Cerebral palsy (CP) was defined as "a permanent, but not unchanging disorder of movement and posture due to a non-progressive defect or lesion of the brain in early life" by the Little Club in 1964. This definition is not universally agreed but it is still widely used. It may be associated with cognitive, sensory and behavioral manifestations.
The prevalence of CP has changed very little over the past 40 years. As a result of improved survival of prematurely born infants with very low birth weight, more individuals have severe motor disability and associated handicaps. The incidence of CP is 2∼5/1,000 live births, but at 7 years of age, the rate is estrmated to be 2/1,000 births.
Management of a child with CP requires a multidisciplinary approach shared with the child and family and should support for them.
Numerous ways have been tried to moderate the abnormalities found in the different varieties of CP. The aim of treatment is to prevent the development of deformity, suppress unwanted or abnormal movements and promote optimal function. The well-known systems of physical therapy include those of the Bobaths, Vojta and the Peto.
Occupational therapy concentrates on eye-hand coordination and upper extremity motor control and other activities of daily life. Orthosis usually is prescribed to correct abnormal posture of the ankle and foot.
Topical injection of phenol, alcohol solution or botulinum toxin into the motor points or motor nerves of a spastic muscle creates a temporary neurolysis and consequent tone reduction lasting 5 to 6 months. Currently intrathecal baclofen is widely used. Where contractures have occurred in the hips and knees, soft tissue surgery around the hip, knee and ankle in a simple operation may be carried out.
Objective: To evaluate the efficacy of growth hormone in reversing glucocorticoid-induced musculoskeletal changes including osteoporosis and myopathy in rats.
Method: Experimental rats were divided into five groups and each group was composed of 10 rats. The group 1 was administered with saline, group 2 with growth hormone, group 3 with glucocorticoid, group 4 with combined dosages of growth hormone and glucocorticoid, and group 5 with glucocorticoid for 4 weeks and then growth hormone for another 4 weeks. All injections were carried out every other day for 8 weeks. The half of animals were sacrificed after 4 weeks and another half after 8 weeks in each group. The triceps surae muscle was biopsied and examined histologically for the evaluation of mean area of muscle fiber. The femur was removed and dissected for the measurement of its weight, length, and diameter. The bone mineral density of the femur was measured by a dual energy X-ray absorptiometer.
Results: Administration of growth hormone partially reversed the complications of steroid such as decrease in body weight, decrease in weight, length, diameter, and bone mineral density of femur, and decrease in mean area of muscle fiber.
Conclusion: This study indicated that growth hormone could be applied for the management of steroid-induced osteoporosis and myopathy.
Objective: To explore the healing effect of low intensity pulsed ultrasound with three different timing of intervention after tenotomy of Achilles tendon in rats.
Method: One hundred and thirty-two male rats were divided into experimental and control groups. Both groups were classified according to treatment phase: treatment on inflammatory phase (group I), proliferative phase (group II), and maturation phase (group III). Each groups were divided into 2 subgroups according to tendon excision time: 1 day after 7 consecutive treatment on 3 different phases (I-A, II-A, and III-A) and 30 days after tenotomy (I-B, II-B, and III-B). Three MHz pulsed ultrasound was administered on right tendon for 4 mins at 0.5 W/cm2. The excised tendons of all groups were compared histologically and biochemically as control.
Results: The tendons of II-A experimental group revealed increased fibroblasts. The collagen fibers in the neo-tendon of II-B and III-B experimental groups had a tendency to be arrayed more regularly. On I-A group, the neo-tendon showed high immunoreactivity for type I and particularly type III collagen in cytoplasm of fibroblasts and collagen fibers. The imunoreactivity for type III collagen in the neo-tendon of II-A experimental group increased than control. The concentration of collagen of the neo-tendon was significantly increased on I-A and II-A experimental groups compared with control (p<0.05). Collagen concentration of the neo-tendon of II-B experimental group increased significantly compared with control and I-B and III-B experimental groups (p<0.05).
Conclusion: These results suggest that low intensity pulsed ultrasound therapy on injured Achilles tendon may be of benefit such as increasing collagen synthesis in the early healing process, especially in proliferative phase.
Objective: To verify the correlation between auditory event-related potential and Cognitive Capacity Screening Examination (CCSE) in patients with brain lesion.
Method: P300 study using an auditory paradigm was performed in thirty patients with brain lesion, age ranged from thirteen to seventy-three years-old, and then was compared with the score of CCSE.
Results: The mean latency of P300 was 383.07⁑50.63 msec. The mean score of CCSE was 17.10⁑8.62. There was no significant difference in P300 latency and score of CCSE between male and female, and among the types of brain lesion. There was significant negative correlation between P300 latency and score of CCSE (p<0.05, r=0.686), between score of CCSE and age (p<0.05, r=0.364). There was significantly high intra-rater reliability in P300 latency study (alpha=0.9771).
Conclusion: We conclude that P300 electrodiagnostic study is useful for reflection of cognitive function in patients with brain lesion.
Objective: The purpose of this study was to determine whether 1H magnetic resonance spectroscopy (MRS) is a potential tool for the detection of microscopic diffuse axonal injury (DAI) and for the evaluation of functional status of patients with traumatic brain injury (TBI).
Method: Seven patients with severe TBI and fourteen normal control volunteers were examined. Image guided spectra of localized in vivo 1H MRS were obtained from parietal white matter (PWM) and occipital gray matter (OGM) in which definite abnormality was not detected in MR imaging. The severity of TBI was evaluated by the initial Glasgow Coma Scale (GCS), and the functional status was evaluated by Functional Independence Measure (FIM) at the time of the MRS examination, approximately 2 months after onset.
Results: In PWM, the [N-acetylaspartate(NAA)/Creatine(Cr)] ratio was significantly lower, and the [Choline(Cho)/Cr] and [myo-Inositol(mI)/Cr] ratios were significantly higher in the patients with TBI than those of normal volunteers. There was no significant correlation between the ratios of metabolites and GCS scores. However, interestingly, a significant correlation between the [NAA/Cr] ratio in PWM and the FIM scores was observed.
Conclusion: We could conclude that decreased [NAA/Cr], increased [Cho/Cr], and increased [mI/Cr] ratios in PWM can be considered as markers for DAI. Localized 1H MRS has a potential to be used for the detection of DAI in vivo and evaluation of functional status of the patients with TBI.
Objective: The ability to get up from a chair is an important component in maintaining independence and a prerequisite for upright mobility for stroke patients. The purpose of this study was to compare the sit-to-stand movement in stroke patients with that in healthy adult.
Method: Twenty-three stroke patients and thirty-seven young healthy subjects were included in this study. Subjects sat on an adjustable chair with their feet on force plates and performed the standing up movement at a self-paced, comfortable speed. The study patients were tested barefoot. The changes in joint angle, maximal moment, power, and ground reaction force in lower limb were calculated using 3 dimensional motion analyzer throughout the sit-to-stand transfer.
Results: The mean time needed was significantly longer in stroke patients than in young healthy subjects. Pelvic tilting and hip flexion angle at initial and final angle were significantly greater in stroke patients than in young healthy subjects. Maximal momentum, power and change of ground reaction force in ankle joint were significantly lower in stroke patients than in young healthy subjects. Hip external rotation angle at standing point showed significant correlation with maximal hip external rotation and slow walking speed during the comfortable walking.
Conclusion: We concluded that the analysis of sit-to-stand movement in stroke patients may provide a useful guide for gait recovery and training.
Objective: This study was done to evaluate the risk factors associated with recurrence after first-ever stroke.
Method: We retrospectively studied 256 first-ever stroke patients treated in Dong-Eui hospital from March 1997 to February 1998. Telephone or out-patient interviews were performed with these patients regarding stroke recurrence and treatment for hypertension and diabetes mellitus. These were divided into two groups, those with recurrence and those without. Evaluated risk factors for stroke recurrence were the following: history of diabetes mellitus, hypertension, heart disease, smoking, alcohol drinking, and transient ischemic attack; clinical findings at admission of hypertension, diabetes mellitus, hyperlipidemia, heart disease, type and location of stroke; treatment compliance for diabetes mellitus and hypertension after discharge.
Results: The recurrence rate after first-ever stroke was 12.9%. In univariate analysis, significant risk factors for stroke recurrence were history of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge (p<0.05). In multivariate analysis, significant risk factors for stroke recurrence were atrial fibrillation at admission (odds ratio=3.43) and non-compliance with therapy for hypertension after discharge (odds ratio=7.51)(p<0.05).
Conclusion: History of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge are considered to be important factors for recurrence of stroke. So treatment and education for those factors associated with stroke recurrence are needed during rehabilitation program.
Objective: The purpose of this study was to evaluate the prognostic value of sleep apnea syndrome in stroke patients by polysomnography.
Method: Fifteen patients with ischemic stroke were studied with polysomnography. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded. Patients were observed by physician for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Modified Barthel Index (MBI). To evaluate the autonomic nervous system, heart rate variability (HRV) study was done.
Results: Mean SaO2 during polysomnography was 88.2%, and mean recording time was 321 minutes. Apnea types were obstructive, mixed, and central. Respiratory Distress Index (RDI) correlated with functional outcome and mean SaO2. HRV study showed no significant changes under the orthostatic stress in apnea patients.
Conclusion: We concluded that the sleep apnea syndrome could be a prognostic factor in rehabilitation outcome of stroke.
Objective: The purpose of this study was to investigate the effect of dietary soluble fibers added to nasogastric tube-fed formulas and to compare the difference of the degree of diarrhea according to the amount of dietary soluble fibers in stroke or traumatic brain injury patients for comprehensive rehabilitative management.
Method: Fifty-two stroke or traumatic brain injury patients fed by nasogastric tube due to dysphagia were included. They received fiber-free formulas for the first 30 days and then they were randomly assigned to three groups, including the control (fiber-free) group, moderate fiber (3.5 gm fiber/L) group and high fiber (7 gm fiber/L) group. Each group received their respective formulas for the next 30 days. We compared diarrhea score and frequency.
Results: In the control group, the degree of diarrhea was not changed with time. In the moderate and high fiber groups, daily diarrhea score and monthly diarrhea frequency were low compared to the control group (p<0.05). Also, the incidence of pseudomembraneous colitis was low in fiber groups.
Conclusion: We concluded that adding dietary soluble fibers to nasogastric tube-fed formulas may be helpful to reduce the diarrhea and the development of pseudomembraneous colitis. The proper fiber amount will be determined through the following more case studies.
Objective: This study was designed to examine swallowing function of 16 head and neck surgical patients who had postoperative swallowing difficulties and to identify the relationship between the physiologic causes of aspiration and the surgical procedure in each patient.
Method: Group A was five patients who had partial pharyngolaryngectomy due to hypopharyngeal cancer, Group B was nine patients who had wide excision due to oral cavity cancer, and Group C was two patients who had supraglottic horizontal laryngectomy due to supraglottic laryngeal cancer. Their swallowing function was evaluated with videofluoroscopic swallowing study (VFSS).
Results: Aspiration occurred in 40% of patients with partial pharyngolaryngectomy, 44% of patients with wide excision, and 100% of patients with supraglottic horizontal laryngectomy. Group A showed swallowing difficulty because of reduced laryngeal closure and reduced pharyngeal peristalsis. Group B showed swallowing difficulty because of reduced pharyngeal peristalsis, reduced laryngeal function, and impaired tongue control. Group C showed swallowing difficulty for impaired tongue control, reduced laryngeal function, reduced pharyngeal peristalsis, and late swallowing reflex. Most of the patients who had had head and neck cancer surgery can regain normal swallowing function after adequate swallowing rehabilitation.
Conclusion: Each group of head and neck surgical patients had different cause of swallowing difficulty. The knowledge of the determinant component of swallowing pathophysiology is important for successful swallowing rehabilitation.
Objective: The purposes of this study are to estimate the proper replacement time of percutaneous endoscopic gastrostomy Foley catheter for prevention of accidental expulsion from the stomach, and to identify factors influencing deflation of balloon.
Method: Silicone Foley catheters (22 Fr) were placed and compared in the different environments: 1) different acidity (pH 1, 2, 3, 4, 7), 2) static versus dynamic (100 RPM) environment. The balloon capacity of 30 ml versus 5 ml inflated with 5 ml of normal saline were compared. Mean time interval of deflation of balloon down to the capacity of 2.5 ml and 1 ml was estimated and compared respectively.
Results: The results showed no significant difference of the decrease of the balloon of the Foley catheters in each acidity except for pH 1 and dynamic environment. But capacity of balloon could affect deflation. The mean days of deflation of total Foley catheter down to 2.5 ml and 1 ml were 23.5⁑5.3 and 42.2⁑7.2 days respectively.
Conclusion: Physiological gastric acidity and dynamic environment did not affect the deflation of the Foley catheter significantly, but the capacity of the balloon affected it. And suggested proper time of the replacement of the Foley catheter gastrostomy tube is ranged from 24 to 42 days after exchange.
Objective: Rising from a sitting position is very common, yet essential activity in daily life. The activity to perform the sit-to-stand (STS) transfer is a prerequisite for upright mobility. The children with spastic hemiplegic cerebral palsy have postural asymmetry and unequal development of movement patterns of the two sides, which may influence on STS pattern in these children. This study is aimed to evaluate STS pattern in cerebral palsied children with spastic hemiplegia, in comparison with the normal children.
Method: Twelve young children with spastic hemiplegic cerebral palsy and 21 normal developed children were recruited as subjects. A motion analysis system using a Motion analyzer (Vicon 370 M.A. with 6 infrared cameras) was used to examine the STS task. The changes in joint angle, moment, and power of each joints in lower limbs, total duration of STS transfer and each transitional points were assessed.
Results: Total duration of STS and the first phase duration of forward trunk lean (from T0 to T1) was significantly prolonged in hemiplegic children (2.09 sec; 0.70 sec) in comparison with those of normal control children (1.13 sec; 0.32 sec). Maximal hip extension power and maximal knee extension moment and power were significantly decreased in plegic side (0.53 W/kg; 0.14 Nm/kg; 0.18 W/kg) than in sound side (0.79 W/kg; 0.33 Nm/kg; 0.48 W/kg) of hemiplegic children and normal control children (1.28 W/kg; 0.39 Nm/kg; 0.58 W/kg). Maximal ankle dorsiflexion was significantly increased in the sound side (27.8o) of hemiplegic children than in plegic side (22.5o) and normal control children (21.9o).
Conclusion: Characteristics through the kinematic and kinetic analysis of STS transfer was identified in spastic hemiplgic cerebral palsied children. Slowness of speed, decreased power generation of knee and hip of plegic side and asymmetric movement of joint angles in these patients were major characteristics which were distinct from normal control children. Slowness of speed of STS was thought to be mainly from prolongation of first phase.
Objective: The objectives of this study were to evaluate the reliability of the Korean version of Spinal Cord Independence Measure (SCIM) and to compare the sensitivity of the SCIM to functional changes of spinal cord injury (SCI) patients with that of the Functional Independence Measure (FIM).
Method: Seventeen subjects with SCI were studied. The SCIM was translated and modified to convert as SCIM Korean-version. All patients were evaluated with the SCIM and the FIM by two raters every other week. To determine inter-rater reliability, the relationship between the SCIM scores obtained by two raters was evaluated by Kappa coefficient and linear regression. To determine relative sensitivity of the test to functional changes, changes in the scores on the SCIM and FIM were compared by McNemar test.
Results: The Kappa coefficient of the various individual tasks in SCIM ranged between 0.63 and 1.00. High correlations were also found between the total SCIM scores for the paired raters (r=0.99, p<0.01). The SCIM detected all the functional changes detected by FIM total scoring, but in 3 (14%) of 22 sequential test batteries, the FIM missed changes detected by SCIM total scoring.
Conclusion: These results demonstrated that the SCIM is reliable and more sensitive than the FIM in reflecting the functional changes of SCI patients.
Objective: The purpose of this study was to determine the clinical usefulness of KCl provocative urodynamic study in spinal cord injured patients with neurogenic bladder.
Method: Urodynamic studies using normal saline and 0.2 M KCl solution were performed on 46 spinal cord injured patients. The reflex volume was measured on urodynamic study using normal saline and 0.2 M KCl solution. If the reflex volume using KCl solution was smaller than 85% of reflex volume using normal saline, it was considered as positive response. Urine culture and urinalysis were also performed before urodynamic study.
Results: KCl provocative tests showed positive response in patients showing current infection on urine culture and urinalysis (p<0.05). Comparing with the positive response group and negative response group, mean maximal bladder capacity was smaller and mean bladder compliance was lower in the positive response group (p<0.05). No significant differences were found between positive and negative response groups according to age, duration since injury, completeness of injury, voiding methods, and anticholinergic medication. The mean reflex volume provoked by KCl solution was smaller and mean bladder compliance provoked by KCl solution was lower than those provoked by normal saline in the positive response group (p<0.01).
Conclusion: The response of KCl provocative test suggested increased bladder-blood-urine barrier permeability by current urinary tract infection. We conclude that the KCl provocative urodynamic study is a useful method for detection of impaired bladder-blood-urine barrier in spinal cord injuries with neurogenic bladder.
Objective: To investigate the difference of outcome variables and demographic features between traumatic and non-traumatic spinal cord injury (SCI) patients.
Method: Medical records of 87 spinal cord injured patients were retrospectively reviewed. The patients were divided into traumatic and non-traumatic groups. The etiology, level and completeness of SCI were investigated. The functional evaluation was performed by Frankel's classification, American spinal cord injury association (ASIA) motor and sensory scores, and modified Barthel scores at the time of admission and discharge. Bladder function and emptying method were also investigated.
Results: Spinal cord injury of non-traumatic etiology was more likely to result in a incomplete injury and more prevalent in females. At admission, the ASIA motor and sensory scores and modified Barthel index of non-traumatic spinal cord injury patient were higher than those of traumatic patients. At discharge, same results were observed for ASIA motor and sensory scores, but the modified Barthel scores showed no difference between the two groups. The changes of the scores between time of admission and discharge showed no significant difference in the two groups. There was no significant difference of bladder type and bladder emptying method.
Conclusion: This study suggest that favorable outcome in non-traumatic spinal cord injury patients might be due to better functional status at the time of admission and not due to the degree of recovery.
Objective: The purpose of this study was to investigate the dose-dependent responses to botulinum toxin A (BTX-A) injection on compound muscle action potential (CMAP) amplitude and needle electromyography (EMG) in local and distant muscles.
Method: The BTX-A (Botox®, Allergan Co.) was injected to the left tibialis anterior (TA): 2, 4, 6, 8 U for each 4 Sprague-Dawley rats; 5, 10, 15, 20 U for each 2 rats. The sciatic nerve conduction and needle EMG were performed in the right and left TA immediately before BTX-A injection, on 2 days after injection, weekly for 1 to 10 weeks, and then monthly for 4 months.
Results: The range of dose-dependent maximal paralysis of the injected muscle was from 94% to 99.2% on 7 days after injection. With the lapse of time, the amplitudes in the left sciatic nerve conduction recovered, the abnormal spontaneous activities disappeared, and the power in spectral analysis of motor unit action potential increased. The range of dose-dependent reductions of the CMAP amplitude of the right TA was from 41.8% to 69.9% in the distant muscle, but there was no abnormal spontaneous activity in needle EMG study. As higher doses of BTX-A were injected, the degree of amplitude reduction became larger and the duration of amplitude reduction became longer in both local and distant TA muscles.
Conclusion: We observed the dose-dependent muscle paralysis with injection of BTX-A. The systemic effects by local injection were induced and the durations of local and systemic effects were proportional to the BTX-A dosage.
Objective: To study the changes of magnetic evoked potentials by thinking of simple motion without actual muscle action of that motion.
Method: We use H-reflex to test the excitability of relevant pools of spinal motor neurons and Magnetic Evoked Potentials (MEPs) to study the core of brain motor activity. The H-reflex and MEPs were obtained in three different conditions. 1) non-facilitation (NF), that is, resting state without actual motion and without thinking of that motion. 2) volitional-faciliation (VF), with actual motion which is usual manner of facilitation of MEPs. 3) thinking-facilitation (TF), without actual motion but with imaginary thinking of that motion. We evaluate the thresholds, amplitudes and latencies of H-reflex and MEPs in each three condition.
Results: Comparing with the parameters in NF condition as a baseline, there were no significant changes in any parameters of H-reflex in TF condition, but there were significant changes in threshold and amplitude of H-reflex in VF. On the while there were significant changes both in VF and TF of MEPs. The amount of facilitation of MEPs were greater in VF than in TF; the amount threshold decrement, amplitude increment and latency decrement of MEPs were greater in VF than in TF.
Conclusion: Thinking of simple motion without actual muscle action of that motion could facilitate the MEPs, and this facilitation is induced by increasing activity of brain motor cortex not by that of spinal cord level.
Objective: High body temperature may alter nerve conduction in demyelinated neurons. This study was designed to investigate the changes in nerve conduction parameters in response to the heat applied over the wrist in the patients with carpal tunnel syndrome (CTS).
Method: 16 hands of CTS patients and 16 hands of normal subjects were involved in this study. Motor and sensory nerve responses were measured at 32oC and 42oC in all the subjects. Infrared was applied on the wrist to warm the skin to 42oC. Changes of relative amplitude, duration, and latency of evoked potentials in median sensory and motor nerves of CTS patients were compared with those of the normal subjects. Correlation between the latency measured at 32oC and changes of amplitude of motor and sensory nerve responses after warming to 42oC was evaluated in CTS group.
Results: Relative reduction in duration of motor responses in CTS group was significantly greater than in normal group. Relative reduction of motor and sensory amplitude, and sensory latency were greater in CTS. There was no significant relation between motor and sensory latency at 32oC and relative amplitude reduction in motor and sensory responses at 42oC.
Conclusion: Increase in temperature may increase the number of blocked nerve fibers in patients with CTS than in normal subjects.
Objective: The purpose of this study was to evaluate therapeutic effect of local steroid injection in carpal tunnel syndrome, and to make a comparison between therapeutic effect in patients with and without diabetic neuropathy.
Method: 30 patients (40 hands) with carpal tunnel syndrome diagnosed clinically and electrophysiologically were injected with 40mg of methylprednisone. Patients were evaluated with the visual analogue scale after 4 weeks and 8 weeks. According to the therapeutic responses, the patients were grouped into: excellent; good; poor; failed; recurrent.
Results: After 4 weeks, symptom relief was noted in the 95% of all cases: 100% of the patients without diabetic neuropathy; 82% of the patients with diabetic neuropathy. After 8 weeks, symptom relief was noted in the 82.5% of all cases: 86% of the patients without diabetic neuropathy; 73% of the patients with diabetic neuropathy. There was no statistically significant difference between the patients with and without diabetic neuropathy (p>0.05).
Conclusion: We concluded that local steroid injection in carpal tunnel syndrome was an effective therapeutic modality for a short term and local steroid injection in the carpal tunnel syndrome with diabetic neuropathy diagnosed by palmar test also had a good effect.
Objective: To analyze the patterns of isokinetic knee torque curves in normal population and determine the characteristics of those curves.
Method: Two hundred and eightly-six normal subjects were included. The isokinetic knee torque curves were divided into three parts; to the angle of peak torque generation, to the point 10∼20 degrees prior to end of joint motion, and to the end of joint motion. Each part was classified as convex(1), flat(2) and concave(3) type according to the shape. The curves were named such as 1-2-2 in order. Types of the curves, peak torque, angle of knee at peak torque, total acceleration energy, age, and sex of the subjects were compared.
Results: For knee extensors, frequencies of the curve types were 1-2-2(A), 1-2-1(B), 1-3-1(C), and 1-3-2(D). Mean ages of type A and B curves were slightly higher than types of C and D. Mean peak torque was greatest in type D. For knee flexors, the frequencies were 1-2-2(A), 1-2-1(B), and 1-1-2(C). Female predominance were found in type B while type C was found mostly in male. Mean peak torque was greatest in type C.
Conclusion: The most common torque curve type was 1-2-2 for knee extensors and flexors. Torque curve types of knee extensors showed differences in age and torque curve types of knee flexors showed differences in sexual distribution.
Objective: The purpose of this study is to evaluate objectively and quantitatively gait improvement after total hip arthroplasty (THA) using a 3-dimensional computerized Vicon motion analyzer.
Method: A preoperative gait evaluation was performed within one month before surgery and two postoperative gait evaluations at 6 months intervals after surgery. Pre- and postoperative gait parameters of 176 patients with unilateral total hip arthroplasty were evaluated and data were compared with those of 56 healthy persons.
Results: 1) Single limb support of affected limb increased significantly at postoperative 6 and 12 months compared with preoperative data. 2) The improvements of hip flexion and abduction of affected limb were in almost normal range at postoperative 12 months. 3) Maximal hip flexor moment in terminal stance of affected limb reached to nearly normal level at postoperative 12 months.
Conclusion: A quantitative gait analyzer is a very useful tool to assess objectively the success of THA as substantiated by the results of this study with a significant improvement in all the parameters of gait., Unilateral total hip arthroplasty, Gait analysis, Kinematics of hip joint
Objective: To investigate the effect of therapeutic exercise on patients with osteoarthritis of knee in view of functional capacity.
Method: The subjects were 80 patients with osteoarthritis of knee. Patients were randomly allocated to exercise or no exercise (control) group. Osteoarthritis was diagnosed on the base of clinical features, X ray findings. Therapeutic exercise was consisted of quad-setting exercise, isokinetic exercise, squatting exercise. Effects of therapeutic exercise were evaluated by muscle function, functioal performance and degree of pain.
Results: In exercise group, muscle function such as torque and endurance of extensor and flexor of knee were increased significantly compaired with control group (p<0.05). Increment was more apparent in extensor. In both group, pain was decreased but more apparent in exercise group (p<0.05). Functional performance was assessed in terms of dependency, difficulty and amount of pain. Exercise group showed improvement of functional performance in walking inside, climbing stairs (p<0.05) but control group did not show improvement. Seventy percent of patients with osteoarthritis of knee showed increment of body weight above 10 kg compaired with their twenties.
Conclusion: When we manage the osteoarthritis of knee, therapeutic exercise should be included in the treatment regimen as well as physical and medical therapy.
Objective: To determine the therapeutic effect of transforaminal epidural injections in patients with refractory lumbar radicular pain.
Method: Thirty-five patients with lumbar radicular pain who did not receive any other interventional procedures were studied. Transforaminal epidurograms and epidural steroid injections via eighty-nine intervertebral foramens were performed under C-arm fluoroscopic visualization. After confirmation of proper needle placement, 20∼40 mg of triamcinolone and 1 cc of 2% lidocaine hydrochloride were injected into each safe triangle of the intervertebral foramen. Patients were evaluated for visual analogue scale (VAS) and straight leg raising (SLR) test at pre-injection, 1 week post-injection and 3 months post-injection. Changes over time were assessed statistically using ANOVA.
Results: The averages of VAS reduced significantly (p<0.05) from 5.6⁑1.8 at pre-injection, to 3.5⁑1.7 at 1 week pos-tinjection, to 2.1⁑2.0 at 3 months post-injection, respectively. The averages of SLR augmented significantly (p<0.05) from 51.6o⁑16.7o at pre-injection, to 66.6o⁑16.0o at 1 week post-injection, to 77.2o⁑15.1o at 3 months post-injection, respectively. Twenty-six out of thirty-five patients (74.3%) had a successful long-term outcome, reporting at least an over 50% reduction between pre-injection and 3 months post-injection in VAS.
Conclusion: Transforaminal epidural injection is an effective treatment for patients with lumbar radicular pain when evaluated after 1 week and 3 months post-injection.
Objective: To evaluate (1) the effect of chronic low back pain on bone mineral density, and (2) the effect of chronic low back pain on trunk muscle strength in women.
Method: Subjects were 118 women patients (ages of 28∼65 years) suffering from chronic low back pain more than three months and control groups were 218 healthy women (age of 26∼72 years). We measured bone mineral density (BMD) at the lumbar spine and proximal femur using Dual X-ray absorptiometry and trunk muscle strength using Cybex 660 dynamometer.
Results: There was no significant difference between groups in lumbar spine BMD, in proximal femur BMD, or in trunk flexor muscle strength. However, trunk extensor muscle strength was reduced significantly in patient group. Trunk extensor muscle peak torque was 64.69⁑18.48 Nm in the patient group and 73.84⁑22.50 Nm in the control group in 30o/sec, and 58.65⁑18.59 Nm in the patient group and 65.68⁑20.28 Nm in the control group in 60o/sec.
Conclusion: The results suggest that chronic low back pain does not affect the BMD. However, it causes trunk extensor muscle weakness; therefore, trunk extension exercise will be help to the patients with chronic low back pain.
Objective: To examine the correlation between the prevalence and the risk factors of low back pain.
Method: The number of subjects in this study was 575 men and 325 women who have visited the health center of the CHA hospital. The prevalence of low back pain was evaluated and the risk factors were assessed by history taking, physical examination and the questionnaires. Estimated factors influencing low back pain were age, sex, height, weight, body mass index, waist to hip ratio, range of motion, smoking, alcohol drinking, fitness and other disease.
Results: 1) Low back pain was correlated with age, sex, waist to hip ratio, flexibility, arthritis, nervous and depressive disorder and daily activities. 2) Chronic low back pain was correlated with age, right lateral bending, arthritis, cardiovascular disorder and daily activities. 3) Radicular symptom was correlated with age, left and right lateral bending, smoking, exercise, arthritis, nervous and depressive disorder, diabetes and daily activities. 4) Height, weight, body mass index and alcohol drinking had no correlation with low back pain.
Conclusion: Understanding of the risk factors for low back pain will be helpful for providing objective standards for assessment of low back pain and preventing occurrence and recurrence of low back pain.
Objective: The purpose of the this study was to determine whether pain location indicated in pain drawings was related to the specific lumbo-sacral radiculopathy.
Method: The study group consisted of 153 patients (62 men, 91 women) complaining low back pain with or without radiating pain. Nerve conduction study and electromyographic evaluation were performed for the diagnostic purpose. Chi-square test and multivariate stepwise discriminant analysis were used to identify the patients with radiculopathy on the basis of their pain drawings.
Results: There was significant relationship between pain location indicated in the pain drawing and the lumbar radiculopathy (p<0.05). In patient without the anterolateral thigh pain, the positivity of S1 radiculopathy was high. In patients with anterolateral thigh and leg pain without posterior thigh pain, the positivity of L5/S1 radiculopathy was high. For predicting the level of the lesion there were three discriminant functions (p<0.05). Patients with S1 radiculopathy showed negative correlation with anterolateral thigh pain. L5/S1 radiculopathy showed negative correlation with posterior thigh pain but were predicted by pain drawing on anterolateral lower leg.
Conclusion: The results of this study indicate that pain drawings may be helpful in identifying specific radiculopathy. As with any evaluation, the drawings should be considered in combination with findings from other diagnostic methods and interpreted with caution and in light of the full clinical picture.
Objective: This study was aimed to demonstrate definite diagnostic radiologic criteria between normal and flatfoot.
Method: Sixty healthy subjects and fifty two flatfoot cases were evaluated by radiologic measurements. We evaluated criteria for longitudinal arch curve by measuring of calcaneal pitch, talocalcaneal angle, talometatarsal angle, metatarsal angle and navicular height I and II.
Results: Over 10 years old, there was significant correlation between normal group and flatfoot in calcaneal pitch, talocacaneal angle, difference angle, metatarsal angle, navicular height I and II. But below 10 years old, there was difference in only talometatarsal angle and metatarsal angle. Therefore talometatarsal angle and metartarsal angle are valuable in diagnosis of flatfoot in all age group.
Conclusion: In diagnosis of flatfoot, variable radiologic measurement are clinically significant.
Objective: Day hospital program for the brain injured patients has been developed and conducted as a model project in the National Rehabilitation Hospital of Korea since August 1998. This article is to present our 1-year experience and evaluate the efficacy and effectiveness of the program.
Method: All patients treated in day hospital from August 1998 to July 1999 were included. Functional Independence Measure (FIM), ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status), Medical Outcome Study 36-item Short Form Survey (SF-36) were assessed at admission and discharge. Patient satisfaction was surveyed at discharge. Program cost was compared with that of inpatient control group.
Results: 1) Among 51 subjects (32 males, 19 females, mean age 57), 48 suffered stroke and 2 had traumatic brain injury. Average length of stay was 10 weeks and 45 patients (88.2%) were discharged to home. 2) FIM total score, motor subtotal score and cognitive subtotal score were all incresed significantly (p<0.01). 3) ESCROW score was also improved significantly (p<0.01). 4) SF-36 showed significant improvement in physical functioning, role limitation-emotional, mental health and general health (p<0.05). 5) 95.1% answered satisfaction with the program and 73.2% reported health enhancement. 6) Program costs were significantly lower than the inpatient group (p<0.01).
Conclusion: Day hospital seems to be a useful program for comprehensive rehabilitation for the brain injured, and needs to be pervaded throughout the country with proper payment.
Neurilemmoma is benign neurogenic tumor which arise from the sheath of Schwann, its incidence on cervical nerve root are very rare. The patient with cervical root involvement presents pain or sensory disturbances of the upper extremity, neck, and/or chest wall. Usually, symptoms caused by pressure on the sensory and motor nerve roots with tumor mass. We report a patient with C8 dorsal nerve root neurilemmoma, with the brief review of literature.
A 43 years old woman had suffered from a lower back pain for 2 months. She experienced pain aggravation after spinal manipulative therapy that was practiced by non-licentiate. Physical examination showed tenderness on L1 and L2 spinous processes. Radionuclide bone scan with 99mTc-MDP showed increased radioactivity of L1, L2 vertebral bodies. The MRI finding showed low signal intensity of L1 and L2 vertebral bodies in T1-weighted image and high signal intensity in T2-weighted image. Needle biopsy finding showed fibrosis and inflammatory cell invasion of bone marrow. We concluded that she had tuberculous spondylitis and non-detection or negligent treatment of a preexisting disease contributed to aggravation of her symptoms.
We report one case of tuberculous spondylitis aggravated by spinal manipulative therapy with review of literatures