뇌성마비의 조기진단을 위한 이학적 평가항목의 개발

Abstract

Early diagnosis of cerebral palsy may help to provide early therapeutic intervention.

The early treatment of cerebral palsy is critical in the prevention of deformity and promotion of normal movement patterns. However, it is difficult to identify those who are at substantial risk of cerebral palsy before the age of one, particularly in its mild and moderate forms. The purpose of this study was to analyze and establish an efficient early diagnostic tool for cerebral palsy. The subjects in this study were 247 infants selected from outpatients at the Rehabilitation Hospital of Yonsei University from December, 1987 to March, 1996. The infants had problems in motor development or a past history of perinatal risks and all were under one year of corrected age.

The assessments included a structured developmental history taken from the child's parents, evaluation of motor development status, and neurological examiniations including assessment of muscle tone, several primitive reflexes and Vojta's postural reactions. These infants were assessed every 2∼3 months. According to the findings of developmental milestones, muscle tone, and Vojta's postural reactions, we divided the patients into high and low risk groups.

The final diagnosis confirmed that 126 children had cerebral palsy, 43 children had other diagnoses while 78 children turned out to be normal.

We found that diagnosis of cerebral palsy during the first six months of postnatal period relied mainly on abnormal muscle tone, Vojta's postural reactions, developmental motor delay, a positive finding of asymmetric tonic neck reflex and a negative finding of optical righting reaction. The sensitivity and specificity of the evaluation methods were 91.1% and 66.7%, respectively in the first six months of postnatal period.

In conclusion, we have proved that the delayed motor development, abnormal muscle tone and abnormal Vojta's postural reactions are very valuable tools for the early diagnosis of cerebral palsy.