Selective posterior rhizotomy (SPR) is a neurosurgical procedure designed to alleviate spasticity and has been successfully used for children with spastic cerebral palsy. We evaluated eleven children who had follow up over 6 months after SPR among sixteen children who underwent SPR from August 1995 to July 1996. The authors have analyzed the status of the children with spastic cerebral palsy before and after operation to determine the effects of this therapy on muscle tone, functional grade, gross motor function and gait pattern. Gross motor function was measured by gross motor function measure(GMFM) scale. Postoperative tests showed reduction in muscle tone in all cases compared with preoperative assessments. Functional grade was increased in 90% of the cases more than one grade. The total gross motor mean score change between the preoperative and 6 months postoperative score was 16. Gross motor scores were analysed in each of 5 dimensions(88 conditions), i.e., lying and rolling, sitting, crawling and kneeling, standing, and walking, running, jumping. Gross motor score for each dimension improved in all cases. The greatest improvement was seen in sitting scores. The results of gait analysis of 2 ambulatory patients showed increased range of motion of hip and knee joints throughout the gait cycle and increased ankle dorsiflexion during swing phase. These results showed that SPR combined with intensive postoperative rehabilitation for children with spastic cerebral palsy had a significant positive effect on gross motor function.
Ankle ; Cerebral Palsy* ; Child* ; Deception ; Follow-Up Studies ; Gait ; Hip ; Humans ; Knee Joint ; Muscle Spasticity ; Neurosurgical Procedures ; Range of Motion, Articular ; Rehabilitation* ; Rhizotomy* ; Running ; Walking

OBJECTIVE: The present study was undertaken to evaluate the findings of multimodality evoked potentials, brain MRI and EEG in cerebral palsy children and to identify the correlations between these findings. METHOD: We examined Brain MRI, EEG and evoked potentials including visual evoked potentials(VEPs), brainstem auditory evoked potentials(BAEPs) and somatosensory evoked potentials(SSEPs) in 80 cerebral palsy children. RESULTS: 1) Abnormal findings of brain MRI and EEG were 79.4% and 81% respectively. 2) Abnormal responses of VEPs and BAEPs were 28.1% and 18.8%. 3) In the median and tibial nerve SSEPs, abnormal responses were 14.6% and 28.6%. Abnormal findings of the tibial nerve SSEPs were more frequent than the median nerve SSEPs. 4) In children with spastic hemiplegia, the abnormal SSEPs were much greater in the affected limb than unaffected limbs. 5) There was a significant correlation between the SSEP abnormalities and brain MRI or EEG abnormalities in cerebral palsy children. CONCLUSION: The data obtained in this study would be helpful for identifying and assessing the central nervous system deficits of cerebral palsy children.
Brain Stem ; Brain* ; Central Nervous System ; Cerebral Palsy ; Child* ; Electroencephalography* ; Evoked Potentials* ; Extremities ; Hemiplegia ; Humans ; Magnetic Resonance Imaging* ; Median Nerve ; Tibial Nerve

OBJECTIVE: To investigate the biomechanic influence of body weight unloading on the hemiplegic gait and to provide database for producing optimal strategies of gait training through body weight unloading (BWU) in hemiplegic patients. METHOD: We evaluated dynamic electromyographic data, temporal parameters of gait, and energy consumption in 20 hemiplegic patients walking on a treadmill with 0%, 10%, 20%, 30% and 40% of their BWU at their comfortable walking speed. RESULTS: 1) Stance phase and double limb support phase significantly decreased, and swing phase and single limb support phase increased according to BWU. 2) Asymmetricity of temporal parameters of gait improved according to BWU. 3) O2 rate, O2 cost, O2 pulse and heart rate significantly decreased with increasing BWU. 4) Muscular activities of rectus femoris, vastus medialis and biceps femoris decreased at initial contact and first half of stance phase and activities of medial gastrocnemius significantly decreased during entire stance phase with increasing BWU. CONCLUSION: BWU during treadmill locomotion would be advantageous as a therapeutic approach to retrain gait in hemiplegic patients.
Body Weight* ; Electromyography ; Extremities ; Gait ; Gait Disorders, Neurologic* ; Heart Rate ; Humans ; Locomotion ; Quadriceps Muscle ; Walking

Objective: To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods: This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results: All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals postECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet.Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year postECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.

Objective: To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods: This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results: All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals postECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet.Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year postECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.

In 2008, the Korean Centers for Disease Control and Prevention (KCDC) initiated Korean Community Health Survey (KCHS), the first nationwide survey to provide data that could be used to plan, implement, monitor and evaluate community health promotion and disease prevention program. This community-based cross-sectional survey has been conducted by 253 community health centers, 36 community universities and 1,500 interviewers. The KCHS standardized questionnaire is developed jointly by KCDC staff, a working group of health indicators standardization subcommittee and 16 metropolitan cities and provinces with 253 regional sites. The KCHS was administered by trained interviewers and the quality control of KCHS was improved by introduction of computer-assisted personal interview in 2010. The questionnaire was reviewed annually so that revised and/or new questions could be added based on public health policy. The additional questions included the fixed and rotating cores, emerging issues and optional modules. The standardized questionnaire of KCHS covered a wide variety of health topics, which could be used to assess the prevalence of personal health behaviors related to causes of disease. The KCHS data allows that the differences of health issues among provinces can be directly compared. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention.
Centers for Disease Control and Prevention (U.S.) ; Community Health Centers ; Cross-Sectional Studies ; Health Behavior ; Health Promotion ; Health Surveys ; Humans ; Organothiophosphorus Compounds ; Prevalence ; Public Health ; Quality Control ; Surveys and Questionnaires

PURPOSE: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. MATERIALS AND METHODS: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. RESULTS: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. CONCLUSION: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.
Academies and Institutes ; Acute Pain ; Analgesics ; Female ; Fentanyl* ; Humans ; Male ; Nausea ; Prospective Studies ; Quality of Life ; Radiotherapy* ; Sleep Initiation and Maintenance Disorders ; Transdermal Patch*