The purpose of this study was to compare the effects of anterior walker and posterior walker on gait parameters and body alignment of children with cerebral palsy. The intraclass correlation coefficient was .99 for intertester reliability. Intratester reliability was between .96 and .99. The use of posterior walker increased gait velocity and facilitated more upright posture. The measurement of joint angle program was found to be reliable to measure range of motion. This study has a limitation of generalizing the results to all children with cerebral palsy. Research is required to investigate the effect of posterior walker on energy efficiency.

The purposes of this study were to research the current state of evaluation of children with delayed development and cerebral palsy and determine pediatric physical therapists' knowledge of assessment tools and their use. The subjects were 130 pediatric physical therapists (general hospitals, university-related hospitals, rehabilitation centers, etc.). Data was obtained from August 24, 1999 to October 18, 1999 by means of a survey questionnaire. The results were as follows: 1. The current state of pediatric physical therapist evaluation of children with delayed development and cerebral palsy. 1) Tools used to assess functional areas of children with cerebral palsy were: subjective description format-128 (47.1%); the GMFM-58 (21.3%); facility-generated tool-51 (18.8%); and DDST-15 (5.5%). 2) Tools used to assess developmentally delayed children were: subjective description format-121 (50.6%); the GMFM-43 (18.0%); facility-generated tool-41 (17.2%); and DDS T-14 (5.9%). 3) After their college or university study, therapists who had attended lectures on evaluation were 113 (86.9%); 13 (10.0%) therapists had not attended any lectures on evaluation 2. Test scores of physical therapists' professional knowledge of evaluation procedures: high (more than 36 points)-74 (56.9%); moderate (18~35 points)-39 (30.0%); and low (below 17 points)-none. 1) For therapists treating cerebral palsied children, 73 (65.2%) were in the high range, 39 (34.8%) were in the moderate range and none were in the low range. 2) For therapists treating children with delayed development, 71 (65.7%) were in the high range, 37 (34.3%) were in the moderate range and none were in the low range. Although the general degree of professional knowledge of evaluation was quite high, there was a lack of variety in the assessment tools used With a large number of therapists depending on subjective description. Possible reasons for the low rate of objective asses sment tool use: 1) Poor clinical environment: too many clients and lirnited treatment time. 2) Lack of any medical insurance fee category for specific assessment tools. 3) Lack of continuing education opportunities in pediatric evaluation skills during or after either college-based (3 year) or university-based (4 year) education programs. Based on the study results, provision of more extended educational opportunities would promote the use of a greater variety of objective assessment tools by pediatric physical therapists.

이 연구의 목적은 Motor-Free Visual Perception Test (MVPT)와 Mariannene Frostig Developmental Test of Visual Perception (DTVP)을 사용하여 뇌성마비 아동과 정상아동의 시 지각 능력의 차이를 알아보고, 뇌성마비의 사지마비군과 양하지마비군, 그리고 정상아동군에서 두 평가도구의 결과에서 제시한 시 지각능력의 차이를 비교하기 위한 것이다. 뇌성마비 아동 21명(사지마비 11명,

The purpose of this study was to know whether the performance of activities of daily living(ADL) affect the depression level of disable people or not. In this study, the ADL item was divided into two category as basic ADL and instrumental ADL. The particip- ants were 67 persons with cerebral palsy(aged 16 to 49). Over 80% of the subjects had independent ability to perform the basic ADL, but, in instrumental ADL items, 50% of them needed assistance. Each of basic and instrument ADL item were signific- antly correlated to the depression level(p<0.01). The Spearman correlation coefficients of basic and instrumental ADL item were 0.336 and 0.416 respectively. As before, ins-trumental ADL item score was more correlated to depression level than basic ADL item score.

The purpose of this study was to compare and evaluate various hand functions in three hip flexion postures(70°, 90°, 110°)in persons with spastic diplegic cerebral palsy using by Jebsen Hand Function Test. 14 children with mild or moderate spastic diplegia were chosen in the Rehabilitation Hospital, Yonsei University Medical Center. Both hands were tested 3 times by ten intervals in three hip flexion postures (70°, 90°, 110°). Data Collected were analysed using nonparame-tric test, Friedman's Test. Results were as follows: 1. The right hand mean score of Jensen Hand Function Test showed no significant difference in any of the three hip flexion postures. 2. The left hand mean score of Jensen Hand Function Test showed no significant di- fference in any of the three hip flexion postures. The results showed that the hand function of children with spastic diplegia was not affected in three hip flexion postures, but it is necessary to maintain well supported pelvic posture for good hand function.

Many children with physical disability have feeding difficulties. In cases of children with cerebral palsy, feeding difficulties can be seen in abnormal oral motor activity and defective swallowing coo rdination. These problems originate from neurological lesions. The purpose of this study was to i nvestigate the effect of trunk and neck position on the following aspects of swallowing: stages of oral preparation, pharyngeal swallowing reflex, pharyngeal clearing and aspiration. Sixteen subjects with quadriplegic cerebral palsy were examined to assess their swal-lowing abil ity using videofluoroscopy(VFS). Subjects were evaluated in four different positions 1) trunk erect with the neck flexed 30°2) trunk reclined 30°posteriorly with the eck positioned neutrally 3) trunk re clined 30°posteriorly with the neck flexed 30° 4) trunk in supine with the neck flexed 30°. Friedman's test was used to analyze the effect of posi tion of the neck and trunk on swallowing. The results were as follows: 1. Ability of oral preparation was significantly better with the subject's trunk recli-ned 30°poste riorly and the neck flexed 30°than with the trunk erect and the neck flexed 30°(p < 0.05). 2. Ability of pharyngeal clearing was significantly better with the subject's trunk er-ect and the neck flexed 30° than in supine with the neck flexed 30°(p < 0.05). 3. Incidence of swallowing reflex was not significantly different among the four posi- tions (p > 0.05). 4. Prevention of aspiration was significantly better with the subject's trunk reclined 30°posteriorl y and the neck flexed 30° than with the trunk reclined 30°posteriorly and the neck neutrally positi oned or in supine with the neck flexed 30°(p < 0.05). These results suggest that positions of both the neck and the trunk have an effect on swallowi ng in children with cerebral palsy. The position with the trunk reclined 30°posteriorly and the n eck flexed 30°was found to be optimal for oral preparation and prevention of aspiration. Further r esearch to study swallowing ability in conjunc- tion with respiratory function is indicated.

Recently the researches to enhance the hand function of brain injured clients are increased. One of those aspects is related to in-hand manipluation. In-hand manipulation is divided to four types: that is finger-to-palm translation. palm-to-finger translation, shift, and rotation. The purpose of this study was to find type of in-hand manipulation in normal adults in six activities and to differentiate the pattern of in-hand manipulation between normal adults and children with cerebral palsy. The participants were consist of twenty normal adults and twenty cerebral palsy. children. As a results, cerebral palsy children significantly used at lower frequence than normal adults in 3 activities. Also, in the other items, there are some pattern to differenciate between normal adults and cerebral palsy children but that was not significant statistically. The development of in-hand manipulation skills involves improvement in the dimension of activities of daily living skills training and more detailed evaluation method will be needed.

Thumb adduction is an abnormal pattern typically noted in children with spastic cerebral palsy. This abnormal pattern can limit hand function, specifically in the type and quality of prehension pattern used and in the coordination of release. This ABAB single-subject research was designed to examine the effects of short thumb opponens splint on hand function in cerebral palsy. The subject was a 4 years and 8 months old boy with right upper extremity spasticity. The child was fitted with a short thumb opponens splint, which was worn for 8 hours per day during the daytime. Two different measures were used: (a) prehension component scores; (b) Bruininks-Oseretsky test of motor proficiency. Data was collected three times a week for 10 weeks. Visual analysis of data indicate that after the application of a short thumb opponens splint, improvements were noted in the prehension pattern and fine motor functional task. The results of this study suggest that short thumb opponens splint may prove efficaciousness in the treatment of the child with cerebral palsy.

The purpose of this case study was to introduce botulinum toxin A injection in cerebral palsy. Spasticity can be managed using a variety of methods. Eliminating aggravating sources, promoting stretching and bracing, and positioning are the least invasive methods of treatment. Botulinum toxin A injection is a relatively recent method of spasticity management in children with cerebral palsy. A 3-year old boy was evaluated for possible botulinum toxin injection to promote left side function. The patient had left hemiparetic cerebral palsy. He walked with bilateral intoning, much worse on the left than on the right and with excessive plantar flexion on the left. Botulinum toxin A was injected into the left medial gastrocnemius, with the goals of improving quality of gait. Finally, botulinum toxin treatment of would improve the motor function and ambulatory status in cerebral palsy by hypertonicity, spasticity, dynamic contracture and athetoid movement.

Hand skills are important to interaction with environment. Hands are the tools most often used to accomplish work, to play, to express and communicate. This study observed the grasp patterns of spastic cerebral palsied(39) and athetoid cerebral palsied children(l3). They were asked by occupational therapist that wrote their name with pencil and colored a circle with crayon. Their grasp patterns were recorded on the basis of which fingers were used to grasp the object, the surface areas of the fingers in contact with the object, and the position of the joints of the fingers. This paper will present the skill acquisition and the activities of daily living for the fine motor skill and self care to the child who has a disability affecting hand skills.

An A-B-A-C single subject research design was used to assess the effectiveness of transcutaneous electrical nerve stimulation(TENS) and inhibitive techniques on spasticity in a 10-year-old girl with cerebral palsy. Stimulation electrodes were placed over the sural nerve of the right leg. The standard method of cutaneous stimulation, TENS with impulse frequency of 100 Hz, was applied. Inhibitive techniques including stretch, antagonist contraction, and weight bearing were used. The tonus of the leg muscle was measured by means of a surface-EMG biofeedback unit. Visual analysis of data indicate that the child showed clinically significant reduction of spasticity in passive ankle movement following 30 minutes of TENS and inhibitive techniques application, respectively. The effect of TENS on spasticity inhibition was similar to that of inhibitive techniques. This result suggests that for this child with cerebral palsy, the application of TENS to the sural nerve may induce short-term post-stimulation inhibitory effects on the spasticity of cerebral palsy. Replication of this study with a more complex single-subject design involving more subjects is recommended to confirm this result.

The purpose of this study was to compare and evaluate various hand functions in the most common position (chair sitting, standing, floor sitting) used by cerebral palsied children with spastic diplegia. The results, analysed statistically, could be useful in suggesting treatment strategy for the improvement of hand function in such patient. For this study, 27 children mild or moderate spastic diplegia were chosen. They were patients of the Rehabilitation Hospital, Yonsei University Medical Center. Both dominant and nondominant hands were tested by the Box and Block Test. Bilateral hand function was tested by bead striding and card sorting activities. Collected data was analysed using univariate correlation analysis and MANOVA. Results were as follows: 1) In chair sitting there was a significant positive correlation between dominant hand scores in the Bloc and Box Test and chronological age, gestation period, and time of treatment initiation. In bilateral hand function, card sorting scores correlated positively with time of treatment initiation. 2) In standing, there was a significantly positive correlation between dominant hand scores in the Block and Box Test and time of treatment initiation. 3) In floor sitting, there was a significantly positive correlation between the dominance hand scores in the Block and Box Test and the tine of treatment initiation. Bead stringing, a bilateral hand activity, correlated positively with gestation period and birth weight but negatively with the postnatal incubation period. 4) That score of children who walked showed no significant difference in any of the three postures. 5) Highest test scores in children who could nat walk were in the Box and Block Test for nondominant hand in bead stringing for bilateral hand function. There scores occurred with the children in thee chair sitting posture. The results showed that, in order to improve hand function in children with spastic diplegia, it is necessary to maintain a well supported upright trunk posture with variations allowed for relevance to the chosen position of thee improvements hand activity being performed.

The purpose of this study was to compare and evaluate various hand functions in the most common positions (chair sitting, standing, floor sitting) used by cerebral palsied children with spastic diplegia. The results, analysed statistically, could be useful in suggesting treatment strategy for the improvement of hand function in such patients. For this study, 27 children with mild or moderate spastic diplegia were chosen. They were patients of the Rehabilitation Hospital, Yonsei University Medical Center. Both dominant and nondominant hands were tested by the Box and Block Test. Bilateral hand function was tested by bead stringing and card sorting activities. Collected data was analysed using univariate, and MANOVA. Results were as follows: 1. The scores of children who walked showed no significant difference in any of the three postures. 2. The highest test scores in children who walked with assistance (aid /other person) were in the Box and Block Test for the nondominant hand, and in bead stringing for bilateral hand function. These scores occurred with the children in the chair sitting posture(p(0.05). The results showed that, in order to improve hand function in children with spastic diplegia, it is necessary to maintain a well supported upright trunk posture with varia- tions allowed for relevance to the chosen position of the hand activity being performed.

본 연구는 뇌병변 장애아동과 보호자가 가정에서 편리하게 사용할 수 있는 자세유지기 디자인을 제시하기 위해 진행되었다. 연구를 위해 먼저 뇌병변 장애아동의 특성, 자세유지기의 종류와 특성을 파악하였다. 그리고 국내외에서 개발된 자세유지기를 ‘경제성’ ‘사용성’ ‘심미성’ ‘범용성’ ‘이동성‘ 측면에서 비교 분석하였다. 또한 사용성 테스트를 실시하여 자세유지기의 사용상의 문제점 및 요구사항을 파악하였다. 사용성 테스트에는 4명(장애아동 2명, 보호자 2명)이 참가하였다. 마지막으로 위의 조사결과를 종합하여 디자인개발 방향을 설정한 뒤 이를 토대로 디자인을 전개하였다. 디자인결과물로 아동의 성장에 따라 프레임의 너비 등을 쉽게 조절할 수 있는 A안과, 사용자의 신체에 맞게 조절이 가능하면서도 세련된 스타일로 실내 환경과도 잘 어울리는 B안이 제시되었다. 최종결과물은 자세유지기 전문 업체의 양산성검토를 거쳐 상품화될 계획이다.