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.
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
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
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
참고문헌
1. Korean Society of Pediatric Rehabilitation & Developmental Medicine. Pediatric Rehabilitation. 2nd ed.Seoul: Gunja Publishing Co;2013. p. 365
2. Park MS, Kim SJ, Chung CY, Kwon DG, Choi IH, Lee KM. Prevalence and lifetime healthcare cost of cerebral palsy in South Korea. Health Policy. 2011; 100:2–3. 234–238.
3. Johnston MV. Plasticity in the developing brain: implications for rehabilitation. Dev Disabil Res Rev. 2009; 15:2. 94–101.
4. Moon SH, Kim JY, Kim LH, Jang IS. A review of recent acupuncture therapy for developmental disorder. Korean J of Meridian & Acupoint. 2004; 20:3. 129–146.
5. You HS, Oh MS, Song TW. The literature study on the cerebral palsy. Journal of Korean medicine research center of Daejun University. 2009; 9:1. 469–501.
6. Li LY, Liu ZH, Xie QL. Meta-Analysis on scalp acupuncture based therapy in treating children cerebral palsy. World Journal of Acupuncture-Moxibustion. 2014; 24:3. 49–53.
7. Zhang Y, Liu J, Wang J, He Q. Traditional Chinese Medicine for treatment of cerebral palsy in children: a systematic review of randomized clinical trials. The Journal of Alternative and Complementary Medicine. 2010; 16:4. 375–395.
8. Lee YG, Chae JW. A patient with lower limbs’ delayed motor development was demonstrated hang-ji: A case report. J Korean Oriental Pediatrics. 2007; 21:3. 215–221.
9. Yu SA. Two cases of patients with developmental disorder treated by herbal medicine alone. J Korean Oriental Pediatrics. 2011; 25:2. 39–54.
10. Lee HW, Yun YJ, Yu SA, Park YH, Park BW, Kim BY, et al. A cross-sectional survey of clinical factors that influence the use of traditional Korean Medicine among children with cerebral palsy. Integr Med Res. 2018; 7:4. 333–40.
11. Kim SY, Shin YI, Nam SO, Lee CH, Shin YB, Ko HY, et al. Concurrent Complementary and Alternative Medicine and Conventional Rehabilitation Therapy in the Management of Children with Developmental Disorders. eCAM. 2013; article ID 812054.
12. Kim YW, Jang SG, Kim YI, Hong KW, Lee H, Lee BR. Survey Research on the Cerebral Palsy Children. J Korean Acupuncture & Moxibustion. 2002; 19:4. 89–100.
13. Hong JS. A study on health care utilization of children with cerebral palsy [dissertation]. Seoul: Seoul National Univ;2004.
14. Holt RL, Mikati MA. Care for child development: basic science rationale and effects of interventions. Pediatric neurology. 2011; 44:4. 239–53.
15. Hurvitz EA, Leonard C, Ayyangar R, Nelson VS. Complementary and alternative medicine use in families of children with cerebral palsy. Developmental medicine and child neurology. 2003; 45:364–70.
16. Lee KG, Bae SH, Shin HK. Assessment on forecasting study of Traditional Chinese Medicine(1990–2010). J Korean Oriental Med. 2007; 28:1. 117–125.
17. Seo YJ, Kang SH, Kim YH, Choi DB, Shin HK. Systematic review on the customer’s use of and satisfaction with oriental medical services. J Korean Oriental Med. 2010; 31:1. 69–78.
18. Wu Y, Zou LP, Han TL, Zheng H, Caspi O, Wong V, et al. Randomized Controlled Trial of traditional Chinese medicine (Acupuncture and Tuina) in Cerebral Palsy: Part 1-Any increase in seizure in integrated acupuncture and rehabilitation group versus rehabilitation group? J Alternat Complemen Med. 2008; 14:8. 1005–9.
19. Kim IJ, Kang JK, Lee SA. Factors contributing to the use of complementary and alternative medicine by people with epilepsy. Epilepsy and Behavior. 2006; 8:3. 620–4.
20. Lee JS, Son KH, Hwang GS, Kim MJ. Effect and safety of Shihogyejitang for drug resistant childhood epilepsy. eCAM. 2016; article ID3410213.
21. Kim BY, Lee HJ, Yun YJ. Rehabilitation Therapy Selection Process in Parents of Children With Cerebral Palsy-Grounded theory. J Rehab Res. 2018; 22:2. 175–212.