Analysis of Korean Medicine Treatment in Children with Cerebral Palsy

Article information

J Korean Med. 2019;40(1):12-23

doi : https://doi.org/10.13048/jkm.19002

Hyunwoo Jeong ¹, Youngjin Hur ², Youngju Yun ³

¹School of Korean Medicine, Pusan National University

²Hur Korean Medical Clinic

³Department of Integrative Medicine, School of Korean Medicine, Pusan National University

Correspondence to: 윤영주 (Youngju Yun), 경상남도 양산시 물금읍 금오로 20 부산대학교 한의학전문대학원, Tel: +82-55-360-5955, E-mail: mdkmdyun@pusan.ac.kr

Received 2019 January 14; Revised 2019 March 04; Accepted 2019 March 04.

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.

Keywords: cerebral palsy; Korean medicine; disease characteristics; observational study; acupuncture; herbal medicinr

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

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).

Table 1

Comparison of Characteristics in Current-use Group and Withdrawal Group

Table 2

The Perception of the Parents Having Children with Cerebral Palsy about Effectiveness of Korean Medicine Treatment

Table 3

Aspects of Korean Medicine Treatment within One Observation Year

Table 4

Differences of Intensity of Treatments According to the Disease Characteristics

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Article information Continued

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

Fig. 2

Reasons for Ceasing Herbal Medication or Acupuncture

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*
KM was effective (N (%))	No	12 (31.6%)	22 (55.0%)	0.037a*

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%)
medical institution	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
age (mean=31.98±18.63mos)	more than 32 mos (n=16)	89.00±112.28	0.950	15.38±22.00	0.018a*	104.38±111.47	0.258	575.69±427.84	0.782
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
sex	female (n=13)	113.62±115.91	0.339	40.92±54.62	0.969	154.54±146.78	0.824	623.23±434.97	0.425
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
type of CP	non-spastic (n=15)	158.33±129.93	0.005a*	39.93±50.49	0.634	198.40±147.36	0.032a*	503.07±384.30	0.628
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
severity (GMFCS)	grade 4,5 (n=14)	118.50±140.82	0.855	46.36±41.63	0.113	165.00±154.27	0.414	690.00±535.60	0.085
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
medication-administration	no (n=33)	97.09±111.60	0.661	40.61±57.00	0.788	137.76±140.61	0.788	589.42±420.71	0.157
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
dietary supplements	no (n=20)	139.53±146.75	0.300	59.40±67.52	0.057	198.93±184.68	0.273	546.87±426.19	0.683
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
Assist-device use	no (n=15)	118.70±131.73	0.412	52.20±66.98	0.257	171.00±168.17	0.381	455.00±383.94	0.080
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
seizure	no (n=38)	87.66±107.37	0.405	38.79±54.11	0.699	126.50±134.50	0.326	568.55±398.18	0.226

*: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