The increment of the proportion of elderly population has been very rapid not only in the developed country but also in South Korea during the second half of the 20th century. This demographic change attracts an interest in the field of the Gerontology and Geriatric Medicine and also need for the specialists in this field has been increased. There are different terminologies which are related each others; Gerontology which is the scientific study of the problems of aging in all their aspects- clinical, biological, historical, and sociological and Geriatrics which is the branch of medicine which treats all problems peculiars to old age and the aging, including the clinical problems of senescence and senility. The elderly who is the object of geriatrics, usually is defined by age (for example, over 65) or by physical condition and disability. The characteristics of elderly comparing with young are vague presenting symptoms and chronicity and progressively deteriorating. Geriatrician has an ability to be a comprehensive and know the importance of multidisciplinary approach. By far, the assessment the function of the elderly patient are an important tool for diagnosis and planning the treatment. The one of the most important goal of elderly is to keep the function to live independently as long as possible. (J Korean Acad of Rehab Med 2002; 26: 367-369)
Objective: To investigate the effect of rehabilitation therapy on functional recovery in chronic stroke patients.
Method: Brunnstrom stage for neurologic recovery, modified Barthel index (MBI) for functional recovery, and possibility of gait were assessed in 66 chronic stroke patients. MBI and possibility of gait were compared the patients who received rehabilitation therapy (Rehab patients) with the patients who did not receive rehabilitation therapy (non- Rehab patients) in each Brunnsrom stage.
Results: In Brunnstrom stage III, 13 of 15 Rehab patients could walk 10 m or more, but none of 7 non-Rehab patients could walk independently, and this difference was statistically significant. MBI score was also significantly higher in Rehab patients than non-Rehab patients (71.3 vs 18.9, p=0.000) in Brunnstrom stage III. In Brunnstrom stage IV, V, VI, MBI score and possibility of gait were higher in Rehab patients than non-Rehab patients, but not significant.
Conclusion: We can confirm the effect of rehabilitation therapy on functional recovery, and this effect seems to be more decisive in neurologically low recovery status patients. (J Korean Acad Rehab Med 2002; 26: 370-373)
Objective: To evaluate the effect of donepezil on cognitive function in patients with brain injury who had cognitive impairment.
Method: Twenty one subjects with brain injury (18 males, 3 females) were enrolled and classified into two groups, experimental and control group. There was no significant difference between two groups in age, postonset duration, and level of education. For the experimental group, one tablelet of AriceptⰒ (5 mg of donepezil per tablet) was administered daily for 6 weeks. The baseline and follow up cognitive assessments were performed before and 6 weeks after. Mini- mental Status Examination (MMSE), Computerized Neuropsychologic Test (CNT), Judgement of Line Orientation (JLO), and visuospatial Wechsler memory test were used for the assessment of cognitive function.
Results: In baseline study, two groups showed no difference in their cognitive function. After 6 weeks, the experimental group showed significantly higher performance in forward digit span, verbal learning test, backward visual span, visual learning test, non-verbal Wechsler memory test, and judgement of line orientaion than control group (p＜0.05).
Conclusion: These results suggested that the administration of AriceptⰒ was beneficial in improving the cognitive function, especially verbal and visual memory and visuospatial perception in patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 374-378)
Objective: This study aimed to assess optimal stimulation intensity and to investigate other variables on functional electrical stimulation (FES) for hemiplegic upper limb.
Method: We divided hemiplegic subjects into two groups, acute (n=28) and chronic (n=18), and control subjects into old (n=26) and young (n=27). Electrical stimulation was performed on the forearm of both sides in hemiplegic patients and of the nondominant side in normal controls. The stimulation site that aimed at open hand motion was targeted to the extensor digitorum and extensor pollicis brevis muscles. We measured the peak to peak amount of current and skin impedance while making hand extension.
Results: The acute and chronic hemiplegic groups required a greater current than the control groups (p＜0.01). The hemiplegic side required a greater current than the non- hemiplegic side (p＜0.001). There was no significant difference of current amount between the acute and chronic hemiplegic groups. The current amount was significantly correlated with subject's age (p=0.001). No difference of skin impedance was found among any of the groups.
Conclusion: Irrespective of disease duration on hemiplegia, a greater current is required in the hemiplegic upper limb than in the normal upper limb. Age was an important factor in determining stimulation intensity. (J Korean Acad Rehab Med 2002; 26: 379-384)
Objective: Shoulder pain in hemiplegia is common and serious problem, but is not completely understood and somewhat controversial. This preliminary study attempt to evaluate the effect and usefulness of subacromial massage in the management of hemiplegic shoulder.
Method: In this ramdomized controlled trial, twenty nine hemiplegic patients with shoulder pain and limitation of motion were treated with either subacromial massage (treatment group) or massage on the supra-acromial area (control group). Outcome measurement of pain intensity, and range of motion were obtained by blinded assessment.
Results: After massage, in treatment group, mean active range of shoulder motion was increased by 14.3o in abduction, 9.0o in flexion, 10.3o in external rotation and 13o in internal rotation versus 3.9o in abduction, 7.5o in flexion, 4.3o in external rotation and 6.4o in internal rotation in control group. The mean pain intensity decreased from VAS 5.47 to 3.8 in treatment group and from VAS 4.57 to 3.71 in control group. This result was statistically significant, except in increment of active range of motion of flexion and external rotation of shoulder joint.
Conclusion: Subacromial massage was used in an effort to increase shoulder motion and to reduce shoulder pain in hemiplegic patients. There were increase in shoulder motion especially abduction, and decrease shoulder pain in study group compared with control group. Further investigation in the form of long term follow up studies is needed. (J Korean Acad Rehab Med 2002; 26: 385-390)
Objective: To evaluate the effect of chronic pain on psychosocial functions in adults with athetoid cerebral palsy.
Method: Thirty-five adults with athetoid cerebral palsy were recruited as subjects, then the radiologic and electrodiagnostic studies were assessed. The characteristics of pain in severity and disability status with Von Korff's chronic pain grade classification system and psychosocial functional status using affect balance scale, Beck depression inventory, social adjustment scale and satisfaction with life scale were evaluated.
Results: Twenty-eight (80.0%) subjects had the pain lasting more than 3 months. The mean score of characteristic pain intensity was 65.5⁑11.5. Eleven subjects (31.4%) showed both abnormal radiologic and electrodiagnostic findings, and these subjects had higher disability score among the subjects who complaint of chronic pain (p＜0.05). The pain intensity had significant relationship with negative affects such as depression and dissatisfaction with life style (p＜0.05). In addition, social adjustment tended to be lower in subjects with severe chronic pain.
Conclusion: Chronic pain was commonly observed in adults with athetoid cerebral palsy, and the pain adversely affected psychosocial functions. Therefore, proper management of chronic pain might be helpful for enhancing their psychosocial functions in these subjects. (J Korean Acad Rehab Med 2002; 26: 391-397)
Objective: We performed to obtain the normal values of Gross Motor Function Measure (GMFM) in normally developed children. We designed this study to inform the degree of gross motor functional disability or delay in children with cerebral palsy, comparing with score values of GMFM in normal children.
Method: One hundred-sixteen normally developed children who were in the age of 12 to 47 months were recruited. Their GMFM tests were performed by a pediatric physical therapist. They were grouped by age of 6 months and the scores were compared with all of each groups.
Results: The GMFM scores in normal children increased with ages. The rates of increment in scores were fast till 35 months of age and inter-individual differences of GMFM scores were greater in younger age groups (less than 36 months of age) than older groups. Even the means of GMFM scores were higher in the girls than boys, the differences between sexes were insignificant statistically.
Conclusion: Norms of GMFM obtained in normally developed children who were in the age of 12 to 47 months. It would be helpful to assess the degree of motor functional disabilities or delay in children with physical disabilities. (J Korean Acad Rehab Med 2002; 26: 398-402)
Objective: It is known that Mechanical in-exsufflator (MI-E) can reduce pulmonary complications such as pneumonia, atelectasis in tetraplegia by increasing inspiratory and expiratory capacity. The aim of this study is to clarify the effectiveness of MI-E on pulmonary function and coughing capacity in tetraplegia.
Method: Thirty tetraplegic patients who had neither history nor radiologic finding of pulmonary disease were divided into two groups; control (n=15) and experimental (n=15) groups. Control group received conventional pulmonary rehabilitation, while experimental group received additional MI-E therapy for one month. The pulmonary function was evaluated by measuring percentage of predicted value of vital capacity (% VC), maximal insufflation capacity (MIC), unassisted peak cough flow (UPCF), volume assisted peak cough flow (VPCF), manual assisted peak cough flow (MPCF), manual and volume assisted peak cough flow (MVPCF). These data of pulmonary function before and after treatment were compared between two groups.
Results: 1) There are significant improvement of pulmonary function in both groups (p＜0.05) except UPCF in control group before and after treatment. 2) The experimental group showed more improvement in MIC, VPCF, MPCF and MVPCF than control group (p＜0.05).
Conclusion: MI-E therapy can be used as an effective therapeutic modality for the improvement of pulmonary function in combination with conventional pulmonary rehabilitation. (J Korean Acad Rehab Med 2002; 26: 403-408)
Objective: To investigate the immediate effect of dorsal penile nerve (DPN) stimulation on detrusor pressure (Pdet) and blood pressure (BP) during hyper-reflexic contractions of the bladder in patients with cervical spinal cord injury (SCI).
Method: The subjects were eight male patients with cervical SCI who had symptoms of autonomic dysreflexia. During water-cystometry, BP was monitored using an intra-arterial catheter into the radial artery, and was recorded simultaneously with the Pdet. Electrical stimulation was applied to the DPN, using surface electrodes each time a bladder contraction was detected. Baseline BP and BP at the first and the last hyper-reflexic contractions of bladder were measured with Pdet, respectively.
Results: As Pdet increased, the BP increased in all cases. The reflex contractions of the bladder were effectively suppressed by DPN stimulation, and as the Pdet decreased during stimulation, radial arterial pressure also decreased immediately and significantly.
Conclusion: DPN stimulation can lower both Pdet and the elevated BP. (J Korean Acad Rehab Med 2002; 26: 409- 413)
Objective: To compare the degree of change of current perception threshold (CPT) results with the degree of nerve conduction study (NCS) change and evaluate the effectiveness of the CPT in following up patients who went through operation for carpal tunnel syndrome (CTS).
Method: Twenty hands with CTS were examined with CPT and NCS, before, 2 weeks after and 2 months after operation. In the CPT, the threshold of the median nerve was measured, in the NCS, amplitude and latency of the median nerve was measured. Subjects were divided into 3 groups according to the severity by NCS results and into 2 groups according to the subjective perception of improvement.
Results: The subjects mean age was 51.4. Changes of NCS results in amplitude and latency showed no statistical relevance. CPT study result changes demonstrated to be statistically significant. Improvement of CPT results seen in the period of 2 weeks and 2 months and the initial first 2 weeks showed no difference. Change of CPT results showed correlation not in accordance with the severity of the NCS study, but with the symptomatic improvement of the patients.
Conclusion: CPT can be an effective tool in evaluating the improvement of symptoms and may be used as a follow up tool in patients with CTS. (J Korean Acad Rehab Med 2002; 26: 414-419)
Objective: The purpose of this study was to observe the characteristics of the clinical improvement and the electrodiagnostic study in non-traumatic facial nerve palsy.
Method: The clinical observation and the electrodiagnostic study were done in 57 of 266 patients who were treated at the Kyunghee Medical Center from December 2000 to July 2001. The initial study was done at 2 weeks from the onset time, and the follow-up study was done at 3 months later. The blink reflex, nerve conduction study and needle EMG were done, and made a statistical comparison between the initial and follow-up study.
Results: The clinical improvement and the change of the electrodiagnostic study between the initial and follow-up study were remarkable in the patients with expected to be good and fair prognosis. In the electrodiagnosis study, there were no statistical correlations on the % degeneration of the CMAP amplitude in the patients with expected to be poor prognosis.
Conclusion: Although the ideal electrodiagnostic study does not yet exist, the best method of evaluating the facial nerve is side-to-side evoked amplitude comparison, and not only the initial study but also the follow-up, this method would be very useful. (J Korean Acad Rehab Med 2002; 26: 420-425)
Objective: Recently, cultured myoblast transplantation has been extensively studied as a gene complementation approach in such genetic diseases as Duchenne muscular dystrophy (DMD). In the present work we investigated the stimulating effects of the growth factors, such as basic fibroblast growth factor (bFGF), leukemia inhibitory factor (LIF) and interleukin-1 (IL-1), on growth rate and differentiation of myoblast.
Method: Human myoblasts were cultured from biopsy and treated in vitro with various concentration of bFGF, LIF and IL-1. In serum-free defined medium the following observation were made to evaluate differentiation.
Results: bFGF and LIF except IL-1 were found to have stimulating effect of myoblast proliferation comparing to control group (p＜0.05), yet there were no statistically significant differences among each growth factors (p＞0.05). The most significant growth stimulation of myoblasts in culture was achieved by adding 3.0 ng/ml of bFGF, producing a stimulation effect up to 2.01-fold. All myoblasts treated with growth factors differentiated into myotube.
Conclusion: Our findings indicate that bFGF and LIF stimulate the proliferation of myoblast, which may result in an effective way in producing large numbers of myoblasts for clinical myoblast transplantation in DMD patients. (J Korean Acad Rehab Med 2002; 26: 426-431)
Objective: This study was designed to investigate the effect of forearm position on the maximal isometric voluntary supination and pronation strengths and EMG activities in the related muscles.
Method: The maximal isometric supination and pronation strengths were measured in 14 normal male subjects using Work simulatorⰒ at 4 different forearm rotation position. EMG activities were simultaneously measured in supinator and biceps brachii during supination and pronator quadratus and pronator teres during pronation.
Results: The maximal isometric supination strength and EMG activities of biceps brachii and supinator were significantly higher as the forearm was more pronated (p＜0.05). The maximal isometric pronation strength and EMG activi-ties of pronator teres were significantly higher as the forearm was more supinated (p＜0.05). The maximal isometric supination and pronation strengths were higher in the dominant side than those of the nondominant side (p＜0.05) and EMG activities of pronator teres and supinator were higher in the dominant side than in the nondominant side (p＜0.05).
Conclusion: The supination and pronation strengths and EMG activities of related muscles were influenced by the forearm rotation position. Therefore the forearm position should be considered in evaluation of upper limb strength and function, and rehabilitation of upper extremity for improving strength and minimizing the overuse of supination and pronation. (J Korean Acad Rehab Med 2002; 26: 432-438)
Objective: This research aimed to define the relationship between the lower lumbar disc herniation and the morphology of the iliolumbar ligaments using magnetic resonance imaging.
Method: 24 male and 36 female patients were classified into two groups according to their disc herniation grade- those in whom the L5-S1 disc was less herniated than L4-5 disc, those in whom the L5-S1 disc was more herniated than the L4-L5 disc on magnetic resonance images. The lengths of iliolumbar ligaments were measured on T1- weighted coronal images. The angles of iliolumbar ligaments were measured on T1-weighted axial images.
Results: The length of iliolumbar ligament was not different between L4-L5 disc herniation and L5-S1 disc herniation. The degree of iliolumbar ligament angle difference (asymmetry of direction) at L5-S1 disc herniation was more deviated in paracentral disc herniation compared with central disc herniation.
Conclusion: The morphology of the iliolumbar ligament, especially its asymmetry of direction, may be a factor influencing the development of disc herniation at L5-S1. (J Korean Acad Rehab Med 2002; 26: 439-444)
Objective: To evaluate the effects of dextrose prolotherapy on knee osteoarthritis.
Method: The patient population consisted of 20 individuals with knee osteoarthritis. Patients have suffered from knee pain for six months or more along with Kellgren's grade 2 or more radiographical change in knee compartment. They were injected monthly with 15% and 25% dextrose on knee joints for 4 months. The outcome was measured by visual analogue scale (VAS) for pain, pain rating score, and WOMAC osteoarthritis index at a month after 4th injection.
Results: Seventeen of the 20 patients achieved significant diminution of pain or disability scores after dextrose prolotherapy compared with pre-treatment status. There were significant reductions in VAS score, pain rating score, and WOMAC osteoarthritis index after dextrose injection (p＜0.05). Three patients dropped out over follow up period due to lack of efficacy.
Conclusion: Prolotherapy injection with dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. (J Korean Acad Rehab Med 2002; 26: 445-448)
Objective: To classify the findings of magnetic resonance imaging of the lumbar interspinous ligaments in relation to the lumbar disc herniation, disc degeneration, and lordosis.
Method: The subjects were 45 herniated intervertebral disc (HIVD) patients and 35 normal subjects on MRI finding. The magnetic resonance features of the interspinous ligament were classified into five categories according to their signal intensities: type 1A (low intensity on T1- and T2- weighted images without hypertrophy of spinal process); type 1B (same signal pattern as in type 1A with hypertrophy of spinal process); type 2 (low intensity on T1- and high intensity on T2-weighted images); type 3 (high intensity on T1-weighted images); type 4 (others).
Results: The most common type in both HIVD patients and normal subjects was type 3. The mean age and disc degeneration grade of the type 1B ligaments were significantly higher. Lordosis of type 1B of L5-S1 interspinous ligament was increased with significant difference.
Conclusion: The classification of the MRI findings of interspinous types didn't show statistical difference between HIVD patients and normal subjects, but was helpful in assessing the degree of the degeneration of the intervertebral disc and age. (J Korean Acad Rehab Med 2002; 26: 449- 455)
Objective: This study is designed for comparison of the clinical usefulness between computerized and manual inclinometer and to find out more reliable and acceptable method in measuring spinal ROM (range of motion).
Method: Twenty healthy volunteers (mean age 23⁑4) were selected. Spinal ROM was measured by computerized and manual inclinometer twice a week. Data was analyzed with paired t-test and Pearson's correlation test.
Results: There was no significant difference between the measured value of two methods. In the repeated measurement by computerized inclinometer, there was significant reliability of spinal ROM except right rotation of the lumbar spine, and by manual inclinometer, there was significant reliability of spinal ROM except cervical left lateral bending, thoracic lateral bending, and lumbar right rotation (p＜0.05). In cases of computerized inclinometer, estimated times to measuring ROM were 8 min 46 sec in cervical spine, 10 min 22 sec in thoracic spine, 9 min 50 sec in lumbar spine, and of manual inclinometer, those were 3 min 27 sec in cervical spine, 5 min 8 sec in thoracic spine, 4 min 35 sec in lumbar spine.
Conclusion: In the measurement of spinal ROM, computerized inclinometer is more reliable than manual inclinometer for its higher reliability, but has a limitation of long measurement time. This study suggest that computerized inclinometer can be acceptable tool for accurate measuring spinal ROM. (J Korean Acad Rehab Med 2002; 26: 456- 460)
Objective: To test the hypothesis that changing the desk height or keyboard design with fixed neck posture will change posture of the upper extremity and the trapezius tension, and to suggest the appropriate the desk height and the keyboard design to relieve the tension of the trapezius.
Method: Five men volunteered. Four desk heights (5 cm below, same as, 5 cm above, 10 cm above the olecranon) and three keyboard designs (flat, wrist support, natural) were set up. The posture of the upper extremity was analysed by 3 dimensional Ariel performance analysis system. The tension of trapezius was measured by surface EMG.
Results: The trapezius tension was low when the desk height was below the olecranon in 'flat' keyboard, and was low when the desk height was no higher than 5 cm above the olecranon in 'wrist support' and 'natural' keyboard. The trapezius tension went with the change of the shoulder flexion, abduction, elevation and the elbow flexion in 'flat' keyboard, and went with the change of the shoulder flexion and elevation in 'wrist support' and 'natural' keyboard.
Conclusion: To lessen the tension of the trapezius, the desk height should be below the olecranon in 'flat' keyboard and no higher than 5 cm above the olecranon in 'wrist support' and 'natural' keyboard. The keyboard design should include the wrist support which relieved the tension of trapezius by giving the resting point. (J Korean Acad Rehab Med 2002; 26: 461-469)
Objective: To evaluate the axonal degeneration after nerve block with phenol and ethanol injection into tibial nerve.
Method: Tibial nerves of thirty Sprague-Dawley rats were exposed. For the developement of neuropathic pain, the method of intraneural injection was performed. Five percent phenol, 90% ethanol or normal saline were injected into the epineurial sheath of tibial nerve at each group. The mechanical and thermal allodynia were evaluated in post- injection 1, 2, 3, and 4 weeks. The mechanical allodynia was evaluated by withdrawal response to 10 stimulations with von Frey hair. Thermal allodynia was tested by withdrawal response to 5 stimulations with acetone. Motor nerve conduction study was performed in post-injection 1, 2, and 4 weeks.
Results: In behavioral test, the experimental group exhibited increased withdrawal response to mechanical and cold stimulation, but there was no significant difference between two groups, phenol and ethanol groups. In motor nerve conduction study, compound motor action potential amplitude loss were observed in experimental group, but there was no significant difference between two groups, phenol and ethanol groups.
Conclusion: These results suggest that axonal degeneration of ethanol is roughly similar to those of phenol block. (J Korean Acad Rehab Med 2002; 26: 470-474)
Objective: This is a study to evaluate relationships between the occurrence of lymphedema and clinicopathologic factors in postmastectomy patients.
Method: We studied 448 patients who underwent breast cancer surgery during the periods from January 1998 to December 2000, of which 69 patients developed lymphedema during the follow up period. We investigated the medical records of these follow-up patients. The general characteristics were tested by a chi-square test and student t-test and the possible risk factors were comparatively analyzed on these patients by a multiple logistic regression analysis.
Results: The incidence of lymphedema was significantly high with higher stages (p＜0.05). The incidence of lymphedema was significantly high in higher N staging, but not in higher T staging. Patients who received radiation therapy also showed higher incidence rates (p＜0.05). Patients who underwent Patey procedure showed higher incidence than those who underwent Auchincloss procedure. With increasing age, more lymphedema developed (p＜0.05).
Conclusion: These results suggest that the stage of tumor, state of lymph node metastasis, methods of surgical treatment, use of irradiation, and patient's age are the possible risk factors for the development of lymphedema. These risk factors might be useful as clinical indices for the prevention of postmastectomy lymphedema. So, we have to exert our efforts to minimize the development of lymphedema. (J Korean Acad Rehab Med 2002; 26: 475-479)
Hypertrophic olivary degeneration is usually caused by a lesion in the triangle of Guillain and Mollaret. The inciting pathology includes ischemic, inflammatory, degenerative or, less frequently, traumatic lesions. Clinically, it is usually accompanied by palatal myoclonus or other forms of segmental myoclonus. We present four patients with hypertrophic olivary degeneration studied with MRI after severe head trauma. MRI was performed between 5 and 18 months respectively after trauma. Although post-traumatic tremor was observed in three patients, none of patients showed palatal myoclonus. MRI showed multiple post-traumatic lesions within the dentato-rubro-olivary pathway associated with enlargement and increased signal intensity of the inferior olives. (J Korean Acad Rehab Med 2002; 26: 480-484)
Congenital fiber type disproportion (CFTD) has been described as a form of congenital myopathy characterized by the smallness and marked predominance of type I fibers in a muscle biopsy. Only major morphological characters in CFTD are the abnormality of the size of muscle fibers and the disproportion of the type of muscle fibers. Clinical feature of CFTD is characterized by congenital hypotonia, nonprogressive muscle weakness and delayed motor milestones. The disease is sometimes associated with a myopathic pattern in the electromyography (EMG) and a slightly increased creatine kinase (CK). In this report, we describe a case of the child presented the subtle clinical symptoms of mild proximal weakness of lower extremities, who was diagnosed as CFTD not by the laboratory findings such as EMG and muscle enzyme study of CK initially but with a muscle biopsy finally. (J Korean Acad Rehab Med 2002; 26: 485-488)
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