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Research paper thumbnail of Age Impact on Gross Motor Function Classification System after Single Event Multi-Level Chemoneurolysis in Children with Cerebral Palsy

Research paper thumbnail of A Retrospective Review of Unintended Effects Following Single-Event Multi-Level Chemoneurolysis with Botulinum Toxin-A and Phenol in Children with Cerebral Palsy

PM & R : the journal of injury, function, and rehabilitation, Jan 29, 2015

Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats variou... more Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats various limbs at multiple levels with chemoneurolytic agents in patients with spasticity. Phenol is used in combination with Botulinum toxin A (BTX-A) to enable spastic muscles to be treated without overdosing BTX-A. To review unintended effects of SEMLC for children with spastic cerebral palsy (CP). Retrospective chart review SETTING: Pediatric rehabilitation outpatient clinic, academic medical center PARTICIPANTS: 98 children with CP who underwent SEMLC at least one occasion. SEMLC MAIN OUTCOME MEASURES: Unintended effects (UEs), the goal achievement for each SEMLC session, Gross Motor Function Classification System (GMFCS-ER) RESULTS: A total of 98 subjects and 146 SEMLC procedures were reviewed. Demographics: mean age 7.56 [SD 4.28] years; 57% male; 14 hemiplegia, 22 diplegia, 8 triplegia, & 54 quadriplegia. Most of SEMLCs (72%) were done with combination of BTX-A and 5% phenol in a sessio...

Research paper thumbnail of The Efficacy and Safety of Single Event Multi-Level Chemoneurolysis with Botulinum Toxin-A and Phenol in Children with Cerebral Palsy

Research paper thumbnail of A Retrospective Review of Unintended Effects Following Single-Event Multi-Level Chemoneurolysis with Botulinum Toxin-A and Phenol in Children with Cerebral Palsy

PM & R : the journal of injury, function, and rehabilitation, Jan 29, 2015

Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats variou... more Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats various limbs at multiple levels with chemoneurolytic agents in patients with spasticity. Phenol is used in combination with Botulinum toxin A (BTX-A) to enable spastic muscles to be treated without overdosing BTX-A. To review unintended effects of SEMLC for children with spastic cerebral palsy (CP). Retrospective chart review SETTING: Pediatric rehabilitation outpatient clinic, academic medical center PARTICIPANTS: 98 children with CP who underwent SEMLC at least one occasion. SEMLC MAIN OUTCOME MEASURES: Unintended effects (UEs), the goal achievement for each SEMLC session, Gross Motor Function Classification System (GMFCS-ER) RESULTS: A total of 98 subjects and 146 SEMLC procedures were reviewed. Demographics: mean age 7.56 [SD 4.28] years; 57% male; 14 hemiplegia, 22 diplegia, 8 triplegia, & 54 quadriplegia. Most of SEMLCs (72%) were done with combination of BTX-A and 5% phenol in a sessio...

Research paper thumbnail of No. 290 The Continued Efficacy of Repeated Single-Event Multi-Level Chemoneurolysis in Children With Cerebral Palsy

Research paper thumbnail of Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

Stereotactic and Functional Neurosurgery, 2013

The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of ... more The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of severe intractable focal and multifocal spastic hypertonia. We occasionally operated SPN in diffuse spastic disorders. To study surgical outcome of SPN in terms of severity of spasticity and functional condition. Patients harboring refractory harmful spasticity of various origins were enrolled into the present study. They were clinically evaluated by using the Modified Ashworth Scale (MAS), passive range of motion (PROM) and functional status. These variables were compared between pre- and postsurgery by using the paired t test and the Wilcoxon signed-rank matched-pairs test. One hundred and forty-one SPNs were accomplished in 33 patients. Overall mean pre- and postoperative MAS and PROM were 3.0 and 0.7 (p < 0.001) and 78.3 and 102.3° (p < 0.001), respectively. Analysis of individual SPN subgroups also demonstrated statistically significant improvement of both parameters. Furthermore, we found significant gait improvement among 10 ambulatory subjects. Nine bed-bound cases attained significant enhancement of sitting competency and ambulatory condition. SPN is an efficacious neurosurgical intervention in the treatment of spasticity. It is apparently beneficial in the reduction of spasticity, amelioration of functional status, facilitation of patient care and prevention of long-term musculoskeletal sequelae.

Research paper thumbnail of Combined Ablative Neurosurgical Procedures in a Patient with Mixed Spastic and Dystonic Cerebral Palsy

Stereotactic and Functional Neurosurgery, 2010

Harmful generalized spasticity is an obstacle in rehabilitation and caregiving. Neurosurgical int... more Harmful generalized spasticity is an obstacle in rehabilitation and caregiving. Neurosurgical intervention is a therapeutic option for patients with severe spasticity who do not respond to nonoperative management. Currently, intrathecal baclofen therapy (ITB) is a good alternative treatment for such patients. However, the ITB device is costly and the intrathecal drug is not available in Thailand. We report a combined use of ablative neurosurgical procedures in a patient with severe generalized spasticity and disabling cervical dystonia (CD). The assembled operations including selective peripheral denervation for CD, microsurgical dorsal root entry zone lesion for upper limb spasticity, and selective dorsal rhizotomy for lower limb spasticity were conducted in a single session. Furthermore, recurrent spasticity of the upper extremities was subsequently treated by selective peripheral neurotomy. The spasticity and CD totally disappeared after all operations. The patient became able to sit and perform head turning. Additionally, we also found an improvement in swallowing and the voluntary movement of the lower limbs.

Research paper thumbnail of PO25-TH-19 Combined ablative neurosurgical procedures in a patient with mixed spastic and dystonic cerebral palsy

Journal of the Neurological Sciences, 2009

Research paper thumbnail of Utilization of intraoperative electromyography for selecting targeted fascicles and determining the degree of fascicular resection in selective tibial neurotomy for ankle spasticity

Acta Neurochirurgica, 2013

Background Selective tibial neurotomy (STN) is an effective neurosurgical intervention for treati... more Background Selective tibial neurotomy (STN) is an effective neurosurgical intervention for treating ankle spasticity. The authors use intraoperative electromyography (EMG) for selecting targeted fascicles and determining the degree of fascicular resection in STN. This study reports surgical techniques and outcomes of the operation. Methods Participants who underwent STN with utilization of intraoperative EMG were recruited. Modified Ashworth Scale (MAS), passive range of motion (PROM) of the ankle in plantar flexion and dorsiflexion, Massachusetts General Hospital Functional Ambulatory Classification (MGHFAC) and ability to attain full plantigrade stance were assessed pre-and postoperatively. Results Twenty-one STNs were performed in 15 patients. The mean pre-and postoperative MAS and PROM were 2.8 and 0.4 (p<0.001), 39.5 o and 66.0 o (p<0.001), respectively.

Research paper thumbnail of Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Clinical Interventions in Aging, 2011

To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pr... more To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pre-and post-trial. Participants: Elderly with falls in the previous year. Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet. Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods. Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P , 0.001) except for functional reach in the frequent fall group. Most subjects (72%-79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling $3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98). Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.

Research paper thumbnail of Age Impact on Gross Motor Function Classification System after Single Event Multi-Level Chemoneurolysis in Children with Cerebral Palsy

Research paper thumbnail of A Retrospective Review of Unintended Effects Following Single-Event Multi-Level Chemoneurolysis with Botulinum Toxin-A and Phenol in Children with Cerebral Palsy

PM & R : the journal of injury, function, and rehabilitation, Jan 29, 2015

Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats variou... more Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats various limbs at multiple levels with chemoneurolytic agents in patients with spasticity. Phenol is used in combination with Botulinum toxin A (BTX-A) to enable spastic muscles to be treated without overdosing BTX-A. To review unintended effects of SEMLC for children with spastic cerebral palsy (CP). Retrospective chart review SETTING: Pediatric rehabilitation outpatient clinic, academic medical center PARTICIPANTS: 98 children with CP who underwent SEMLC at least one occasion. SEMLC MAIN OUTCOME MEASURES: Unintended effects (UEs), the goal achievement for each SEMLC session, Gross Motor Function Classification System (GMFCS-ER) RESULTS: A total of 98 subjects and 146 SEMLC procedures were reviewed. Demographics: mean age 7.56 [SD 4.28] years; 57% male; 14 hemiplegia, 22 diplegia, 8 triplegia, & 54 quadriplegia. Most of SEMLCs (72%) were done with combination of BTX-A and 5% phenol in a sessio...

Research paper thumbnail of The Efficacy and Safety of Single Event Multi-Level Chemoneurolysis with Botulinum Toxin-A and Phenol in Children with Cerebral Palsy

Research paper thumbnail of A Retrospective Review of Unintended Effects Following Single-Event Multi-Level Chemoneurolysis with Botulinum Toxin-A and Phenol in Children with Cerebral Palsy

PM & R : the journal of injury, function, and rehabilitation, Jan 29, 2015

Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats variou... more Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats various limbs at multiple levels with chemoneurolytic agents in patients with spasticity. Phenol is used in combination with Botulinum toxin A (BTX-A) to enable spastic muscles to be treated without overdosing BTX-A. To review unintended effects of SEMLC for children with spastic cerebral palsy (CP). Retrospective chart review SETTING: Pediatric rehabilitation outpatient clinic, academic medical center PARTICIPANTS: 98 children with CP who underwent SEMLC at least one occasion. SEMLC MAIN OUTCOME MEASURES: Unintended effects (UEs), the goal achievement for each SEMLC session, Gross Motor Function Classification System (GMFCS-ER) RESULTS: A total of 98 subjects and 146 SEMLC procedures were reviewed. Demographics: mean age 7.56 [SD 4.28] years; 57% male; 14 hemiplegia, 22 diplegia, 8 triplegia, & 54 quadriplegia. Most of SEMLCs (72%) were done with combination of BTX-A and 5% phenol in a sessio...

Research paper thumbnail of No. 290 The Continued Efficacy of Repeated Single-Event Multi-Level Chemoneurolysis in Children With Cerebral Palsy

Research paper thumbnail of Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

Stereotactic and Functional Neurosurgery, 2013

The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of ... more The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of severe intractable focal and multifocal spastic hypertonia. We occasionally operated SPN in diffuse spastic disorders. To study surgical outcome of SPN in terms of severity of spasticity and functional condition. Patients harboring refractory harmful spasticity of various origins were enrolled into the present study. They were clinically evaluated by using the Modified Ashworth Scale (MAS), passive range of motion (PROM) and functional status. These variables were compared between pre- and postsurgery by using the paired t test and the Wilcoxon signed-rank matched-pairs test. One hundred and forty-one SPNs were accomplished in 33 patients. Overall mean pre- and postoperative MAS and PROM were 3.0 and 0.7 (p &amp;amp;lt; 0.001) and 78.3 and 102.3° (p &amp;amp;lt; 0.001), respectively. Analysis of individual SPN subgroups also demonstrated statistically significant improvement of both parameters. Furthermore, we found significant gait improvement among 10 ambulatory subjects. Nine bed-bound cases attained significant enhancement of sitting competency and ambulatory condition. SPN is an efficacious neurosurgical intervention in the treatment of spasticity. It is apparently beneficial in the reduction of spasticity, amelioration of functional status, facilitation of patient care and prevention of long-term musculoskeletal sequelae.

Research paper thumbnail of Combined Ablative Neurosurgical Procedures in a Patient with Mixed Spastic and Dystonic Cerebral Palsy

Stereotactic and Functional Neurosurgery, 2010

Harmful generalized spasticity is an obstacle in rehabilitation and caregiving. Neurosurgical int... more Harmful generalized spasticity is an obstacle in rehabilitation and caregiving. Neurosurgical intervention is a therapeutic option for patients with severe spasticity who do not respond to nonoperative management. Currently, intrathecal baclofen therapy (ITB) is a good alternative treatment for such patients. However, the ITB device is costly and the intrathecal drug is not available in Thailand. We report a combined use of ablative neurosurgical procedures in a patient with severe generalized spasticity and disabling cervical dystonia (CD). The assembled operations including selective peripheral denervation for CD, microsurgical dorsal root entry zone lesion for upper limb spasticity, and selective dorsal rhizotomy for lower limb spasticity were conducted in a single session. Furthermore, recurrent spasticity of the upper extremities was subsequently treated by selective peripheral neurotomy. The spasticity and CD totally disappeared after all operations. The patient became able to sit and perform head turning. Additionally, we also found an improvement in swallowing and the voluntary movement of the lower limbs.

Research paper thumbnail of PO25-TH-19 Combined ablative neurosurgical procedures in a patient with mixed spastic and dystonic cerebral palsy

Journal of the Neurological Sciences, 2009

Research paper thumbnail of Utilization of intraoperative electromyography for selecting targeted fascicles and determining the degree of fascicular resection in selective tibial neurotomy for ankle spasticity

Acta Neurochirurgica, 2013

Background Selective tibial neurotomy (STN) is an effective neurosurgical intervention for treati... more Background Selective tibial neurotomy (STN) is an effective neurosurgical intervention for treating ankle spasticity. The authors use intraoperative electromyography (EMG) for selecting targeted fascicles and determining the degree of fascicular resection in STN. This study reports surgical techniques and outcomes of the operation. Methods Participants who underwent STN with utilization of intraoperative EMG were recruited. Modified Ashworth Scale (MAS), passive range of motion (PROM) of the ankle in plantar flexion and dorsiflexion, Massachusetts General Hospital Functional Ambulatory Classification (MGHFAC) and ability to attain full plantigrade stance were assessed pre-and postoperatively. Results Twenty-one STNs were performed in 15 patients. The mean pre-and postoperative MAS and PROM were 2.8 and 0.4 (p<0.001), 39.5 o and 66.0 o (p<0.001), respectively.

Research paper thumbnail of Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Clinical Interventions in Aging, 2011

To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pr... more To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pre-and post-trial. Participants: Elderly with falls in the previous year. Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet. Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods. Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P , 0.001) except for functional reach in the frequent fall group. Most subjects (72%-79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling $3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98). Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.