뇌성마비 아동의 형제자매에서 나타나는 정서와 사회성 발달

남지현,김성우,신정빈,유성,이선경,김영기,노정숙 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.2

Objective: To investigate the psychological development such as emotional and social aspects of typically developing siblings of children with cerebral palsy. Method: Eighteen siblings of children with cerebral palsy aged 5 to 12 years and their mothers were included and the interview and psychological assessment were administered by developmental psychologist. All children were asked to complete the Children's Depression Inventory (CDI), State- Trait Anxiety Inventory (STAI), Piers-Harris Children’s Self- Concept Scale, Korea Child Behavior Checklist and Korean Educational Developmental Institute-Wechsler Intelligence Scale for Children (KEDI-WISC). All participating mother were asked to complete Minnesota Multiphasic Personality Inventory (MMPI), Beck's Depression Inventory (BDI). For control group, eighteen children with healthy sibling and their mothers were enrolled. Results: Siblings of children with cerebral palsy showed higher mean score of CDI and STAI. And there were no differences in the CDI and STAI according to frequency of treatment, duration of treatment of children with cerebral palsy. There were no significant difference in Piers-Harris children’s Self-Concept Scale and Korea Child Behavior Checklist between study group and control group. More than half of mothers of children with cerebral palsy showed depression in BDI and higher score of psychopathic Deviate and psychasthenia in MMPI. Children of mothers with depression in BDI showed higher mean score of CDI and STAI. Conclusion: It is necessary to consider extended service to promote psychosocial well-being of children with cerebral palsy and siblings in community-based service organizations. Objective: To investigate the psychological development such as emotional and social aspects of typically developing siblings of children with cerebral palsy. Method: Eighteen siblings of children with cerebral palsy aged 5 to 12 years and their mothers were included and the interview and psychological assessment were administered by developmental psychologist. All children were asked to complete the Children's Depression Inventory (CDI), State- Trait Anxiety Inventory (STAI), Piers-Harris Children’s Self- Concept Scale, Korea Child Behavior Checklist and Korean Educational Developmental Institute-Wechsler Intelligence Scale for Children (KEDI-WISC). All participating mother were asked to complete Minnesota Multiphasic Personality Inventory (MMPI), Beck's Depression Inventory (BDI). For control group, eighteen children with healthy sibling and their mothers were enrolled. Results: Siblings of children with cerebral palsy showed higher mean score of CDI and STAI. And there were no differences in the CDI and STAI according to frequency of treatment, duration of treatment of children with cerebral palsy. There were no significant difference in Piers-Harris children’s Self-Concept Scale and Korea Child Behavior Checklist between study group and control group. More than half of mothers of children with cerebral palsy showed depression in BDI and higher score of psychopathic Deviate and psychasthenia in MMPI. Children of mothers with depression in BDI showed higher mean score of CDI and STAI. Conclusion: It is necessary to consider extended service to promote psychosocial well-being of children with cerebral palsy and siblings in community-based service organizations.

발달장애 환아의 진단을 위한 임상적 특징과 뇌영상 촬영의 진단적 의의

오광수(Kwang-So Oh) 대한소아신경학회 2000 대한소아신경학회지 Vol.8 No.2

목적 : 발달장애 환아를 조기에 발견하는 것은 교육이나 재활치료를 빨리 시행함으로써 장애의 정도를 최소화하고 사회에 적응을 빨리 시킬 수 있는 장점이 있다. 그러나 영, 유아 초기에는 발달 장애의 증상 및 징후가 분명치 않고 중추신경계의 전반적인 기능부전의 공통된 증상을 보이므로 진단이 쉽지 않다. 발달장애 환아의 조기 진단을 위해 시행하는 여러 가지 검사나 임상적인 특징이 진단적 의의가 있는지를 연구함으로써 환아의 조기진단과 치료에 도움을 주고자 본 연구를 시행하였다. 방법 : 1992년 5월부터 2000년 5월까지 8년 동안 본원 소아과에 발달장애를 주소로 내원한 환아 96명을 대상으로 시행한 뇌자기공명영상촬영, 신경학적 및 발달선별검사, 뇌간 청각유발전위 및 시각유발전위검사, 뇌파검사, 혈액검사, 염색체 검사, 임상심리검사와 환아의 출생 기왕력, 두위측정 등의 결과를 후향적으로 분석하여 발달장애 환아에서 각 질환별로 임상적인 특징과 검사소견을 비교하고 검사 방법들의 진단적 의의를 분석하였다. 결과 : 전체 환아 96명 중 남녀비는 1.5:1로 남아가 많았고, 진단시 평균연령은 33.9±30.1개월이었다. 진단별 분류는 뇌성마비(41.7%), 미세 뇌기능장애(17.7%), 발달성 언어장애(14.6%), 자폐증(13.5%), 정신지체 및 청력장애(12.5%)의 분포를 보였다. 발달성 언어장애 환아 14례 중 13례에서 정상 만삭 분만하였고 뇌 MRT는 11례 중 1례에서 이상소견을 보였으며 뇌파검사 5례 모두 정상소견을 보였다. 청각유발전위 검사는 9례 중 3례(33.4%)에서 이상 소견을 보였고 이중 2례는 반복성 중이염 환아였다. 미세 뇌기능장애 환아 17례 중 3례에서 출생시 자궁내발육부진, 2례에서 미숙아 출생력을 가지고 있었다. MRI는 15례 중 5례(33.4 %)에서 이상소견을 보였고, 뇌파검사 10례 중 6례(60.0%)에서 이상소견을 보였으며 이중 5례는 간질을 동반하였다. 소두증은 17례 중 7례(41.2%)에서 나타내고, 청각유발전위검사는 2례에서 시행하여 모두 일측성 이상 소견을 보였다. 정신지체환아 및 청력장애 환아 12례 중 5례(41.7%)에서 소두증을 보였으며 청각유발전위검사는 8례에서 시행하여 4례(50%)에서 이상소견을 보였다. 뇌 MRI는 9례에서 시행하여 3례(33.4%)에서 이상 소견을 보였다. 자폐아동 13례의 출생력은 과거력을 알 수 없는 1례를 제외한 12례 모두 정상 분만하였으며 소두증은 4례(30.8%)였다. 뇌 MRI는 12례에서 시행하여 간질을 동반한 1례에서 해마경화증 소견을 보였으며 나머지 11례 모두 정상 소견을 보였다. 청각유발전위검사는 9례에서 시행하여 2례(22.3%)에서 이상 소견을 보였다. 간질은 4례(30.8%)에서 동반되었다. 뇌성마비 환아 40례 중 16례(40%)가 미숙아이었고 주산기 가사증은 10례(25%)이었다. 뇌성마비의 형태별 분류는 강직성 하지마비가 15례(37.5%)로 가장 많았으며 강직성 사지마비 12례, 편측마비 6례, 혼합형 4례, 아테토이드형 3례순 이었다. 뇌 MRl 소견은 40례 중 36례(90%)에서 이상 소견을 보였고 뇌실주위백질연화증 15례(37.5%)로 가장 많았다. 청각유발전위검사는 15례에서 시행하여 6례(40%)에서 이상 소견을 보였다. 소두증은 40명 중 24례(60%)에서 나타났다. 경련성 질환은 14례(35%)에서 동반이 되었고 뇌파검사는 68.9%에서 이상 소견을 보였다. 최종진단에 따른임상적 특징과 검사방법들의 진단적 의의에 대한 결과는 뇌 MRI 소견은 뇌성마비와 다른 발달장애 환아의 감별진단에 의의가 있었으며(P<0.001), 뇌파검사와 두위측정의 소견은 뇌성마비와 발달성언어장애 환아의 진단에 통계적인 의의가 있었다(P<0.05). 재태연령의 소견은 뇌성마비와 자폐증 아동의 진단에 통계적인 의의를 보였다(P<0.01). 청각유발검사와 염색체 검사는 대상환아 수가 적어 통계적인 의미를 가지지 못했다. 결론 : 발달장애 환아의 분류와 빈도는 뇌성마비, 미세 뇌기능장애, 발달성 언어장애, 자폐증, 지능장애의 순이었으며, 진단을 위해 뇌 MRI는 뇌성마비와 다른 발달장애의 비교를 위해, 뇌파검사와 두위측정은 뇌성마비와 발달성 언어장애, 출산력은 뇌성마비와 자폐아동 간에 통계적으로 유의한 차이점을 보여주어 진단에 도움을 주었다. Purpose: In order to identify developmental disability and help the patients earlier, the diagnostic significance of clinical characteristics and neuroimaging findings for diagnosis of children with developmental delay was studied. Methods:The clinical records and diagnostic procedures including head size, gestational age, Denver developmental screening test, brain MRI, EEG, brainstem auditory evoked potential(BAEP), chromosomal karyotyping, and final diagnosis of 96 patients with developmental delay were retrospectively reviewed. Results: The final diagnosis of 96 children with developmental disability were cerebral palsy(41.7%), minimal cerebral dysfunction(17.7%), developmental language disorder(14.6%), autism(13.5%), and mental retardation with or without hearing impairment(12.5%), in order of frequency. Of the 40 cases with cerebral palsy, 36 cases(90%) had abnormal MRI. There was a significant difference between cerebral palsy and the others of developmental disabilities in MRI abnormality. Of the 55 EEGs, abnormal findings was shown in 26 cases(68.9%). All of the 5 patients with developmental language disorders had normal EEG, and 20 cases(68.9%) of the 29 patients with cerebral palsy showed abnormal EEG. There was a significant difference between cerebral palsy and developmental language disorder in EEG. Prematurity was in 22 cases(22.9%) of 96 patients, 16 cases(40%) in cerebral palsy, and none in autism. There was a significant difference between cerebral palsy and autism in gestational age. Microcephaly was present in 42 cases(43.7%) among 96 patients, and 2 cases(14.3%) in developmental language disorder, 24 cases(60%) in cerebral palsy. There was a significant difference between cerebral palsy and developmental language disorder in head circumference. Conclusion: There was a diagnostic significant difference of head circumference and EEG, gestational age, and brain MRI for comparison of patients with cerebral palsy and developmental language disorder, cerebral palsy and autism, and cerebral palsy and the other developmental disabilities, respectively.

The Relationship between Degree of Stress and Quality of Life in Mothers of Children with Cerebral Palsy

윤미정,이완희,이재섭 대한물리치료학회 2012 대한물리치료학회지 Vol.24 No.3

Purpose: This study investigated the relationship between degree of stress and quality of life in mothers of children with cerebral palsy. Methods: This study’s subjects were 77 mothers of children under 10 years of age with cerebral palsy. The instrument is a self-administered, structured, written questionnaire. The tool that measured the degree of stress was created by modifying the questionnaire by Park (2004). Quality of life for all mothers with cerebral palsy was evaluated by the ShortForm-36 Health Questionnaire. To verify the effects on degree of stress and quality of life arising from general characteristics, t-tests and ANOVAs were conducted. The correlation between degree of stress and quality of life was analyzed via Pearson’s correlation analysis. Results: The mothers’ degree of stress was rated as 2.69 out of 5; their quality of life was rated as 53.07 out of 100. There was a significant negative correlation between quality of life and the age of cerebral palsy and positive correlations between quality of life and mother’s age, background, and family income. Degree of stress among mothers has a positive correlation with quality of life. Conclusion: This study provides basic data about the relationship between degree of stress and quality of life in mothers of children with cerebral palsy. Purpose: This study investigated the relationship between degree of stress and quality of life in mothers of children with cerebral palsy. Methods: This study’s subjects were 77 mothers of children under 10 years of age with cerebral palsy. The instrument is a self-administered, structured, written questionnaire. The tool that measured the degree of stress was created by modifying the questionnaire by Park (2004). Quality of life for all mothers with cerebral palsy was evaluated by the ShortForm-36 Health Questionnaire. To verify the effects on degree of stress and quality of life arising from general characteristics, t-tests and ANOVAs were conducted. The correlation between degree of stress and quality of life was analyzed via Pearson’s correlation analysis. Results: The mothers’ degree of stress was rated as 2.69 out of 5; their quality of life was rated as 53.07 out of 100. There was a significant negative correlation between quality of life and the age of cerebral palsy and positive correlations between quality of life and mother’s age, background, and family income. Degree of stress among mothers has a positive correlation with quality of life. Conclusion: This study provides basic data about the relationship between degree of stress and quality of life in mothers of children with cerebral palsy.

Overview of Physical Therapy for Children with Cerebral Palsy

Tae- young Oh 대한신경치료학회 2019 신경치료 Vol.23 No.1

Purpose This study was to find out proper concept and intervention to treat in physical therapist’ s perspective according to recognize the changing definition of cerebral palsy, and to investigate the several classification and intervention for children with cerebral palsy. Methods The electronic journal site was searched by terms "cerebral palsy", "intervention", physical therapy”. We analyzed and descript the total 24 cited articles from 9 articles in Science Direct, and 16 articles in K-RISS from 20 Oct. 2018 to 7 Jan. 2019. Results Later definition of cerebral palsy emphasized secondary musculoskeletal problem over time in children with cerebral palsy. In early definition emphasized person’s function or neurological disability. Prevalence rate of cerebral palsy were 6~8% from perinatal asphyxia, the overall prevalence of cerebral palsy has remained constant in recent years despite increased survival of at-risk preterm infants. Gross Motor Function Classification System (GMFCS) has been widely employed internationally to group individuals with cerebral palsy into one of five levels based on functional mobility or activity limitation. The treatment must be goal oriented, such as to assist with mobility, reduce or prevent contractures, improve positioning and hygiene, and provided comfort. Each member of the child’s multidisciplinary team, including the child and both parents, should participate in the serial evaluation and treatment planning. Conclusion We found that the definition of cerebral palsy is changing to focus on secondary problem over time and the children with cerebral palsy is best cared for with an individualized treatment plan that provides a combination of interventions.

뇌성마비의 경중도와 유형에 따른 골밀도와 골교체의 생화학적 표지자

김희상,이인성,안경회 大韓再活醫學會 1999 Annals of Rehabilitation Medicine Vol.23 No.2

미숙아의 뇌실주위 백질연화증과 뇌성마비의 연관성에 대한 연구

한태륜,방문석,임재영,윤보현,김인원 大韓再活醫學會 1997 Annals of Rehabilitation Medicine Vol.21 No.5

뇌성마비아동의 학습양식 특성

김은라,박재국 한국특수교육학회 2014 특수교육학연구 Vol.48 No.4

본 연구는 뇌성마비아동과 일반아동의 학습양식 특성과 뇌성마비아동의 성별 및 장애유형에 따른 학습양식 특성을 탐색하고자 하였다. 이를 위하여 뇌성마비아동 45명, 일반아동 45명을 대상으로 학습양식검사를 실시하였으며, 이에 따른 결과는 다음과 같다. 뇌성마비아동과 일반아동은 학습양식의 하위요인 중 소리, 동기화, 사회성, 이동성에 대한 선호도에서 통계적으로 유의미한 차이가 있는 것으로 나타났다. 뇌성마비아동의 성별에 따른 환경적, 정서적, 사회적, 물리적 요인의 선호도 차이는 나타나지 않았으며 장애유형에 따라 밝기, 학습 자료의 지각, 학습시간에서 통계적으로 유의미한 선호도 차이가 확인되었다. 이러한 연구 결과를 바탕으로 뇌성마비아동의 학업 성취를 향상시키고 학습에 대한 긍정적 태도를 길러 주기 위한 학습활동의 계획과 교육적 중재 제공 시 적극적으로 활용될 수 있을 것이다. While much research has been conducted on learning style in Korea, no study has been done to investigate the learning style of elementary school students with cerebral palsy. Incorporating learning styles information into the curriculum for the students with cerebral palsy is a means of providing differentiated instruction. Therefore, the purpose of this study was to determine whether elementary school students with cerebral palsy display different learning style preferences from non-disabled students and whether there are learning style differences between the male and female with cerebral palsy, spastic and non-spastic cerebral palsy. This study selected 45 elementary school students with cerebral palsy and 45 without disabilities and employed the Learning Style Inventory Primary Version designed by Janet Perrin. The findings of this study indicated that elementary school students with cerebral palsy significantly differed from non-disabled students on the following variables: sound, motivation, sociological, mobility. The study also indicated there were no significant differences in the learning style between the male and female with cerebral palsy. However there were significant differences between the spastic and non-spastic cerebral palsy on the following variables: light, perceptual strengths, time of day. Based on these findings, intervention adapted by learning style preferences of the students with cerebral palsy can be provided.

소아 편마비 환자에서 구속유도 운동치료가 뇌피질 재조합에 미치는 영향

이지인,천경아,변승득 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.4

Objective: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). Method: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. Results: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. Conclusion: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP. Objective: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). Method: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. Results: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. Conclusion: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP.

보완대체 의사소통 활용 상대방 중심 질문하기 중재가 중도 뇌성마비 아동의 의사소통 상호작용에 미치는 효과

김경미,한경임 한국지체.중복.건강장애교육학회 2017 지체.중복.건강장애연구 Vol.60 No.2

Purpose: The purpose of this study was to verify teaching partner-focused questions on communicative competence of a child with cerebral palsy. This study was undertaken with the following goals: (a) investigate the frequency of partner-focused questions of the child with cerebral palsy, (b) investigate the change of partner’s communicative interaction skills, (c) investigate the communicative functions of the child with cerebral palsy, (d) investigate the communicative role of the child with cerebral palsy. Method: The child was seven year old girl with spastic cerebral palsy in a daycare center for children with disabilities. The research method was based on the multiple probe design across settings for a child with cerebral palsy in home, daycare center, and community cafe. An experiment was conducted by providing vocabulary acquisition training and teaching partner-focused questions by using a script for 4 days per week in her daycare center. After videotaping from natural activities with communicative partners for 20 minutes in each settings, researchers collected the data on the frequency of partner-focused questions of the child, the change of communicative interaction skills of communicative partner, the change in communicative function and the change in communicative role of the child. Results: First, teaching partner-focused questions was effective on increasing of partner-focused questions of the child with cerebral palsy. Second, two communication partners, her sister and her teacher used communicative interaction skills but the other partner used a little. Third, while the child with cerebral palsy used partner-focused questions, her communicative functions were varying. Finally, the use of partner-focused questions had a positive effect on initiative communicative role of the child with cerebral palsy. Conclusion: Even though the child with cerebral palsy showed the improvement of communicative functions and roles after teaching partner-focused questions, the improvement was limited in the home. The child did not show an active interest in the interaction with people in other settings. 연구목적: 본 연구의 목적은 AAC를 활용한 상대방중심 질문하기 중재가 중도 뇌성마비 아동의 의사소통 상호작용에 미치는 효과를 알아보는 것이었다. 연구문제는 (a) AAC 사용 중도 뇌성마비 아동의 상대방중심 질문 변화, (b) 의사소통 상대방의 상호작용 기술 사용 변화, (c) AAC 사용 중도 뇌성마비 아동의 의사소통 기능의 변화, (d) AAC 사용 중도 뇌성마비 아동의 의사소통 역할의 변화를 알아보는 것이었다. 연구방법: 본 연구에서는 가정, 어린이집, 지역사회 상황에 대한 상황간 간헐기초선 설계를 사용하였다. 중재는 AAC 상징 어휘 습득과 상대방 중심 질문 중재로 구성되었다. 스크립트와 환경중심 언어중재 전략을 사용하였으며, 연구에 참여한 아동은 7세의 여자 아동으로 장애아전문어린이집에 재학 중이었다. 연구결과: 연구 결과, 첫째, 상대방 중심 질문하기 중재는 AAC 사용 중도 뇌성마비 아동의 상대방 중심 질문 비율을 향상시켰다. 둘째, 가정과 어린이집에서는 의사소통 상대방의 상호작용기술 사용이 많았지만 지역사회 상황에서는 많지 않았다. 셋째, 상대방 중심 질문을 통해 AAC 사용 중도 뇌성마비 아동의 의사소통 기능이 다양해졌다. 넷째, 상대방 중심 질문을 통해 AAC 사용 중도 뇌성마비 아동의 의사소통 역할이 개선되었다. 결론: 상대방 중심 질문 중재 후 AAC 사용 중도 뇌성마비 아동의 의사소통 기능과 역할이 향상되었지만 그것은 가정에 한정되고, 다른 상황에서는 크게 향상되지 않은 것에 대한 논의가 필요하다.

디지털 치료제가 뇌성마비 아동의 균형 및 보행에 미치는 효과 : 체계적 고찰

김정현 대한물리치료과학회 2023 대한물리치료과학회지 Vol.30 No.4

Background: Digital therapeutics are software medical devices that provide evidence-based treatments to prevent, manage, and treat disease. Digital therapies have recently been shown to be effective in motivating children with cerebral palsy as a tool in neuropsychological therapy. Digital therapies improve postural control, balance and gait in children with cerebral palsy. Therefore, this study aims to investigate the effects of digital therapies on balance and gait in children with cerebral palsy and to provide guidelines for prescribing digital therapies for children with cerebral palsy. Design: A Systematic Review Methods: This study searched for English-language articles published in medical journals from January 2000 to July 2023 using PubMed and MEDLINE based on the year of initiation of the digital therapy. The search terms used in the study were 'digital technology' OR 'digital therapeutic' OR 'mobile application' OR 'mobile health' OR 'virtual reality' OR 'game' AND 'cerebral palsy', 'balance' 'gait' as the main keywords. The final article was assigned an evidence level and a Physiotherapy Evidence Database (PEDro) score to assess the quality of clinical trials studies. Results: The digital therapies applied to improve balance and gait in children with cerebral palsy are game-based virtual reality training and the Nintendo Wii Fit program. Both digital therapy interventions had a significant effect on improving balance in children with cerebral palsy, and virtual reality training significantly improved balance and gait. However, there were no significant improvements in balance and gait within two weeks of treatment, regardless of the type of digital intervention. Conclusion: The study suggests that this data will be important in building the evidence base for the effectiveness of digital therapies on balance and gait in children with cerebral palsy and in advancing clinical protocols.