Progress of PTSD symptoms following birth: a prospective study in mothers of high-risk infants.

OBJECTIVE: To understand how postpartum posttraumatic stress disorder (PTSD) symptoms in mothers of high-risk infants progress and identify what factors predict postpartum PTSD. STUDY DESIGN: We prospectively obtained self-reported psychological data from neonatal intensive care unit discharged infants' mothers (NICU mothers) at the infants' corrected ages of 1 (T0), 3 (T1) and 12 months (T2) and mothers of healthy infants (controls). Maternal sociodemographic and infant-related factors were also investigated. RESULT: PTSD was present in 25 and 9% of NICU mothers and controls, respectively. We identified four PTSD patterns: none, persistent, delayed and recovered. The postpartum PTSD course was associated with trait anxiety. Whether the infant was the first child who predicted PTSD at year 1 (adjusted odds ratio=7.62, 95% confidence interval=1.07 to 54.52). CONCLUSION: Mothers of high-risk infants can develop early or late PTSD, and its course can be influenced by factors besides medical status. We therefore recommend regular screenings of postpartum PTSD.

Childhood obesity in ambulatory children and adolescents with spastic cerebral palsy in Korea.

OBJECTIVE: Childhood obesity is an emerging health issue in Korea. We investigated the prevalence of obesity and its trend over time in ambulatory Korean children with CP. METHODS: We retrospectively reviewed the medical records of 1,397 children with CP between 1995 and 2008. The data were grouped into 4 time periods (1995-1997, 1998-2002, 2003-2004 and 2005-2008). The prevalence of obesity over each period and its relationship to gender, birth weight, age, and gross motor function classification system were investigated. RESULTS: The percentage of obese children was 5.8%, overweight children 11.2%, and underweight children 10.4%. The prevalence of obesity significantly increased from the first time period to the third time period. The prevalence of obesity found in our study was significantly lower than the report from the U.S.A. during same time period between 1994 and 2004 (p<0.05). The prevalence of obesity significantly decreased with age as well. CONCLUSIONS: The prevalence of obesity in our subjects significantly increased and has reached a plateau in recent years. Compared to the prevalence of childhood obesity in ambulatory individuals with CP in the U.S.A. study, the prevalence in our study was significantly lower.

The short-term effects of combined modified constraint-induced movement therapy and botulinum toxin injection for children with spastic hemiplegic cerebral palsy.

OBJECTIVE: The aim of this study was to investigate whether modified constraint-induced movement therapy (mCIMT) following a botulinum type A toxin (BoNT-A) injection enhances the effects of the BoNT-A injection into the spastic upper limb of children with hemiplegic cerebral palsy (CP). METHODS: A combined therapy with mCIMT and BoNT-A was given to 17 children in group A. Fifteen children in group B received only the BoNT-A injection. The muscle tone, the movement pattern, and the How Often and the How Well scales in the revised Pediatric Motor Activity Log (revised PMAL) were assessed before and 3 weeks after intervention. RESULTS: Three participants in group A dropped out due to poor tolerance of mCIMT. There were significant improvements in the muscle tone and the movement patterns for both groups (p<0.05), and the changes were not significantly different between the two groups. The How Often and the How Well scales in the revised PMAL were significantly improved in group A (p<0.05), but not in group B. CONCLUSION: A combined therapy of mCIMT and BoNT-A seems to be helpful to enhance the effects of the BoNT-A injection in the functional use of the affected limb in children with hemiplegic CP.

Detection of focal cerebral injury using diffusion tensor magnetic resonance imaging in a boy with becker muscular dystrophy.

Here, we report on a boy affected by both cerebral palsy and Becker muscular dystrophy (BMD). He had infrequently used his right hand since birth. But brain magnetic resonance imaging (MRI) taken at the age of 15 months showed no specific finding. Approximately 1 month later, muscle enzymes of his older brother were incidentally found to be elevated. The patient and his brother were diagnosed with progressive muscular dystrophy by gene analysis. At the age of 6 years, he underwent orthopedic surgery due to a right equinovarus deformity and BMD was confirmed by concomitant muscle biopsy. During the post-operative rehabilitation, clumsiness of the right hand was also observed. A follow-up brain MRI with diffusion tensor imaging (DTI) was taken. Although no responsible lesion was found on conventional MRI, DTI and fiber tractography revealed a decrease in the quantity of fibers in the left corticospinal tract. He was additionally diagnosed as having cerebral palsy.

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients.

STUDY DESIGN: Prospective single centre study. OBJECTIVES: Pulmonary rehabilitation focuses on improving the expiratory muscle function in order to increase the reduced cough capacity in patients with cervical spinal cord injuries (SCI). However, an improvement in the inspiratory function is also important for coughing effectively. Therefore, this study was to examine the significance of the inspiratory muscle strength on the cough capacity in the patients with a cervical SCI. SETTING: SCI unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS: The vital capacity (VC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured. Moreover, the unassisted peak cough flow (PCF) and assisted PCF under three conditions were evaluated. RESULTS: All three assisted cough methods showed a significantly higher value than the unassisted method (P < 0.001). The VC correlated with the voluntary cough capacity and the MIP (R = 0.749) correlated more significantly with the VC than the MEP (R = 0.438) (P < 0.01). The MIP showed a higher correlation with both the unassisted PCF and all three assisted PCFs than the MEP (P < 0.001). CONCLUSIONS: The management of the inspiratory muscle strength should be considered in the pulmonary rehabilitation at cervical SCI patients.

Verrucous carcinoma of the foot from chronic pressure ulcer.

STUDY DESIGN: This is a case report with literature review. OBJECTIVE: To describe a case of verrucous carcinoma, a rare histopathologic type, complicating a chronic pressure ulcer of duration less than 3 years. SETTING: The department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, USA. METHOD: A 24-year-old African-American male with long-standing incomplete paraplegia visited the wound clinic due to a pressure ulcer that had lasted for more than 1 year on the medial side of the right foot. Despite conservative management for almost 2 years after the initial visit, the ulcer is suspected to have undergone malignant transformation. Histological study led to the diagnosis of verrucous carcinoma that necessitated transtibial amputation on the right foot. RESULT: The carcinoma developed within 3 years, which was a relatively short time period for a pressure ulcer to have undergone malignant transformation. The diagnosis of verrucous carcinoma has never been reported as carcinoma complicating a pressure ulcer. No evidence of local recurrence or distant metastasis was seen in postoperative 10 months. CONCLUSION: The possibility of malignant transformation should be kept in mind in cases of pressure ulcers that are unresponsive to treatment or that show morphological changes suspected to be cancerous. Furthermore, early detection and intervention increases the probability for successful outcome.