• The Journal of Korean Physical Therapy
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• v.9 no.1
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• pp.127-145
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• 1997

The purpose of this study wa9 to analyse the gait patterns of two female children with hemiplegic cerebral palsy by using the three-dimensional video motion analysis technique. Case 1 has mild spastic hemiplegia on the right side while Case 3 has moderate spastic hemiplegia on the left side. A group of 10, normal female children of the same age(7-8 years old) were selected as the control group for comparison. Time and distance variables as well as the Center of Mass displacement, and the pelvic and joint motions in three anatomical planes were analysed for this purpose. The following observations were made through the analysis : Case 1 revealed an asymmetrical gait pattern in which the step length of the unaffected side was shorter than that of the affected side, which wan a result of the effort to minimize loading on the affected leg by shortening the swing phase of the unaffected leg. Case 1 scored similar phase ratios, cadence and walking velocity to the normal group. A slight posterior tilt of the pelvis was observed throughout the gait cycle. Less hip and knee flexion than the normal group was observed, and demonstrated hyperextension of the knee in the terminal stance phase. The main problem in case 1 originated from the insufficient dorsiflexion of the affected foot during the swing phase. Therefore, Case 1 has difficulty with foot clearance in the swing phase. Usually, this is compensated for by using exessive hip abduction and medial rotation in conjuction with trunk elevation as well as increased vortical displacement of the center of mass. Case 1 revealed a foot-flat initial contact pattern. Case 2 was characterized by a consistent retraction ef the affected aide of the body througout the gait cycle, As a result, an asymmetrical gait pattern with increased stance phase ratios of the unaffected side was observed. In spite of this the step lengths of both sieds were similar. Case 2 scored lower cadence and walking speed than the normal group with lower gait stability. The main problem in Case 2 originated from an excessive plantaflexion of the affected foot which, in turn, rebutted in high hip and knee flexion. Hyperextension of the knee was observed at mid-stance, and execessive anterior tilt of the pelvis throughout the gait cycle was noticed. A gait pattern with high hip abduction and medial circumduction was maintained for the stability in the stance phase and foot clearance in the swing phase. Case 2 revealed a forefoot-contact initial contact pattern.

• The Journal of Korean Physical Therapy
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• v.6 no.1
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• pp.49-60
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• 1994

Stress is experienced when a person tries to maintain stability in the face of life change but is not able to meet the adaptive demands of change. This can be especially true for the parents who has a cerebral palsy childs who needs long term rare, where parents, are the primary source of care and responsibility. Successful coping leads to maintenance of the parents role and this has an effect on the health status of the child. This descriptive study was attempted to identify stress factors, levels and helpful coping patterns for parents who must take care of cerebral palsy children. Data were collected from 43 subjects who were parents of children diagnosed with cerebral palsy The informations gathered from March 25, 1994 to April 14, 1994 by means of structured questionnaires were analyzed. Two instruments were used to collect the data 1) Lee's stress questionnaire consisted of 33 stress factors and measured by four point Likert scale. 2) Modified Chronic Health Inventory for parents: The modified CHIP included 43 items of coping methods with four point Likert scale. The results of this study were as follows: 1) Stress items could have a maximum score of three points, for a total possible score of 132 points. The mean score for the total was 92.02 points. The item mean score was 2.85 points showing that the parents were experiencing moderate to much stress. 2) The items with the highest stress items were 16 items. The stress items with the lowest mean scores were 10 items. 3) Of the stress categories: The highest stress category was related to changes in the illness status of the child and difficulty in taking rare of the child. The second stressful category was related to the prognosis of the child's condition. The least stress was noticed to social-personal relationships and the responsibility of the care givers. 4) Items measuring coping in the parents had a maximum score of three points each with a total possible roping score of 172 points. The mean score for the total was 103,9 paints. The item mean score was 2.42 points indicating that there were responses of little helpful to moderately helpful on each coping pattern. 5) The most helpful coping items were 7 items. The least helpful coping items were 2 items. 6) Effectiveness of the coping for each patterns was examined : Understanding the illness condition from communication with parents of children with the same condition and consultation with the medical team was the most helpful coping pattern. Family's coorperation and integration and optimism were a moderately helpful coping pattern. Social support psychological stability and self esteem were the least helpful toping pattern. In conclusion, the highest stress for parents of children with cerebropalsy was found to be very stressful changes in the illness of the child and to taking care of a child who is suffering. The parents were helped by the coping methods using understanding of the illness condition through consultation with the medical learn and communication with parents in the same situation. Based on the knowledge, care could develop intervention strategies appropriate for them, help them to develop their effective coping patterns, and give support them in the process of coping with their stress.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.174-180
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• 2002

Purpose: Ursodeoxycholic acid (UDCA) is known to decrease hepatic injury by promoting the biliary secretion of retained toxic endogenous bile acids in hepatobiliary diseases complicated by total parenteral nutrition (TPN). However, most studies have focused on treatment for complications after TPN. We investigated the preventive role of early administration of UDCA in TPN-induced hepatobiliary complications by a randomized, double-blind, placebo-controlled trial. Methods: Between May 2000 and May 2002, thirteen patients, who were given TPN more than 10 days in the hospital, were assigned randomly to two groups. One was the case group (7 patients) who were given UDCA simultaneously with TPN regimen, and the other, the control group (6 patients) who were given placebo. Their age ranged from 1 day to 13 years. They were affected with diseases impossible for enteral nutrition, such as prematurity, cerebral palsy, chronic diarrhea, anorexia nervosa, pancreatitis, and cyclic vomiting. The duration of TPN ranged from 10 to 70 days. Hematologic parameters including liver function test were measured at regular intervals, and the duration, composition, administration rate, total calorie of TPN were recorded. The serum levels of total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were compared between groups after cessation of the study. Results: The autoregressive coefficient of the control group was 0.4419 (p=0.0651) in bilirubin, -0.0431 (p=0.7923) in AST, 0.2398 (p=0.2416) in ALT, and 0.2459 (p=0.1922) in alkaline phosphatase by mixed procedure model when the parameters were referred to the case group. Conclusion: The serum level of total bilirubin did not increase in comparison with that of the control group, but statistically insignificant, when both TPN and UDCA were administered simultaneously from the beginning.

• Child Health Nursing Research
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• v.2 no.1
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• pp.93-111
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• 1996

The purpose of the study is to identify the lived experience of mothers who have children with cerebral palsy in order to understand their agony. Moreover, the result of study was to find some nursing intervention for disabled children and their mothers. For this purpose, ten mothers who are willing to cooperate with this research were selected at random from those who have children with the cerebral palsy, currently using the municipal facilities for the handicapped with cerebral malfunction. Data collection was done from October 4, 1994 th December 31, 1994. The data were collected by asking the mothers mentioned above with some unstructured open-ended questions, recorded on the tapes with permission by the interviewee in order to prevent missing of the interviewed contents. These collected data have been substantiated and properly analyzed on the basis of phenomenological approach initiated by Colaizzi's method. The results and validity are proved to be credible by means of the individual checking of the interviewed mothers. The results of this study are as follows : 1. When the mother is first informed of the diagnosis of cerebral palsy on her child, she usually misses the crucial timing needed for proper treatment of the child's disorder because she is notified through the doctor's indifference and his apparently inactive, matter-of-fact attitude. At first she suspects the doctor's diagnosis and tries to attribute it to the unknown cause from a certain genetic problem and then she quickly wants to deny the whole situation that her child is really suffering from the cerebral palsy. The reality is too much for her to accept as it is and she would not believe her child is abnormal. Therefore, she even attempts depend on the power of God for its solution. 2. The mother, who goes thorough this kind of uncommon experiences, is totally devoted to the treatment and care of the child and completely ignores her own life and happiness. At the same time, she feels sorry for her other normal children she believes having not enough care and concern. Also, she feels sorry for the sick child when the child's brothers or sisters show special concern for the patient out of sympathy. It is sorry and not satisfied for her that the child is growing with abnormality and neighbor other around have inappropriate attitudes. Likewise, she is discontent with her husband's lack of concern about the child's treatment. She believes that the health care system in this society isn't fulfilling its due purpose. In the state of her utmost distress and anxiety, she always feels the need of competent consultants, and is angry about that her child is treated as an abnormal being, she is trying to hide the child from other people and to make him or her disappear, if possible. Although she doesn't have harmonious relation with her husband, she id happy when he shows his affection for the child and she feels relieved and thankful when the relatives don't mention about the child's condition Since the child's overall status of health is continuously in unstable conditions, requiring her all-time readiness for an emergency, she feels guilty of her child's illness toward the fEmily members as if it was her own fault to have borne such an abnormal child and she feels responsible for the child morally and financially if necessary Because her life is centered on taking care of the child, she cannot afford to enjoy her own life and happiness. She is a lonely mother, fatigued, with no proper relationship with other people around her. With this sense of guilt and responsibility as a mother of an unusual disease, she has no choice but to grieve her destiny from which she is not allowed to escape. 3. Nevertheless, the mother with the child suffering from the cerebral palsy does not easily give up the hope of getting her child cured and she believes that in the long run, though slower than hoped, her abnormal son or daughter will be eventually cured to become a normal sibling someday. This kind of hope is sustained by the mother's strong faith coming from observing the progress of other similar children getting better. Sometimes she is encouraged to have this faith by other mothers who share the same painful experiences, believing that her child will improve even more rapidly than others with the same palsy. Full of hope, she painstakingly waits for the child's healing. Moreover, she plans to have another child. she thinks that the patient child's brothers and sisters only can truly understand and look after the patients. However, when she notices that the progress of other children under the treatment does not look so hopeful, she is distressed by the thoughts that her child may never get well. Too, she is worried that the patient's brother or sister will be born as the same invalid with the cerebral disease. She is discouraged to have another baby as much as she is encouraged to. She is also troubled by the thought that in case she has another baby, she will have to be forced. to neglect the patient child, especially when she does have an extra hand or some reliable person to help her with taking care of the patient.