Since average life expectancy has improved in the last century, the percentage of the elderly population has been gradually increased. The World Health Organization makes a statement that health is a state of not only the absence of disease, but also complete physical, mental or social well being. For this reason, exercise is broadly recommended for almost all the elderly.
The benifits of exercise for the elderly include a significant reduction in risk of coronary heart disease, hypertension,
diabetes, obesity, osteoporosis, and a improvement of cardiovascular fitness, independency in activities associated with daily living, and the quality of life.
This article gives an account of the benifits and considerations of regular exercise in the elderly, and critically reviews the literature on proper intensity, duration, frequency, and type of exercise at both aerobic/endurance training and strength/resistance training prescribed in older adults. (J Korean Acad Rehab Med 2002; 26: 121-126)
Objective: To find out the characteristics of the foot pressure distribution and the path of center of pressure (COP) in the children with cerebral palsy, compared with normal control children.
Method: Twenty-four children with spastic cerebral palsy (CP) and 38 normal children were participated in this study. The parameters of foot contact, plantar pressure and COP were measured using F-scan system (Teksan Inc.) with pressure sensitive insoles inserted in the shoes.
Results: The total contact area, mid foot contact width and also the pressure of hallux and medial side of mid foot were significantly higher in the children with CP than in normal
controls. While the pressure of hind foot was significantly lower in the children with CP compared with normal controls. Anteroposterior distance and velocity of COP were significantly lowered in the cerebral palsied children. The paths of COP of both groups were directed inwardly without any significant differences between both groups.
Conclusion: We can identify the characteristics of the foot pressure distribution and the path of COP in the children with spastic CP using F-scan system. These quantitative data of foot scan may be useful for evaluating the foot pathology during the gait in the children with CP. (J Korean Acad Rehab Med 2002; 26: 127-132)
Objective: To investigate the relationships between scoliosis and kyphotic or lordotic posture in Duchenne muscular dystrophy (DMD) patients, this study explored the factors influencing the development of spinal deformity.
Method: Twenty five DMD patients with scoliosis were conducted to roentgenographic study to obtain Cobb's angle. In addition, rotation grade of the spine, as well as the degree of kyphotic and lordotic postures were obtained using the Moe pedicle method, kyphotic index and lumbosacral angle respectively. The data were assessed for the correlations among spinal deformities as well as the evaluation of functional state. After comprehensive rehabilitation programs for six months including scoliosis correction exercise, breathing exercise and thoracolumbosacral spinal orthosis, the effects of spinal deformity and pulmonary function were analyzed. An age-matched control group of 15 male patients
with scoliosis were analyzed and compared with the experimental group.
Results: In the experimental group, the scoliosis angles were negatively correlated with kyphotic index (r=0.80, p＜ 0.01). In the control group, no correlations of statistical significance were detected among different types of spinal deformity. In addition, the rotation grade was found to be positively correlated with the scoliosis angle in the experimental group (r=0.89, p＜0.01). Furthermore, the larger the scoliosis angle, the patients functional state was found to be poorer (r=0.56, p＜0.01).
Conclusion: In DMD patients, a strong correlation was found between the scoliosis and kyphotic posture. For the prevention of kyphotic posture, further study on the relevant therapeutic approach would be needed. (J Korean Acad Rehab Med 2002; 26: 133-139)
Objective: To determine the effects of the voluntary contraction of muscles and magnetic stimulation intensity on the motor evoked potential (MEP) and the silent period (SP).
Method: We studied MEPs and SPs in opponens pollicis muscle in 30 healthy adults (male: 16, female: 14) while varying the amount of the voluntary contraction and the stimulation intensity. We analyzed MEPs and SPs in relation to sex, recording site, opposition power and height.
Results: 1) During the contraction, the latencies of MEP were significantly shorter than during the relaxation. 2) The amplitudes of MEP reached plateau at 30% of maximal voluntary
contraction and increased with increment of stimulation intensity without limitation. The amplitudes of MEP of right hand were bigger than left hand. There were no significant differences according to sex and recording site. 3) The durations of SP were directly proportional to the degrees of voluntary contraction and the stimulation intensity.
Conclusion: Transcranial magnetic stimulation should be performed under the same voluntary contraction and magnetic stimulation intensity. (J Korean Acad Rehab Med 2002; 26: 140-146)
Objective: To evaluate the usefulness of the sural/superficial radial sensory nerve action potential amplitude ratio (SRAR) in the electrodiagnosis of diabetic polyneuropathy.
Method: Nerve conduction study was performed in 80 diabetic patients and 31 normal adults. Standard nerve conduction studies were performed. Sural nerve response was recorded with the active electrode on the posterosuperior margin of the lateral malleolus and stimulation 14 cm proximally. Superficial radial nerve response was recorded with the active on the snuffbox and stimulation 10 cm proximally. Baseline-to-peak sensory nerve action potential (SNAP) amplitudes were measured, and SRAR were obtained. The diabetic group was subdivided into an electrophysiologically normal group (DMNL, n=32) and neuro-
pathy group (DMPN, n=48). SRAR was compared among the control (NORM, n=31), DMNL and DMPN groups.
Results: SRAR was 0.344 in NORM, 0.314 in DMNL and 0.145 in DMPN, respectively. SRAR showed 77.1% sensitivity and 93.8% specificity. Sural SNAP amplitude sensitivity was 85.4% and specificity, 88.7%.
Conclusion: The relatively high specificity of SRAR indicates its usefulness in the diagnosis of diabetic polyneuropathy. However, as the superficial radial sensory SNAP amplitude decreased significantly in the diabetic groups compared to control, the SRAR is not superior to the sural SNAP amplitude in the diagnosis of diabetic polyneuropathy. (J Korean Acad Rehab Med 2002; 26: 147-151)
Objective: The purpose of this study was to measure the local and distant effects of BTX-A of different dosage through the electrophysiologic study.
Method: Sixteen Sprague-Dawley rats were used and divided into four groups by the dosage of BTX-A (Botox®, Allergan Co.): 2, 4, 6, 8 U for each of the four rats. BTX-A was injected into tibialis anterior (TA) muscles. Slow rate (3 Hz) and fast rate (20 Hz) repetitive nerve stimulation test (RNST) was performed before and after BTX-A injection. The schedule of postinjection was as follows: 2 days after the injection, every seven days till 10 weeks postinjection, once a month for 4 months.
Results: In the fast rate RNST of the treated TA muscle, dose-dependent increments were seen on the 2nd day postin-
jection and thereafter dose-dependent decrements appeared and weakened over the course of time. In the slow rate RNST of the treated TA, dose-dependent decrements were observed through ten weeks postinjection in all groups. In the fast rate RNST of the untreated TA, incremental responses were produced in all groups in a dose-dependent manner. In the slow rate RNST of the untreated TA, there were no changes.
Conclusion: The BTX-A injection causes local paralysis in the treated muscles and presynaptic dysfunction of the neuromuscular junction in the distant untreated muscles in a dose- dependent manner. This study could not be differentiated between neuromuscular dysfunction, myopathy or neuropathy through these RNST studies. (J Korean Acad Rehab Med 2002; 26: 152-160)
Objective: We measured current perception threshold (CPT) with transcutaneous electrical nerve stimulation (TENS) to prove the selective increment of the threshold of C sensory fiber and to determine onset time and duration of effect for application of TENS.
Method: TENS were applied to fifteen control volunteers for 20 minutes on hand three times per week for 2 weeks duration. The CPT was tested at the distal interphalangeal joint of the second finger with 5 Hz, 250 Hz, and 2,000 Hz in frequency, respectively. The test was repeated immediately and 30 minutes after cessation of TENS. These tests were performed on the first, eighth, and fifteenth day on application of TENS.
Results: The baseline CPT of C fiber was 32.7⁑6.4 102 mA, Aδ fiber 23.2⁑9.4 102 mA, and Aβ fiber 83.9⁑18.1 102 mA. At 30 minutes after cessation of TENS in the fifteenth day, the CPT of C fiber increased markedly and that of Aδ fiber increased a little. The CPT of Aβ fiber didn't increase for 2 weeks.
Conclusion: With application of TENS, the threshold of C and Aδ fibers selectively increased, especially 30 minutes after removal of TENS application. This effect was outstanding after 2 weeks' application. (J Korean Acad Rehab Med 2002; 26: 161-166)
Objective: This study was designed to assess the ulnar nerve using ultrasonographic measures at the elbow in patients with cubital tunnel syndrome.
Method: We examined 20 healthy men as control and 10 patients with cubital tunnel syndrome. We measured the short, long axis and area of ulnar nerve with the shoulder abducted at 60o and elbow fully extended posture in prone position. The mean age of control and patients were 46.4 (30∼60) years old and 48.8 (30∼61) years old, respectively.
Results: In normal group, the size of ulnar nerve at medial epicondyle, 5 cm proximal to medial epicondyle and 5 cm distal to medial epicondyle was 4.0×2.0 mm, 6.2 mm2, 3.7×2.1 mm, 5.8 mm2 and 3.7×2.0 mm, 6.0 mm2 respectively,
where as in the patients group, it was 5.7×2.9 mm, 13.1 mm2, 5.2×3.1 mm, 12.7 mm2 and 4.7×2.8 mm, 10.2 mm2 respectively. In cubital tunnel syndrome, the size of ulnar nerve was smaller in the distal portion of the medial epicondyle compared to the size measured at proximal or medial epicondyle. There was significant differences between the size of the ulnar nerve in controls and patients with cubital tunnel syndrome (p＜0.05).
Conclusion: The ultrasonography can accurately detect the morphologic changes in the ulnar nerve, so it will be useful in diagnosis of cubital tunnel syndrome. (J Korean Acad Rehab Med 2002; 26: 167-171)
Objective: To assess the median nerve compression with ultrasonography before and after the carpal tunnel release and to assess the correlation between electrophysiologic findings and ultrasonographic findings of the median nerve.
Method: We studied 50 hands of 29 patients diagnosed as carpal tunnel syndrome electrophysiologically and 20 hands of 19 asymptomatic controls. We evaluated the flattening ratio and compression ratio through the short axis and long axis of the median nerve by ultrasonography before carpal tunnel release, 2 weeks and 3 months after release. The correlation of the
improvement between the eletrophysiologic findings and compression ratio was analyzed.
Results: The compression ratio of the median nerve was decreased significantly after carpal tunnel release, compared with that before release. The decrease of the compression ratio correlated with the improvement of the electrophysiologic findings significantly.
Conclusion: The ultrasonography is useful to follow up the median nerve after carpal tunnel release. (J Korean Acad Rehab Med 2002; 26: 172-176)
Objective: MRI findings of adhesive capsulitis (AC) have been rarely documented even though the disease is a rather common disorder. To find reliable MRI parameters, we studied MRI findings of the patients with arthrographically-proven AC.
Method: Eighteen patients with AC (patient group) and eight subjects without AC (control group) were enrolled. Mean age of the former was 55.1 years and that of the latter was 41.4 years. Mean duration of the diseases in patient group was 5.9 months. Oblique coronal and axial MRI images of the shoulder were measured for the thickness of capsule and synovium around the axillary fold (TAF), volume of axillary recess (VAR), and volume of biceps tendon sheath (VBTS), which were com-
pared in both groups using unpaired t-test.
Results: TAF was significantly increased in patient group (p＜0.0001), and the thickened axillary fold greater than 5.1 mm was a useful MRI criterion for the diagnosis of AC with sensitivity of 93% and with specificity of 100%. VBTS was also significantly diminished in patient group (p＜0.05), whereas there was no significant difference in VAR between two groups.
Conclusion: TAF, especially greater than 5.1 mm, and decreased VBTS are useful MRI parameters for the diagnosis of AC of shoulder. (J Korean Acad Rehab Med 2002; 26: 177-181)
Objective: To know the clinically meaningful findings of ultrasonography in plantar fasciitis.
Method: Thirty one feet of 24 patients who had clinical diagnosis of plantar fasciitis and 70 feet of 35 healthy volunteers were evaluated with ultrasound. Sagittal sonograms were obtained in the prone position, and the plantar fascia thickness (PFT) was measured at proximal end near its insertion into the calcaneus. Hypoechogenecity, perifascial fluid collection, tendon rupture, calcaneal spur and calcification were also evaluated.
Results: The plantar fascia thickness (PFT) of the symptomatic heels (SH) of patients group (4.83⁑0.86 mm) was significantly greater than that of their asymtomatic heels (ASH) (2.95⁑0.57
mm)(p＜0.05) and it was also greater than that of control group (2.63⁑0.41 mm)(p＜0.05). The range of difference of both PFT was 0.7∼3.2 mm in patients group and 0∼0.8 mm in control group. Hypoechogenecity was found in 22 SH (71%), perifascial fluid collection in 5 SH (16%) and calcification in 2 SH (6%). Calcaneal bony spur was identified in 7 SH (26%) on simple radiography.
Conclusion: Increased thickness (＞3.8 mm), difference of thickness between SH and ASH (＞1.0 mm) and hypoechogenecity of plantar fascia were clinically meaningful ultrasonographic findings of plantar fasciitis, and ultrasonogrphy can be used as the inital imaging modality for the diagnosis. (J Korean Acad Rehab Med 2002; 26: 182-186)
Objective: The purpose of this study was to evaluate the correlation between each variable on occupational condition and foot deformity by Harris mat footprint.
Method: Subjects were 227 labors having no neurologic or musculoskeletal problems. They were evaluated by clinical history and Harris mat footprint. Three optional parameters of footprints were medial arch angle, metatatarsal arch grade, and hallux valgus angle.
Results: 1) Hallux valgus angles were significantly increased in group of female, above 39 years old, labor, and duration of duty more than 6 years. 2) Medial arch angles were signifi-
cantly decreased in female, above 39 years old, obese person, and labor. 3) Metatarsal arch grades were significantly increased in group of female, above 39 years old, and more than 20 numbers of conveyance, less than 6 years of duration of duty. Foot pain was not related to medial arch angle, metatatarsal arch grade, and hallux valgus angle, respectively.
Conclusion: These results suggest that deformity of foot were related to female, above 39 years old, obese person, position of duty, duration of duty, and standing time. So these peoples maybe helpful for weaning proper modified shoes. (J Korean Acad Rehab Med 2002; 26: 187-192)
Objective: The purpose of this study is to investigate the incidence and ratio of biphalangeal toes in Korean adult and to investigate whether this finding correlates with the evolution of human toes.
Method: The materials used in this study consisted of 1,290 radiographs of the human feet obtained from 645 adults with foot symptom and complete osseous growth. The 1,290 radiographs consisted of anteroposterior weightbearing radiographs and nonweightbearing oblique radiographs. Those were retrospectively reviewed and carried out of detailed macroscopic examinations.
Results: Biphalangeal toe was observed for the 5th toe in 934 cases (72.40%), for the 4th toe in 161 cases (12.48%), for the 3rd toe in 7 cases (0.54%), and for the 2nd toe in 1 case (0.08 %). Bilaterality of biphalangeal and triphalangeal toes for each toe was observed over 97.1%.
Conclusion: Our results are in agreement with Nakashima and it is likely that over 70% of the Asian population have only two phalanges in their fifth toes, and it seems to be an example of microevolution or genetic adaptation to bipedalism. (J Korean Acad Rehab Med 2002; 26: 193-197)
Objective: To evaluate the effects of a new periarticular injection in the patients with knee osteoarthritis.
Method: Twenty seven patients, who had knee pain, were met criteria of knee osteoarthritis of American Rheumatology Association. Two injection sites were used: one to infrapatellar fat pad and the other to near the insertion area of popliteus. At first, 1 cc of 0.5% lidocaine was injected to both sites. If pain was not releaved above 50%, a mixture of 1 cc of 0.5% lidocaine and 10 mg of triamcinolone acetonide was injected to twenty seven patients, 46 knees. All patients were evaluated visual analogue scale (VAS), time for 10 meter walking, time for stair up and down, isometric knee strength before and after
treatment. Paired student t test was done to investigate statistical significance of change of pain and function.
Results: Before treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 6.1⁑2.1, 10.4⁑3.6, 10.8⁑7.1 and 34.0⁑11.4 respectively. After last treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 3.5⁑2.5, 8.3⁑1.7, 8.2⁑3.6 and 38.8⁑12.9 respectively. The difference was stastistically significant between before and after treatment (p＜0.05).
Conclusion: The new periarticular injection is useful in treatment of patients with knee osteoarthritis. (J Korean Acad Rehab Med 2002; 26: 198-202)
Objective: The purpose of this study is to find out what is the effect of epidural corticosteroid injection on bone metabolism.
Method: We have assessed the systemic effects of a single epidural triamcinolone acetonide injection on biochemical indices of bone formation and resorption in patients with lumbosacral radiculopathy. Twenty patients who had lumbosacral radiculopathy and free from exposure to corticosteroid for at least 6 weeks were selected for this study. Patients were classifed as two groups; 1) epidural block with 2% lidocaine 3 ml and 0.9% normal saline 15 ml (4 men, 5 women; mean age 47.2⁑7.6 years) and 2) combination of triamcinolone acetonide 40 mg (5 men, 6 women; mean age 49.6⁑8.2 years). Fasting serum and the second voided urine were collected at 0, 1, 3, 7 and 14 days after the single epidural injection for bone-related biochemical
markers measurements.
Results: 1) Level of serum osteocalcin showed a significant time trend in the epidural corticosteroid injection group. Osteocalcin decreased dramatically from 11.2⁑3.4 ng/ml on day 0 to 5.9⁑2.8 ng/ml on day 1, 6.1⁑1.5 ng/ml on day 3 (p＜0.05). After the initial drop, the level recovered to 9.8⁑3.7 ng/ml by day 7, and returned to preinjection level on day 14, at 10.9⁑4.1. 2) Urinary deoxypyridinoline levels did not show any significant changes.
Conclusion: According to the above results, the epidural injection of corticosteroid may be a better therapeutic mode, with less potential for harmful effects to bone metabolism, in providing effective relief of symptoms to patients with lumbosacral radiculopaties. (J Korean Acad Rehab Med 2002; 26: 203-207)
Objective: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles after combination therapy of continuous hormonal replacement therapy (c-HRT) and alendronate in postmenopausal osteoporosis.
Method: We studied 89 women with postmenopausal osteoporosis (T-score＜2.5) who visited at Department of Rehabilitation Medicine, Kosin Medical Center from August 1999 to March 2001. Subjects were divided into two groups; Group I (n=40), treated with estrogen and alendronate (10 mg/day), and Group II (n=49), treated with estrogen alone. BMD at the lumbar spine and femur, osteocalcin, urine deoxypyridinoline and lipid profiles were measured at baseline and 1-year after treatment.
Results: 1) BMD at the lumbar spine increased significantly
in two groups, and BMD in Group I increased significantly more than that in Group II. But, change of BMD on femoral neck was not significantly different. 2) Biochemical bone markers (osteocalcin and urine deoxypyridinoline) decreased significantly in two groups. 3) Total cholesterol and LDL cholesterol decreased significantly in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There was no significant differences between two groups in lipid profiles.
Conclusion: We concluded that combination therapy with c- HRT and alendronate in postmenopausal osteoporosis was more effective than c-HRT, which would not influence on positive effect of estrogen for lipid metabolism. (J Korean Acad Rehab Med 2002; 26: 208-214)
Objective: To evaluate the effects of local triamcinolone (TAC) injection and weight bearing on healing process of the injured Achilles tendon.
Method: The right Achilles tendons in 54 rats, Sprague- Dawley (about 200 g), were each sutured after transection and allocated into three groups according to the amount of the local injection of TAC (none, 0.25 mg, and 1.25 mg respectively), and subsequently each group divided into three subgroups by the type of weight bearing {normal weight bearing (NWB), treadmill exercise (7∼8 m/min, 10 min/day) from day 7 for 7 days, and hind limb immobilization respectively}. On 15th day rats were sacrificed, and then diameters of both injured and uninjured tendon, numbers of fibroblasts on injured tissues and
the percentage of matured fibroblasts by microscopy were evaluated.
Results: The diameter of the hypertrophied neotendon in groups injected with TAC 1.25 mg was significantly decreased, but not in the others. There were no differences in numbers of fibroblast. As the amount of TAC increased in groups done with NWB and treadmill exercise, the percentages of matured fibroblasts significantly decreased.
Conclusion: The local TAC injection on acute tendon injuries had deleterious effects on healing process of tendon, and follow- up study about the types of weight bearing is needed. (J Korean Acad Rehab Med 2002; 26: 215-222)
Objective: To investigate sympathetic vasomotor response of the hands to cold and warm stress on the foot with Digital Infrared Thermal Imaging (DITI) in normal healthy subjects.
Method: Fifteen healthy subjects were participated in this study. The DITI was taken during immersing right foot in cold and warm water bath. The thermal images of the dorsal hands were captured at the starting point and then every 5-minute up to 30 minutes. The ratio of temperature between the ending point (30T) and the starting point (0T) was calculated.
Results: In cold stress test, the mean 30T/0T ratio were 92.8⁑2.4% and 92.2⁑2.7% in the right and left hands, respectively. There were no statistically significant side to
side differences. The temperature of the each hand was significantly lowered at every 5 minutes interval (p＜0.05). In warm stress test, the mean 30T/0T ratio were 104.5⁑1.8% and 104.4⁑2.0% in the right and left hands, respectively. The temperature of each hand was significantly increased at the first 5 minutes (p＜0.05), and tended to increase until 10 minutes. After then, the temperature was not significantly changed until 30 miniutes.
Conclusion: We could identify the normal sympathetic vasomotor response to the cold and warm stress with DITI. It might be served as an useful baseline data for the identification of sympathetic dysfunction. (J Korean Acad Rehab Med 2002; 26: 223-227)
Objective: The purpose of this study was to examine the strength of the knee and pulmonary function comparing collegians and hockey players in college.
Method: KINㆍCOM isokinetic dynamometer and medigraph were used to evaluate strength of the right lower extremity and pulmonary function to 30 male students comprising 15 hockey players and 15 collegians with no significant difference in age, weight, and height between the two groups. All subjects used their right lower limb as dominant limb.
Results: 1) The significant differences between collegians and hockey players were found in the peak torque at 60o/sec,
180o/sec. 2) The siginficant differences between collegians and hockey players were found in forced vital capacity, forced expiratory volume in one second and expiratory reserve volume on the pulmonary function. 3) The significant correlation between isokinetic strength and pulmonary function were found in peak torque.
Conclusion: It is turned out that hockey players in college have much better isokinetic strength and pulmonary function than collegians, so it is suggested this result have to be considered in selecting hockey players and exercise prescription. (J Korean Acad Rehab Med 2002; 26: 228-232)
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