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JKM > Volume 40(1); 2019 > Article
Jeong, Hur, and Yun: Analysis of Korean Medicine Treatment in Children with Cerebral Palsy

Abstract

Objectives

The purpose of this study was to analyze the aspects of the Korean medicine (KM) treatment among children with cerebral palsy (CP) according to the disease characteristics.

Methods

In a prospective observational multicenter study for children with CP, we analyzed 78 baseline questionnaires of children having experience of KM treatments such as acupuncture and Korean herbal medicine and 43 follow-up data of children who have received KM during the one observation year.

Results

Of all the 182 participants, 38 children were currently getting KM treatment and 40 children have discontinued KM treatment. Children with non-spastic CP and more health problems tended to use KM. The most frequent reason for quitting acupuncture therapy was ‘suffering of children’ and the highest reason of stopping herbal medicine was ‘rejection of children’. Among the 133 participants finished one year follow-up, 43 children have received at least one KM treatment. The average number of acupuncture therapy was twice a week and the average monthly cost of acupuncture therapy and herbal medicine were 65,922 won and 476,003 won, respectively. Children under 32 month old have received significantly more acupuncture and children with non-spastic CP have taken significantly more herbal medicine.

Conclusions

Further study will be required to confirm the effectiveness of KM and increase the utilization of KM among the children with CP. More efforts should be made to increase the convenience of acupuncture therapy and herbal medicine and to expand the insurance coverage of KM for children with CP.

Fig. 1
Flow Chart of the Observational Study and Focus of this Article
KM; Korean Medicine. * comparative analysis of two group has already published (ref 10); † focus of this article; ‡ result of the observational study will be published soon
jkm-40-1-12f1.gif
Fig. 2
Reasons for Ceasing Herbal Medication or Acupuncture
AE, adverse events; NE, no effect; EB, economic burden; CR, child rejected; MR, medical reasons (other oral medication or doctor’s recommendation); TD, inconvenience of time and distance; this is the percentage of subjects who responded to the reason for the withdrawal (30 for herbal medication and 34 for acupuncture).
jkm-40-1-12f2.gif
Table 1
Comparison of Characteristics in Current-use Group and Withdrawal Group
Variable Overall (n=78) Current-use group (n=38) Withdrawal group (n=40) p-value
Age (mos) 39.4±20.1 29.7±17.9 48.7±17.6 <0.001b*
Height (cm) 91.2±12.2 85.7±12.1 96.2±9.9 <0.001b*
Weight (kg) 12.4±3.4 11.1±2.8 13.7±3.4 <0.001b*
Sex Male 53 (68.0%) 25 (65.8%) 28 (70.0%) 0.690a
Female 25 (32.1%) 13 (34.2%) 12 (30.0%)
Type of CP Spastic 43 (55.1.%) 15 (39.5%) 28 (70.0%) 0.007a*
Non-spastic 35 (47.9%) 23 (60.5%) 12 (30.0%)
GMFCS Mild-to-moderate (Grade 1–3) 41 (53.3%) 20 (52.6%) 21 (52.5%) 0.991a
Severe (Grade 4–5) 36 (46.8%) 18 (47.4%) 19 (47.5%)
Accompanying disability no 15 (19.2%) 8 (21.1%) 7 (17.5%) 0.691a
yes 63 (80.8%) 30 (79.0%) 33 (82.5%)
Number of disabilities accompanied 1.8±1.4 1.8±1.5 1.8±1.4 0.943b
Number of other health problems 1.2±1.3 1.6±1.4 0.9±1.2 0.022b*
medication-administration no 51 (65.4%) 26 (68.4%) 25 (62.5%) 0.583a
yes 27 (34.6%) 12 (31.6%) 15 (37.5%)
Assist-device use no 27 (34.6%) 24 (63.2%) 3 (7.5 %) <0.001a*
yes 51 (65.4%) 14 (36.8%) 37 (92.5%)
dietary supplements no 33 (42.3%) 17(44.7%) 16 (40.0%) 0.672a
yes 45 (57.7%) 21(55.3%) 24 (60.0%)
RT times per week 12.2±8.1 9.0±7.7 15.2±7.3 0.001b*

p-value: differences between current-use group and withdrawal group

a: chi-square test; b: Wilcoxon rank sum test; *: statistically significant (p<0.05)

CP, cerebral palsy; GMFCS, gross motor function classification system

Table 2
The Perception of the Parents Having Children with Cerebral Palsy about Effectiveness of Korean Medicine Treatment
Variable Current-use group (N=38) Withdrawal group (N=40) p-value
KM was effective (N (%)) Yes 26 (68.4%) 18 (45.0%) 0.037a*
No 12 (31.6%) 22 (55.0%)

Detail of effect of KM (N (%†)) improvement in physical health 13 (34.2%) 8 (20.0%)
progress in cognitive function 12 (31.6%) 6 (15.0%)
progress in motor function 9 (23.7%) 1 (2.5%)
decrease in spasticity 3 (7.9%) 0 (0.0%)
improvement in pronunciation 2 (5.3%) 0 (0.0%)
decrease in drooling 2 (5.3%) 0 (0.0%)
decrease in seizure frequency 2 (5.3%) 0 (0.0%)
alleviation in constipation 1 (2.6%) 4 (10.0%)
others 11 (28.9%) 9 (22.5%)

KM, Korean medicine; *: statistically significant (p<0.05), a, chi-square test; †, percentile of who answered KM was effective (of 26 and 18 participants in each group, respectively)

Table 3
Aspects of Korean Medicine Treatment within One Observation Year
group KM treatment (at least one KM treatment in a year) (N=43) current use (getting KM on the time of first survey) (N=38)
treatment type acupuncture 9(20.9%) 5(13.2%)
herbal medicine 12(27.9%) 3(7.9%)
acupuncture + herbal medicine 22(51.2%) 30(78.9%)
past experience of KM yes acupuncture 5(11.6%)
herbal medicine 5(11.6%)
acupuncture + herbal medicine 22(51.2%)
no 11(25.6%)
medical institution local KM clinic 30(69.8%) 33(86.8%)
KM hospital 13(30.2%) 5(13.2%)
aspects of acupuncture treatment N=31 (m±sd)(min~max) N=35
period(weeks)/one year 24.61±17.64(1.00~52.00)
number of treatment/week 2.08±1.31 (1.00~6.13) 2.65±2.47 (0.50~12.00)
cost(won)/month 65,922±67,680 (0~286,987)* 43,280±34,643 (0~ 132,000)*
aspects of herbal medicine treatment N=34 (m±sd)(min~max) N=33
period(weeks)/one year 17.03±16.87 (0.14~52.00)
cost(won)/month 476,003±446,849 (48,840 ~2,081,818) 535,182±392,890 (30,000~1,260,000)
number of general rehabilitation therapy number of treatment/week 10.50±7.33 9.0±7.7

KM, Korean medicine; *there was one case of free treatment

Table 4
Differences of Intensity of Treatments According to the Disease Characteristics
group HM (days/yr) p-value AT (number/yr) p-value HM+AT p-value general RT (number/yr) p-value
age (mean=31.98±18.63mos) less than 32 mos (n=27) 108.22±127.99 0.950 51.56±59.14 0.018a* 159.85±158.72 0.258 528.22±358.00 0.782
more than 32 mos (n=16) 89.00±112.28 15.38±22.00 104.38±111.47 575.69±427.84
sex male (n=30) 95.63±125.20 0.339 36.87±50.99 0.969 132.57±144.96 0.824 512.37±358.10 0.425
female (n=13) 113.62±115.91 40.92±54.62 154.54±146.78 623.23±434.97
type of CP spastic (n=28) 70.39±106.60 0.005a* 37.11±52.90 0.634 107.50±134.38 0.032a* 568.82±384.46 0.628
non-spastic (n=15) 158.33±129.93 39.93±50.49 198.40±147.36 503.07±384.30
severity (GMFCS) grade 1,2,3 (n=29) 92.66±112.154 0.855 34.10±55.87 0.113 126.76±140.03 0.414 476.31±263.24 0.085
grade 4,5 (n=14) 118.50±140.82 46.36±41.63 165.00±154.27 690.00±535.60
medication-administration yes (n=10) 114.20±155.61 0.661 29.80±26.84 0.788 144.00±163.06 0.788 402.20±136.59 0.157
no (n=33) 97.09±111.60 40.61±57.00 137.76±140.61 589.42±420.71
dietary supplements yes (n=23) 80.46±102.40 0.300 26.68±37.05 0.057 107.21±107.60 0.273 545.36±363.00 0.683
no (n=20) 139.53±146.75 59.40±67.52 198.93±184.68 546.87±426.19
Assist-device use yes (n=28) 85.74±112.29 0.412 25.83±29.11 0.257 111.57±116.21 0.381 624.91±368.72 0.080
no (n=15) 118.70±131.73 52.20±66.98 171.00±168.17 455.00±383.94
seizure yes (n=5) 203.00±182.61 0.405 32.80±26.64 0.699 235.80±193.74 0.326 373.60±128.96 0.226
no (n=38) 87.66±107.37 38.79±54.11 126.50±134.50 568.55±398.18

*:statistically significant (p<0.05) a, two-sample t test; CP, Cerebral palsy; GMFCS, gross motor function classification system; HM, herbal medicine; AT, acupuncture treatment; RT, rehabilitation therapy

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