• Archives of Plastic Surgery
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• 제34권3호
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• pp.325-329
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• 2007

Purpose: Mobius syndrome is a rare congenital disorder characterized by facial diplegia and bilateral abducens palsy, which occasionally combines with other cranial nerve dysfunction. The inability to show happiness, sadness or anger by facial expression frequently results in social dysfunction. The classic concept of cross facial nerve grafting and free muscle transplantation, which is standard in unilateral developmental facial palsy, cannot be used in these patients without special consideration. Our experience in the treatment of three patients with this syndrome using transfer of muscles innervated by trigeminal nerve showed rewarding results. Methods: We used bilateral temporalis muscle elevated from the bony temporal fossa. Muscles and their attached fascia were folded down over the anterior surface of the zygomatic arch. The divided strips from the attached fascia were passed subcutaneously and anchored to the medial canthus and the nasolabial crease for smiling and competence of mouth and eyelids. For the recent 13 years the authors applied this method in 3 Mobius syndrome cases- 45 year-old man and 13 year-old boy, 8 year-old girl. Results: One month after the surgery the patients had good support and already showed voluntary movement at the corner of their mouth. They showed full closure of both eyelids. There was no scleral showing during eyelid closure. Also full closure of the mouth was achieved. After six months, the reconstructed movements of face were maintained. Conclusion: Temporalis muscle transfer for Mobius syndrome is an excellent method for bilateral reconstruction at one stage, is easy to perform, and has a wide range of reconstruction and reproducibility.

• 한국전문물리치료학회지
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• 제24권1호
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• pp.41-50
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• 2017

Background: The Pediatric Balance Scale (PBS) was developed to assess of balance ability in children with balance problem. The PBS was translated into Korean and its reliability had been studied. However, it had need to be verified using psychometric characteristics including item fit and rating scale. Objects: The purpose of this study was to investigate the item fit, item difficulty, and rating scale of the Korean version of PBS using Rasch analysis. Methods: In total, 40 children with cerebral palsy (CP) (boy=17, girl=23) who were diagnosed with level 1 or 2 according to the Gross Motor Function Classification System participated in this study. The PBS was performed, and was verified regarding the item fit, item difficulty, rating scale, and separation index and reliability using Rasch analysis. Results: In this study, the 'transfer', and 'turning to look behind left and right shoulders while standing still' item showed misfit statistics. in total 40 children with CP. Also, 'transfer', 'standing unsupported with feet together' and 'standing with one foot in front' items showed misfit statistics in diplegia CP group. Regardless of the classification of CP, the most difficult item was 'standing on one foot', whereas the easiest item was 'sitting with back unsupported and feet supported on the floor'. The 4 rating scale categories of PBS were acceptable with all criteria. Both item and person separation indices and reliability showed acceptable values. Conclusion: The PBS has been proven reliable, valid and is an appropriate tool, but it needs to modify the items of PBS according to CP classification.

• 한국전문물리치료학회지
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• 제24권2호
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• pp.58-65
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• 2017

Background: Children with cerebral palsy (CP) have impaired postural control, but critically require the control of stability. Consequently, therapeutic interventions for enhancing postural control in children with CP have undergone extensive research. One intervention is sensorimotor training (SMT) using a Flexi-bar, but this has not previously been studied with respect to targeting trunk control in children with CP. Objects: This study was conducted to determine the effect of SMT using a Flexi-bar on postural balance and gait performance in children with CP. Methods: Three children with ambulatory spastic diplegia (SD) participated in the SMT program by using a Flexi-bar for forty minutes per day, three times a week, for six weeks. Outcome variables included the pediatric balance scale (PBS), trunk control movement scale (TCMS), 10 meter walking test (10MWT), and 3-dimensional movement coordination measurement. Results: The SMT provided no statistically significant improvement in PBS, TCMS, 10MWT, or 3-dimensional movement coordination measurement. However, positive changes were observed in individual outcomes, as balance and trunk control movement were improved. Conclusion: SMT using a Flexi-bar may be considered by clinicians as a potential intervention for increasing postural balance and performance in children with SD. Future studies are necessary to confirm the efficacy of Flexi-bar exercise in improving the functional activity of subjects with SD.

• 혜화의학회지
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• 제9권1호
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• pp.469-501
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• 2000

In the literature study on the cerebral palsy, the results were as follows : 1. Cerebral palsy is defined as a disorder of movement and posture due to a defect or lesion of the immature brain. For practical purposes it is useful to exclude from cerebral palsy those disorders of posture and movement which are of short duration, due to a progressive disease due solely to mental deficiency. 2. Cerebral Palsy is classified with quadriplegia, diplegia, hemi plegia, triplegia, and monoplegia or spastic CP, athetoid CP, ataxic CP, and combined classifications 3. Causes of Cerebral Palsy is any damage to the developing brain, whether caused by genetic or developmental disorders. And it is classified with prenatal.natal and postnatal causes. 4. Management consists of helping the child achieve maximum potential in growth and development. This should be started as early as possible with identification of the very young child who may have a developmental disorder. Certain medications, surgery, and braces may be used to improve nerve and muscle coordination and prevent dysfunction. 5. The aim of treatment is to encourage children and adults to learn to be as independent as possible. Some children and adults who have mild cerebral palsy will have no problems in achieving independence 6. Oji(五遲), Oyeon(五軟) and Okyeong(五硬) have the simmiar concepts with the cerebral palsy. 7. Oji(五遲) Oyeon(五軟) and Okyeong(五硬) are caused by seoncheon-pumbu-bujok(先天稟賦不足) and related with gan(肝), bi(脾) and sin(腎). 8. The treatment is achieved by the method of bogansin(補肝腎), ganggeungol(强筋骨) and boiungikki(補中益氣). And jihwanghwan(地黃丸) has been used most frequently.

• 혜화의학회지
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• 제9권1호
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• pp.661-689
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• 2000

We came to the conculsion after considering all of information from many kinds of books on the cause, pathogenesis and treatment of Flaccidity-syndrome. The results were as follows : 1. Flaccidity-syndrome means limb-relaxation due to muscle atony that isn't able to constraction. It's begun as mild degree from extremities, in some cases ended to quadriplegia or expire. 2. Cause factor and pathogenesis of Flaccidity-syndrome is various. After Lung fluid consuption caused by heat-evil was refered in The Yellow Emperor's Canon of Internal Medicine. They were refered as cause factor that Main channel asthenia, excess of sexual intercourse, wetness-evil, heat-evil gets into the interior, asthenia of the spleen and stomach. Since Ming Dynasty, It's classified to wetness-heat evil, wetness-phlegm, deficiency of vital energy, deficiency of blood, deficiency of yin, blood stasis and indygestion, etc. 3. In the view of treatment of Flaccidity-syndrome, Yangming was selected in The Yellow Emperor's Canon of Internal Medicine, and it's been mean to clear away wetness-heat evil located at Yangming. In the method of acupuncture it was same on the base, and many skills have been used that electronic acupuncture, point-injection theraphy, acupuncture point block, catgut implantaion at acupuncture point, cutaneous acupuncture, auriculo-acupuncture and head acupuncture by the through post generation. 4. Flaccidity-syndrome was defined to weak, disuse and non-pain. Beacause it was non-pain, so medicine to expel wind-evil was prevented to use. But through post generation Flaccidity-syndrome has been treated that is able to cause pain or numness as arthralgia-syndrome. Therefore there is tendency that medicine to expel wind-evil is capable within pathological basement of Flaccidity-syndrome in recent. 5. In the view of west-medicine, Flaccidity-syndrome is diplegia or quadriplegia with sensory disorder, muscle atropy in some cases. And there are spinal disease, peripheral nerve disease, muscular disease, nerve-muscle copula disease. The symptoms are able to amyotomia, numness, sensory disorder, pain.

• 대한물리의학회지
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• 제7권3호
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• pp.357-365
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• 2012

Purpose : The present study has been performed to find the effects on gross motor function and balance ability of applying a balance exercise program consisting of motions able to stimulate balance-related sensory systems on various support surfaces along with goal-oriented upper extremity tasks to enhance the balance ability. Methods : 10children diagnosed as having spastic diplegia were selected as the subject for this study, of whom 5children were randomly assigned to a control group (CG) and the remainder to a balance exercise group (BEG) to perform the upper extremity task on various support surfaces. Each intervention was executed 30minutes per session with 2sessions a week for 12weeks. To make comparisons before and after intervention, gross motor function measure; standing; demention D(GMFM;D), walking/running/jumping ;demention E (GMFM;E) and pediatric balance scale (PBS) were evaluated. Results : The CG showed a significant difference (p<.05) in GMFM;E. BEG showed a significant difference (p<.05) in GMFM;D as well as GMFM;E and in PBS before and after intervention. BEG showed a significant improvement (p<.05) in GMFM;D and the PBS compared with the CG whereas it did not indicate any statistically significant difference in GMFM;E. Conclusion : According to the results of this study, it has been shown that a balance exercise accompanied by upper extremity task on various support surfaces had an effect on improvement in the gross motor function and the balance ability of children with spastic diplegic cerebral palsy.

• 대한감각통합치료학회지
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• 제9권2호
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• pp.15-28
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• 2011

목적 : 본 연구는 뇌성마비 아동에게 감각통합치료를 적용한 후 자기조절 행동에 미치는 효과를 알아보고자 하였다. 연구방법 : 연구대상은 P시에 거주하는 4세의 여아와 6세의 남아로 양하지 뇌성마비로 진단받았다. 본 연구는 단일대상 연구 중 ABA'를 사용하였고, 자기조절 행동을 측정하기 위해 문제 행동에 대한 조작적 정의를 한 후 자유놀이와 중재 후 디지털 카메라로 10분간 녹화하여 문제 행동이 발생할 때마다 체크하여 총발생빈도를 분석하였다. 실험과정은 2010년 12월 1일부터 2011년 2월 26일까지 약 12주가 총 22회기를 실시하였다. 기초선 기간(A) 6회, 중재 기간(B) 14회, 유지 기간(A') 2회로 총 22회기를 실시하였다. 기초선 기간과 유지 기간은 감각통합치료를 하지 않았으며, 중재 기간에는 전정 및 고유수용성 감각처리를 중심으로 한 감각통합치료를 30분간 실시하였다. 결과 : 아동의 자기조절 행동 3개의 빈도수가 기초선 기간과 비교하여 중재기간에 대부분 2표준편차 이상으로 감소되었으며 유지기간에도 유지되었다. 결론 : 자기조절 행동의 변화를 알아보기 위해 평가한 행동 빈도수의 총 평균이 감소되었으며 감각통합치료가 뇌성마비아동의 자기조절 행동에 도움을 주는 것으로 나타났다.

• Clinical and Experimental Pediatrics
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• 제49권5호
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• pp.529-532
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• 2006

목 적 : 뇌성마비는 뇌의 여러 가지 원인에 의해 뇌에 발생한 비진행성 손상으로, 이러한 뇌성마비를 가진 환아의 간질 발생 빈도는 15-90%로 다양하게 나타난다. 이렇게 뇌성마비와 간질이 중복 되서 나타나는 경우에 심각한 중복 장애를 남길 수 있다. 따라서 뇌성마비아 중 간질의 발생아와 비발생아의 특징을 비교하여 장기적인 진료 및 예후의 지표를 삼고자 하였다. 방 법 : 1995년부터 2004년까지 9년간 경희의료원 소아과 외래에서 뇌성마비로 진단받고 추적관찰이 가능하였던 93명을 대상으로 조사하였으며, 이들의 뇌성마비를 분류하고, 간질의 형태와 발병 당시의 나이, 뇌영상소견과 뇌파 소견을 비교하였다. 결 과 : 뇌성마비에서의 간질의 유병률은 93명 중 43명으로 46.2%이었으며, 발작의 초 발 연령은 평균 21.5개월로 1세 미만에서 발생한 경우가 21례(48.8%)로 가장 많았고, 1세 미만에서는 영아 연축과 근간대성 발작의 빈도가 의미 있게 높았으며, 전체적으로는 강직성-간대성 발작이 44.2%로 가장 많이 나타났다. 뇌영상소견에서 가장 많이 동반된 이상은 뇌 피질 위축으로 간질 발생군과 비간질 발생군에서 각각 22례(23.6%)와 12례(12.1%)였으며, 뇌파 소견에서는 간질 발생아의 전례에서 이상 소견을 보였다. 결 론 : 뇌성마비아에서 간질이 동반된 경우 어린 나이에 발생하는 경우가 많았으며, 간질의 형태로는 전신성 간대성-강직성 발작이 가장 많았다. 또한 뇌 영상검사와 뇌파검사에서 뇌성마비아 중 간질 발생아와 비간질 발생아에서 의미 있는 빈도 차이를 보여 조기 진단에 도움을 줄 것으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제45권4호
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• pp.512-518
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• 2002

목 적: 저자들은 뇌성마비의 임상양상과 원인인자를 관찰함으로써 본질환의 원활한 진단과 치료에 도움이 되고자 본 연구를 시행하였다. 방 법: 운동발달 지연이나 자세이상으로 성분도병원 소아과를 방문하여 뇌성마비로 진단 받고 부설 소아물리치료실에서 추적 관찰한 103명의 환아를 대상으로 후향적인 연구를 통하여 뇌성마비 환아의 생리적 분류와 고위험요인 및 뇌단층 또는 뇌자기공명영상의 결과 등을 분석하였다. 결 과 : 1) 총 103명의 환아들 중 남아가 64명, 여아가 39명이었다. 2) 뇌성마비 환아들 중 미숙아 출생이 59명, 만삭아 출생이 44명이었다. 3) 대상 환아 103명의 생리적 국소학적 분류에서는 경직성 반신마비가 55례(53.4%)로 가장 많았다. 4) 대상 환아의 위험인자로 산전인자는 전치태반 1례(0.9%), 태반조기박리 1례(0.9%), 거대세포 바이러스 감염 1례(0.9%)였다. 주산기 인자는 미숙아 출생이 59례(52.2%), 신생아 가사 12례(10.6%), 난산 2례(1.7%), 다태임신 5례(5.5%), 둔위분만 1례(0.9%)였다. 산후인자는 두부 외상 3례(2.7%), 뇌막염 2례(1.8%)였으며, 총 103명의 환아들 중 원인을 모르는 경우도 26례(23%)였다. 5) 대상 환아의 뇌단층촬영 및 뇌자기공명영상 소견은 미숙아군 59례 중 55례에서 관찰한 결과 37례(62.7%)에서 뇌실주위연화증이 가장 많았고 정상소견도 6례(10.2%)였다. 만삭아군은 44례 중 33례에서 관찰한 결과 뇌위축이 15례(41.7%)로 가장 많았고, 정상소견을 보인 경우도 6례(13.6%)였다. 6) 대상 환아 103명 중 29례(28.2%)에서 경련을 동반하였다. 결 론: 최근의 뇌성마비 원인인자와 임상양상 등 그 특징을 이해함으로써 뇌성마비의 진단과 치료에 도움이 될 것으로 사료된다.

• 대한감각통합치료학회지
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• 제14권2호
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• pp.46-57
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• 2016

목적 : 뇌성마비 아동의 자세조절을 향상시키기 위해 국내에서 사용되는 운동 중재의 방법과 효과를 알아보기 위해 체계적 고찰을 사용하여 근거를 제시하고자 하였다. 연구방법 : 누리미디어(DBpia), 학술연구정보서비스(RISS) 그리고 한국학술정보(KISS)의 데이터베이스를 사용하여 2006년 10월 이후로 게재된 국내학회지를 검색하였다. '뇌성마비', '자세조절', '균형'를 키워드로 검색하여 총 18개의 연구가 연구대상으로 선정되었다. 각 연구는 근거의 질적 수준과 방법론적 질적 수준으로 분석하였고 그 결과는 대상자, 중재, 대조군, 결과에 따라 Patient, Intervention, Comparison, Outcome(PICO)로 분석하였다. 결과 : 본 연구의 분석에 사용된 연구의 근거수준은 수준 I이 8개, 수준 III이 5개, 수준 IV가 2개, 수준 V가 3개이었고, 방법론적 질적 수준은 '우수'의 연구가 가장 많았다. 대상자는 경직형 양하지 마비, 실험설계는 무작위 대조군 실험 연구가 가장 많았다. 분석결과 국내에서 사용되는 자세조절 운동 중재는 뇌성마비 아동의 운동능력과 균형능력 향상에 긍정적인 영향을 보였다. 결론 : 국내에서 사용되는 운동 중재는 뇌성마비 아동의 자세조절 능력을 향상시켰다. 앞으로 뇌성마비 아동의 유형별 자세조절 향상을 위한 연구가 이루어져야 할 것이다.