Background: In cerebral palsy (CP), parents’ quality of life and rearing attitude are considered possible factors that influence patients’ quality of life, function level, and performance in daily activities. Despite these facts, little attention has been given to demonstrate a relation between these factors. Objects: This study aimed to demonstrate the relationship between parents’ quality of life, functional level, and performance in daily activities, the quality of life of school-aged children with spastic CP. Methods: This study included 24 parents of school-aged children with spastic CP. The KIDSCREEN-52 and World Health Organization quality of life (WHOQOL)-BREF questionnaires (including physical, psychological, social, and environmental domains) were used as research tools to assess the quality-of-life profiles of the children with spastic CP and those of their parents, respectively. In addition, the function levels and performance in daily activities of the children with CP were assessed by using the gross motor function measure (GMFM) and modified Barthel index (MBI). Correlation and multiple regression analyses were performed to clarify the determinants of the quality of life of the children with CP. Results: The KIDSCREEN-52 score correlated with the total score (r=.735, p<.01) and all domains of the WHOQOL-BREF questionnaire (physical: r=.542, p<.01; psychological: r=.690, p<.01; social: r=.568, p<.01; and environmental: r=.783, p<.01). In addition, significant correlation was found between the KIDSCREEN-52 and MBI scores (r=.411, p<.05), and between the MBI and GMFM scores (r=.427, p<.05). After controlling for age, gender, paralytic type, GMFM, and MBI, the WHOQOL-BREF score (R2=.621), particularly in the environmental domain (R2=.699), remained independently related to the quality of life of the children. Conclusion: These findings suggest that the quality of life of school-aged children with spastic CP can be influenced by the quality of life of their parents. This study provides useful information for future studies to investigate the quality of life of children with CP

Improvement in functional gait is one of treatment goals in treatment of cerebral palsy children. This study intended to examine the effects of insoles for postural correction on gait in spastic cerebral palsy patients by investigating changes in gait temporal spatial parameters. As the subjects, 15 spastic bilateral cerebral palsy patients participated in this study. Temporal spatial parameters of gait were measured using GAITRite system under three gait conditions. Bare foot gait, gait in shoes, and gait in insoles for postural correction were conducted. In order to look at differences in temporal spatial parameters according to three gait conditions, repeated one way analysis of variance was conducted. As post hoc test, Bonferroni was conducted. A significant level was set at α=.05. According to the result of this study, gait velocity, cadence, step length, stride length of the left lower extremity significantly changed. When the subjects put on customized insoles for postural correction, the effect was greatest. There were no significant changes in stance time, single support time, double support time, swing % of gait, and stance % of cycle. Therefore, gait with insoles for postural correction positively influenced functional gait improvement and will be able to be usefully employed for spastic cerebral palsy children as one of gait assistance devices.

The purpose of this study was to investigate the immediate effect of fabric ankle-foot orthosis on spatiotemporal gait parameters, compared to a barefoot condition in children with spastic cerebral palsy. Eleven children with spastic cerebral palsy participated in this study. Spatiotemporal gait parameters were measured with the GAITRite system. Fabric ankle-foot orthosis significantly improved Timed Up and Go test time and gait velocity. There was no significant difference in cadence. The step time significantly improved in both the more and less affected foot compared to the barefoot condition. The step length of the affected foot also significantly improved, but there was no significant difference in the step length of the less affected foot. There was significant improvement in the stride length of both the affected and less affected foot, but no significant difference in single stance or double stance. The fabric ankle-foot orthosis could improve stability, and selective control of the joint and promote better walking in children with cerebral palsy. Consequently, the fabric ankle-foot orthosis might be an alternative assistive device for neurological populations as a primary role instead of the typical ankle-foot orthosis.

This study examined the effects of custom-made foot orthotics on the temporal-spatial gait parameters in children with cerebral palsy. Twenty spastic bilateral cerebral palsy (spastic CP) children (11 boys and 9 girls) participated in this study. GAITRite was used to examine the velocity, cadence, step length differential, step length, stride length, stance time, single support time, double support time, base of support, and toe angle while walking with and without foot orthotics. The differences in temporal-spatial parameters were analyzed using paired t-test. The significance level was set at .05. The velocity, cadence, both step lengths, both stride lengths, both bases of support and right toe angle significantly increased when the children with spastic CP with foot orthotics compared to without foot orthotics (p<.05). The step length differential between the two extremities, left stance time and left single support time, significantly decreased with foot orthotics (p<.05). Right stance time, right single support time, both double support times and left toe angle showed little change (p>.05). This study demonstrated that foot orthotics were beneficial for children with spastic CP as a gait assistance tool.

목적 : 본 연구는 식사보조도구 적용이 경직형 뇌성마비 아동의 자가-섭식 기능에 미치는 영향을 알아보기 위한 것이었다. 연구방법 : 연구대상자는 15세의 경직형 뇌성마비 남자 1명이었으며, 연구는 사례연구였다. 식사보조도구는 대상자의 신체기능 및 손기능을 평가한 후 작업치료사가 대상자에게 적합한 형태를 제작하여 적용하였다. 식사보조도구 적용 전과 후 대상자의 자가-섭식 기능의 변화는 일상생활평가도구인 Functional Independent Measure(FIM) 중 먹기(eating) 항목을 이용하여 평가하였고, 수행의 변화에 대한 만족도는 Canadian Occupational Performance Measure(COPM)의 수행도와 만족도 항목을 통해 측정하였다. 결과 : 식사보조도구를 적용한 이후 FIM의 먹기 영역의 점수는 2점에서 5점으로 증가되었고, 만족도 점수는 2점에서 8점으로 향상되었다. 결론 : 대상자의 신체기능 및 손기능을 고려하여 제작한 식사보조도구의 적용은 경직형 뇌성마비 아동의 자가-섭식 기능을 향상시키는 것으로 나타났다.

The aim of the current study was to assess the effectiveness of backward gait training on the treadmill in patients with spastic diplegic cerebral palsy (CP). Twelve patients with spastic diplegic CP participated in the study. An 8-week course of backward gait training was administered to the subjects for 3 days per week. Pre-intervention and post-intervention assessments of temporal-spatial gait parameters, the symmetry of the bilateral lower extremity weight bearing, and gross motor function were analyzed using motion analysis system, force plate, and Gross Motor Function Measurement (GMFM). There were significant improvements (p<.05) in the measures of both step length and right stance phase time. Joint kinematics showed increase in right hip abduction in initial contact and terminal swing, right hip external rotation and knee flexion in mid-swing, left ankle dorsiflexion in initial contact and terminal swing (p<.05). The symmetry of the bilateral lower extremity weight bearing and GMFM also significantly increased (p<.05). These findings indicate that backward gait training using a treadmill is beneficial for patients with spastic diplegic CP.

The purpose of this study is to see the effect of functional electrical stimulation on forced vital capacity and alternating motion rate in children with spastic cerebral palsy. This study divided 20 children with spastic cerebral palsy into two groups; functional electrical stimulation treatment group and control group. Functional electrical stimulation treatment group had 20min per day treatment three times a week for four weeks and the control group did not have any treatment. Before and after intervention, this study measured forced vital capacity and alternate motion rate(/peo/,/teo/) for all children. Forced vital capacity showed statistically significant increase for the group with functional electrical stimulation(p<.05) while the control group did not show any significant increase(p>.05). Alternate motion rate showed statistically significant increase for the group with functional electrical stimulation(p<.05) while the control group did not show any significant increase(p>.05). This result shows that functional electrical stimulation affected the ability of the children with spastic cerebral palsy who have decreased breathing and phonation capability.

목적 : 사물조작능력 분류 체계(Manual Ability Classification System : MACS)를 통한 경직형 뇌성 마비 아동의 사 물조작능력 수준 분류와 신변처리 기술 간의 상관성을 분석하고자 하였다. 연구 방법 : 본 연구는 경직형 뇌성마비 아동 45명을 대상으로 하였다. MACS의 검사자간 신뢰도를 평가하기 위해 두 명의 검사자가 동시에 평가하였으며, 주검사자가 평가 시행 시 부검사자가 독립적으로 채점하도록 하였다. 검 사자간 신뢰도는 급간 내 상관계수(ICC)를 통하여 분석하였으며 신변처리 기술 능력을 평가하기 위 해 Pediatric Evaluation of Disability Inventory(PEDI)를 사용하였다. MACS와 신변처리 기술 간의 상관성 분석은 스피어만 상관 분석을 사용하였으며, MACS 단계에 따른 신변처리 기술의 차이를 확인하기 위하여 크루스칼- 윌리스 검정 과 맨-휘트니 검정을 시행하였다. 결과 : 연구 결과 MACS의 검사자간 신뢰도는 ICC .93으로 좋은 일치도를 보였다. MACS와 신변처리 기술은 높은 수준의 상관성을 보였으며(r=-.921), 신변처리 기술 모든 항목에서 유의한 상관을 보였다. 그 중 신발 /양말 신기 (r=-.852), 단추/지퍼 채우기(r=-.849), 하의(r=-.846)에서 상관관계가 가장 높았다. 또한 MACS 단계 간 신 변처리 기술 총점 및 모든 하위 영역에서 유의한 차이가 있는 것으로 나타났으며, MACS 1-2단계 간 에는 3가지 항목(얼굴과 몸 씻기, 티셔츠/앞여밈이 있는 의복입기, 단추/지퍼 채우기)에서 유의한 차이를 보였고 , 2-3단계 간 에는 4가지 항목(손 씻기, 하의, 신발/양말 신기, 화장실 이용)에서 유의한 차이를 보였다. 3-4단계 간 에는 단추/ 지퍼 채우기 항목에서 유의한 차이를 보였다. 하지만 4-5단계 간에는 유의한 차이를 보이는 항목이 없었다. 결론 : 사물조작능력 분류 체계는 뇌성마비 아동의 사물조작능력을 평가하기에 신뢰할 수 있는 도구 이다. 또한 뇌성 마비 아동의 사물조작능력 분류 체계는 뇌성마비 아동의 신변처리 기술 수행 능력을 잘 반영하는 유 용한 평가 체 계라고 판단된다.

This study aimed to evaluate factors related to the ability of ambulatory patients with cerebral palsy (CP) to walk over vertical and horizontal obstacles. Twenty patients with spastic CP who were able to walk independently for at least 10 m with or without walking devices were recruited for the study. Participants were required to walk over small obstacles (1, 4, and 8 cm in height or width; total of 6 conditions). A 'fail' was recorded when either the lower limbs or the walking device contacted the obstacle. Linear regression analyses were used to determine the effects of age, sex, walking devices, eyeglasses, subtype (hemiplegia or diplegia), ankle foot orthoses, functional level, and score of body mass index on the ability of obstacle crossing. Fifteen participants (75%) failed to adequately clear the foot or walking device over obstacles in at least 1 condition. The chance of failure in crossing vertical obstacle was affected by the use of ankle foot orthoses, eyeglasses, gender, and CP subtype (p<.05). The failure rate crossing horizontal obstacle was affected by CP subtype. These findings suggest that rehabilitation procedures should (1) consider the clinical characteristics of patients in order to prepare them to be more independent while performing daily activities, and (2) incorporate environmental conditions that patients encounter at home and in the community.

목적 : 자세조절과 시지각 능력은 일상생활 및 학습을 하는 데 있어 기초가 되고 이러 한 요소는 뇌성마비 아동을 치 료하는데 주된 목표가 된다. 따라서 본 연구를 통해 경직형 뇌성마비 아동에서 안구운동프로그램이 자세조절과 시 지각 능력에 미치는 영향을 알아보고자 한다. 연구방법 : 2010년 5월 1일부터 2010년 8월 31일까지 부산에 위치한 P복지관에 내원하는 만4세~8세 경직형 뇌 성마비 아동을 대상으로 하였다. 10명의 경직형 뇌성마비 아동을 무작위로 실험군과 대조군으로 각각 5명씩 배정 하였다. 실험군에게는 안구운동프로그램과 함께 일반적 작업치료를 제공하고 대조군에게는 일반적 작업치료를 시 행하였다. 안구운동 프로그램은 단속성안구운동, 이접안구운동, 추적안구운동, 전정안구운동 4가지로 구성되어 있 다. 활동 중재는 1회 40분씩 주 3회로 8주 동안 제공되었다. 중재 전∙후에 대한 평가는 대동작기능평가(GMFM), 소아균형척도(PBS), 소아뻗기검사(PRT)와 한국판시지각발달검사(K-DTVP)를 사용하였다. 결과 : 안구운동프로그램을 수행한 실험군에서는 GMFM, PBS, PRT와 시각통합을 제외한 K-DTVP 모든 하위평 가항목에서 중재 전과 후의 점수가 통계적으로 유의한 차이가 있는 것으로 나타났으나(p<.05), 대조군에서는 PRT와 K-DTVP의 눈손협응과 공간위치를 제외하고는 통계적으로 유의한 차이를 보이지 않았다. 또한 두 집단 의 평가 점수의 변화량을 비교하였을 때 모든 평가항목에서 실험군이 대조군에 비해 유의한 차이를 보여 자세조절 과 시지각 기능 향상이 대조군보다 더 좋음을 나타냈다(p<.05). 결론 : 본 연구는 경직형 뇌성마비 아동에서 안구운동프로그램 중재가 자세조절 및 시지각능력 향상에 효과적임을 시사한다.

목적 : 본 연구는 등쪽 손목 스프린트(dorsal wrist splint) 적용이 경직성 편마비형 뇌성마비 아동의 손 기능에 미치는 영향을 알아보기 위한 것이다. 연구방법 : 연구 대상은 만 8세 5개월 된 경직성 편마비형 뇌성마비 여자 아동이었으며 개별실험 연구방법(single-subject experimental research design) 중 ABA 설계를 사용하였다. 등쪽 손목 스프린트는 12주 동안 매일 하루 평균 4시간 동안 착용 하도록 하였고, 스프린트를 착용한 상태에서 1시간씩 주 3회 환측 손으로 작업치료를 받도록 하였다. 대상자의 손 기능은 기초선 과정(5회)과 치료 과정(12회), 기초선 회귀 과정(3회) 동안 상자와 나무토막 검사(Box & Block Test)와 수직선 그리기 검사(Vertical Line Drawing Test)를 사용하여 측정하였다. 결과 : 대상자의 손 기능은 기초선 기간보다 치료 기간 동안 향상되었으며 이 향상은 기초선 회귀 과정 동안에도 계속 지속되었다. 결론 : 등쪽 손목 스프린트는 경직성 편마비형 뇌성마비 아동의 환측 손 기능을 향상시키는데 효과적이며, 손목의 외부적 지지를 통해 손가락 움직임의 조절을 향상시키는 것으로 나타났다.

The purpose of this study was to investigate the effects postural changes on respiratory muscles and acoustic parameters of the children with spastic cerebral palsy. Nine children with spastic cerebral palsy who required assistance when walking were selected. The ages of the children ranged from 6 to 9 years old. The phonation of the sustained vowel /a/ and the voice qualities of each child such as fundamental frequency(F0; Hz), pitch variation (Jitter; %), amplitude variation (Shimmer; %) and noise to harmonic ratio (NHR) were analyzed by Multi-Dimensional Voice Program (MDVP). The muscle activity of three major respiratory muscles: pectoralis major muscle, upper trapezius muscle and rectus abdorminalis muscle, were measured by examining the root mean square (RMS) of the surface EMG to investigate the impact of changes in the adjusted sitting posture of each subject. However, the RMS of pectoralis major muscle showed a significant differences (p<.05). Secondly, there were no significant differences in , Jitter and Shimmer between pre and post posture change, but there was a significant difference in NHR (p<.05). The data were collected in each individual; once prior and once after the sitting posture change. The data were analyzed by Wilcoxon signed ranks-test using SPSS version 14.0 for Windows. The findings of this study were as follows; Firstly, the RMS of upper trapezius and rectus abdorminalis muscle were not significant different between pre and post sitting posture changes. From the result, it is concluded that changes in the adjusted sitting posture decreases the abnormal respiratory patterns in the children with spastic cerebral palsy which is characterized by the hyperactivity of the respiratory muscles in breathing. Also, there is increased on the voice qualities in children with spastic cerebral palsy.

목적 : 발의 강직성 저측굴곡으로 인하여 무릎이 과신전된 뇌성마비 아동을 대상으로 발 보조기 착용이 무릎 각도와 독립적인 보행거리에 미치는 영향과 COPM을 이용하여 아동의 보조기 착용 전후의 작업수행의 차이를 알아보았다. 연구방법 : 본 실험은 개별실험연구의 반전연구 ABA' 실험설계를 이용하여 총 18회기를 실시하였다. 기초선 A에서는 발 보조기를 착용하지 않고 무릎각도와 독립적인 보행거리를 측정하였고, 캐나다작업수행측정을 실시하여 보조기 착용 전후의 작업수행의 수행도와 만족도의 변화를 알아보았다. 치료기간인 B에서는 보조기를 아동에게 착용하게 한 후의 무릎각도와 독립적인 보행거리를 측정하였다. 기초선 A'에서는 보조기를 제거한 후의 무릎각도와 독립적인 보행거리 및 작업수행의 수행도와 만족도를 보호자에게 재실시하였다. 무릎각도와 독립적인 보행거리를 평균과 시각적 분석을 이용하였고, 작업수행의 수행도와 만족도는 COPM의 점수 비교를 통하여 알아보았다. 결과 : 아동의 무릎각도는 보조기 착용 전후에 평균 11.63° 감소하였고, 독립적인 보행거리는 평균 6.97m 증가하였다. 아동이 혼자서 화장실 가기, 좋아하는 장난감을 스스로 가지러 가기, 공을 발로 차기 모두 보조기를 착용 하기 전보다 수행도와 만족도가 모두 증가하였다. 결론 : 본 연구 결과를 통하여 뇌성마비 아동의 발의 안정성이 아동의 보행거리뿐만 아니라 작업수행에도 영향을 미친다는 것을 알 수 있었다. 앞으로는 더 많은 수의 아동을 대상으로 보행거리와 아동의 작업을 수행하는데 있어서 자신감과 자율성과의 상관관계에 대한 연구도 이루어져야 할 것이다.

본 연구는 발가락 벌림 보조기(toe spreader)가 긴장성 발가락 굽힘 반사(Tonic Toe Flexion Reflex: TTFR)가 있는 양하지 뇌성마비 아동의 보행에 미치는 영향을 알아보고자 하였다. 12명의 TTFR이 있는 양하지 뇌성마비 아동을 대상으로 같은 날에 맨발과 발가락 벌림 보조기를 착용한 상태에서 보행분석을 실시하였다. 시간 거리 보행변수로 활보장(step length), 보장(step length), 보폭(step width)

본 연구는 강직성 편측 뇌성마비 환자의 보행 기시(gait initiation)의 특성을 파악하고, 동적 단하지 보조기(dynamic ankle foot orthosis : DAFO)가 이런 환자들의 보행 기시에 미치는 영향을 알아보기 위하여 실시하였다. 연구대상자는 19세 선천성 강직성 우측 뇌성마비를 가진 여자 대학생이었다. 연구대상자는 4개의 다른 보행 기시 조건에서 각 조건당 7회의 보행 기시를 하였는데, 각각의 보행 기시 조건은: 1) 보조기

The purpose of this study was to investigate the relation between components of population, maternal health, need for health care, maternal lifestyle and environment from a conceptual model for cerebral palsy, and the occurrence of cerebral palsy with spastic quadriplegic. This study was a case-control design. The subjects consisted of 53 children with quadriplegic cerebral palsy as a case who were receiving treatment after a diagnosis for cerebral palsy at 3 university hospitals and 3 rehabilitation facilities, and 186 children as a control who were visiting well baby clinics and pediatric departments after screening at the same hospitals in Seoul. The data were collected by a structured questionnaire survey from October, 1998 to February, 1999. The odds ratios of risk factor was produced by χ2 and simple logistic analysiss. The unconditional logistic analysis was done by modeling the data, after adjusting for gestational age. Statistically associated with an increase the risks for spastic quadriplegia were asphyxia(OR=221.89, 95% CI 15.8-999.0) and maternal history of admission during the pregnancy (OR=10.55, 95% CI 2.2-50.4). The result suggested that the improvement of obstetric and neonatal care is necessary to prevent cerebral palsy with spastic quadriplegia.

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.