-malformations in 10.62%, 9.56%, and 77.35% of subjects, respectively. Subjects with normal MRI findings had better functional ability than subjects with other MRI findings. MRI findings of a non-malformation origin, such as periventricular leukomalacia, were more common in subjects with preterm birth and low birth weight. Conclusion The KDCP and its first report are introduced in this report, wherein the KDCP established agreement on terminologies of CP. This study added information on the characteristics of subjects with CP in South Korea, which can now be compared to those of other countries and ethnicities.

Effects of lateral electrical surface stimulation on scoliosis in children with severe cerebral palsy: a pilot study.

Abstract Purpose: To evaluate the effects of lateral electrical surface stimulation (LESS) on scoliosis and trunk balance in children with severe cerebral palsy (CP). Methods: Children with severe CP (GMFCS level IV or V) and stationary or progressive scoliosis were enrolled. Children were recommended of two sessions of LESS/day, 1 h/session, for 3 months at home: at 40–80 mA intensity, 200 μs pulse width, 25 Hz frequency, on for 6 s and then off for 6 s on the convex side of the trunk curve. Radiologic (Cobb’s, kyphotic, and sacral angles) and functional [gross motor function measurement (GMFM)-88 sitting score, and trunk control measurement scale (TCMS)] measurements were evaluated at 4 periods: (a) 3 months before, (b) just before, (c) 1 month after, and (d) 3 months after LESS. Results: The median Cobb’s angle of 11 children (median age, 9 years) was 25°, and it showed significant improvements after both 1 and 3 months of LESS. The LESS intensity correlated with the improvement of GMFM-88 siting score. The parents or main caregivers of the children believed LESS had several positive effects without major adverse effects. Conclusions: LESS is effective in scoliosis in children with severe CP and it may improve trunk balance. Implications for rehabilitation Scoliosis is a very complicated problem for the children with severe CP. They do not have many options for treatments and scoliosis is usually refractory. Lateral electrical surface stimulation (LESS) is effective in scoliosis in children with severe CP and it may improve trunk balance. LESS may be another option of managing stationary or progressive scoliosis in the children with severe CP who are unable to undergo surgery.

Visual Evoked Potential in Children With Developmental Disorders: Correlation With Neurodevelopmental Outcomes

Objective To investigate the neurodevelopmental outcomes in children with developmental disorder according to visual evoked potential (VEP) results. Methods We retrospectively analyzed children who visited our Department of Pediatric Rehabilitation Medicine with a chief complaint of developmental disability from January 2001 to July 2015. Of the 549 medical records reviewed, 322 children younger than 42 months who underwent both Bayley Scales of Infant and Toddler Development second edition (BSID-II) and VEP studies were enrolled. We compared the development of 182 children with normal VEP latency and 140 children with delayed VEP latency results using the BSID-II results. The Mann-Whitney U-test was used to analyze the differences between the two groups. Results There were no significant differences in baseline characteristics between the two groups. The delayed VEP latency group showed a significant delay in BSID-II index scores and developmental quotients compared with the normal VEP latency group. In addition, a comparative analysis of developmental quotients of mental and psychomotor domains according to age (younger than 12 months, 12–23 months, and 24–42 months) revealed significantly lower values in children with delayed VEP latency compared to children with normal VEP latency, younger than 12 months and from 12 to 23 months. Conclusion Children with delayed VEP latency showed more developmental delay than children with normal VEP latency. It is suggested that VEP can be easily applied to children with suspected developmental delay when physicians have concerns about visual impairment. Furthermore, it is proposed that VEP results could provide an insight into childrens development and serve as early indicators for consultation with an ophthalmologist for the existing problem.

Comparison of Second and Third Editions of the Bayley Scales in Children With Suspected Developmental Delay

Objective To compare the scores of the Bayley Scales of Infant Development second edition (BSID-II) and the third edition, Bayley-III, in children with suspected developmental delay and to determine the cutoff score for developmental delay in the Bayley-III. Methods Children younger than 42 months (n=62) with suspected developmental delay who visited our department between 2014 and 2015 were assessed with both the BSID-II and Bayley-III tests. Results The mean Bayley-III Cognitive Language Composite (CLC) score was 5.8 points higher than the mean BSID-II Mental Developmental Index (MDI) score, and the mean Bayley-III Motor Composite (MC) score was 7.9 points higher than the mean BSID-II Psychomotor Developmental Index (PDI) score. In receiver operating characteristic (ROC) analysis of a BSID-II MDI score <70, Bayley-III CLC scores showed a cutoff of 78.0 (96.6% sensitivity and 93.9% specificity). In ROC analysis of a BSID-II PDI score <70, the Bayley-III MC score showed a cutoff of 80. Conclusion There was a strong correlation between the BSID-II and Bayley-III in children with suspected developmental delay. The Bayley-III identified fewer children with developmental delay. The recommended cutoff value for developmental delay increased from a BSID-II score of 70 to a Bayley-III CLC score of 78 and Bayley-III MC score of 80.

Poster 492 The Effect of Tablet PC Based Cognitive Training Program (Injini) for Children with Cognitive Impairment in Educational Field

completed high school (42%) and were housewives/husbands (70%). Majority had Gross Motor Function Classification System score of 3 (29%) and Functional Mobility Scale score of 2 (55%). Thirty-one percent scored 2 in the Manual Ability Classification System among participants aged 4-18 years. For the 0e4 years age group, 26% scored ‘below average’ in the Peabody Developmental Motor Skills e 2. All participants had communication and feeding problems, while 58% had seizure. Majority had access to government facilities. Physical and occupational therapy were the most common interventions available. Subgroup analysis showed that spasticity had a negative relationship with motor function e increased spasticity contributes to lower motor function. Conclusions: A framework for a hospital-wide CP profile using this study’s findings can be established to monitor trends and characteristics of this population. Causes of CP are multifactorial and their impact is complex, therefore these should be correlated with alterations in maternal, perinatal and neonatal risk factors, health services and socioeconomic levels. Level of Evidence: Level III