Method: This study was performed retrospectively on 102 patients with acute stroke who were admitted to Department of Rehabilitation Medicine. The inpatients, clinical and functional evaluation were carried out at admission. Functional abilities were measured with the use of the Functional Ambulatory Category (FAC) and the modified Barthel Index (MBI).
Results: The significant prognostic factors of FAC improvement rate were age, National Institute of Health Stroke Scale (NIHSS), Morticity Index, MBI, Mini-Mental State Examination (MMSE), aphasia and Trunk Control Test (TCT) (p＜0.01). The most valuable single factor of FAC improvement rate was TCT. The significant prognostic factors of MBI improvement rate were age, NIHSS, Morticity Index, MMSE, aphasia and TCT (p＜0.01). The most valuable single factor of MBI improvement rate was TCT.
Conclusion: We concluded that TCT could be the most valuable prognostic factor in rehabilitation management outcome of stroke.
Method: The subjects were 13 hemiplegic patients with cerebral infarction and cerebral hemorrhage. Electrical stimulation was applied to skin over the biceps muscle and the triceps muscle for a period of twenty minutes. The evaluation of spasticity was done by using the modified Ashworth scale, free amount of elbow extension, active range of motion and motor strength of elbow flexion and extension at baseline, immediately, 1 week and 4 weeks after electrical stimulation.
Results: Immediately after treatment, free amount of elbowextension increased from 63.8±19.1 degrees to 77.7±22.5 degrees (p＜0.05) and active flexion of elbow flexor increased from 45.0±34.8 degrees to 55.3±39.1 degrees (p＜0.05). The active range of motion of elbow flexor was increased on the 4th week during elec trical stimulation (p＜0.05). The free amount of elbow extension and modified Ashworth scale of elbow flexor spasticity was improved on the 18th day after treatment cessation (p＜0.05).
Conclusion: The results of this study showed that spasticity tended to decrease and maintain a lower level after a varying number of treatment sessions.
Method: Nine patients participated with PWB harness on the treadmill, and nine patients with traditional exercise. In harness group, the gait training with 30% weight reduction was offered on treadmill, they were treated daily and gait training was done for 20 minutes. In no-harness group, traditional gait training was done by physical therapists. Variables were gait parameters assessed by VICON 370 Gait Analyzer, other function tested by Motricity Index and Functional Ambulatory Category.
Results: In linear parameter, the harness group had faster gait speed, longer stride length, and more decreased double support time compared to the no-harness group. In kinematic parameters, the maximal flexion of knee was significantly increased in harness group, but no significant differences was in hip and ankle motion. In kinetic parameters, hip flexion moment of normal side was increased in harness group at heel strike phase, knee flexion moment of normal side was decreased in harness group at heel strike phase.
Conclusion: The gait training with partial weight bearing harness was more effective in acute stroke patients than traditional therapy, and was influenced in gait pattern, functional ability.
Method: Sixteen hemiplegic patients with shoulder subluxation were evaluated by a simple X-ray with and without the slings and the vertical and horizontal distances on the plain AP views were measured. The newly designed arm sling was compared in terms of the effects of correction with a pouch sling and a Bobath sling. The arm sling designed for this study was developed for the purpose of maintaining patients' hands in a functional position and performing ROM exercise of the shoulder easily. The mean values of the vertical and horizontal distance were compared to determine if there was significant difference of function between the new sling and the conventional slings. Variables such as comfort, choice, and easiness for donning and doffing of the arm slings were evaluated by questions.
Resuts: The new sling provided the patients with good vertical correction of the subluxation (p＜0.05) but did not increase the horizontal distance significantly. According to the responses to the questions, the new sling was more comfortable than the conventional slings.
Conclusion: These results support the effectiveness and the comfort of a new sling to decrease subluxation in hemiplegia. Further study on the long term effects or complication of the new sling is recommended.
Method: Ten memory training programs, which included verbal/non-verbal, sequential/ non-sequential, and visual/auditory memory properties were designed and converted to the computer program using C-language. The training program included various aspects of memory such as spatial memory, sequential verbal and nonverbal recall, associated recall, categorical memory, and integrated semantic memory. Each program used familiar pictures and sounds in our living situation to give the patients comfortable feelings and interests. Seven patients with brain injury were trained using the computer-assisted memory program 3 times per week for 4 weeks. All patients were assessed their cognitive function using Seoul Computerized Neuropsychological Test (Maxmedica) before and 1 month after the treatment.
Results: Ten computer-associated memory training programs using C-language were successfully developed. The patients who were trained with computer-assisted memory programs showed higher performances in forward digit span, backward digit span, backward visual span, verbal learning, visual controlled continuous performance, auditory controlled continuous performance, and finger tapping tests after than before the treatment.
Conclusion: The computer-assisted memory training can be used as an additional tool for memory rehabilitation in patients with brain injury.
Method: The subjects of this study were 28 family members of stroke patients who had participated in group education program. The program was composed of eight sessions. The aim of this study was to increase understanding of the nature of stroke and treatment procedures, and to enhance family caregivers' ability to take care of patients, and to reduce family caregivers' burden. The program team members included social workers, medical doctors, and nutritionists. The data was analyzed using Wilcoxon Signed Rank Test.
Results: There were significant differences in all three areas between pre and post groups (p＜0.001). It means the program will help the participants improve mental health state, enhance stress coping skills and improve the perception of social support.
Conclusion: A formalized group education program is an important resource in helping family members understand the stroke and their ability to cope with the rehabilitation process. Since family members provide a critical role in the long-term rehabilitation, family group education should be an essential part in the rehabilitation program.
Method: Thirty-five female Lewis rats were used in the study. Thirteen rats used as normal cystometrogram controls. Twenty-two rats induced EAE were divided into two groups: ten rats as control and twelve rats as dexamethasone injection group. Bladder dysfunction by cystometrogram, severity of weakness, and duration of paralysis were evaluated every other day after the onset of paralysis.
Results: Dexamethasone injection group compared to control group presented short duration of bladder dysfunction (2.5 vs. 4.2 day, p＜0.05) and paralysis (4.5 vs. 7.3 day, p＜0.05). There was a trend for lesser paralysis in the dexamethasone injection group, than control group (weakness scores were 2.4 vs. 3.6, p＞0.05), but it was not statistically significant.
Conclusion: Dexamethasone ameliorates the course of paralysis and bladder dysfunction in EAE. We suggest that dexamethasone treatment is an effective method in treating neurogenic bladder and paralysis in multiple sclerosis.
Method: The subjects were thirty two DMD patients and an age-matched twelve healthy control volunteers. The DMD patients were divided into two groups; ambulatory and non- ambulatory groups. The body composition with dual energy X-ray absorptiometry (DEXA), body mass index (BMI) and functional state of all subjects were measured.
Results: There was no significant difference in BMI among all groups. The non-ambulatory DMD group was siginificantly higher in total body fat (%) compared with other two groups (p＜0.05). The mean lean body mass (%) for upper extrem ities did not show the significant difference; however, for lower extremities, there was a significantly lower in DMD groups (p＜0.05). These findings were corresponded with low muscle functional state for lower extremities in DMD groups.
Conclusion: There was a significant correlation between muscle function and the percentage of mean lean body mass. The assessment of lean body mass by DEXA provides more accurate and reliable information about the muscle function in DMD.
Method: Initial and follow up electrodiagnostic data of 100 patients who had been diagnosed as spina bifida were obtained retrospectively. Electrophysiological diagnosis and neurological level were investigated by the findings of needle electromyography. Each patients were divided into no change, improvement and deterioration group according to follow up study. The change of urodynamic study findings and clinical findings were also investigated. The recent functional outcomes and the presence of complications were evaluated by recent outpatient record.
Results: 56 patients had no change, 15 patients had improvement and 29 patients had deterioration electrophysiologically. The initial electrodiagnostic findings were associated with the functional outcomes in patients with spina bifida (p＜0.05). However, neurological level by electrodiagnostic findings cannot predict functional outcomes except ambulation activities. The change of electrodiagnostic findings of follow up study were related with the change of clinical findings statistically (p＜ 0.05).
Conclusion: Follow up electrodiagnostic study as well as initial study is necessary for the evaluation of the change of neurological states in the patients with spina bifida.
Method: Spinal cords of 25 rabbits were contused by 20 g⁓20 cm weight drop in the 11th thoracic spine. After 2 weeks, muscle stretch reflex was measured. Triceps surae was dissected and stretched for 5 mm at the rate of 2 mm/sec and the length-tension curve were obtained. The slope in the length-tension curve was defined as stiffness index (SI). After baseline measurement, group I (n=6) received 50 mg/kg GBP IM injection and group II (n=8) received 100 mg/kg GBP IM injection, but control group (n=5) did not. Muscle stretch reflex was measured again after 30 minutes and 60 minutes, and then after sciatic nerve section. Active tension was calculated by subtracting passive tension from total tension. Proportion of SI was calculated by dividing follow-up SI with baseline SI.
Results: The proportion of SI of active tension reduced significantly at 30 minutes and 60 minutes compared to baseline (p＜0.001, p＜0.001). The proportion of SI of active tension in both group I and group II reduced significantly than control group (p=0.041, p＜0.001). The proportion of SI of active tension in group II reduced than group I, but it was not statistically significant (p=0.166).
Conclusion: The GBP reduced significantly muscle stretch reflex in spinal cord injured rabbits and showed dose-response tendency.
Method: Ulnar motor nerve conduction studies were performed bilaterally in twenty healthy adult volunteers. For each limb, nerve conduction study was carried out in two different positions. In the first position, shoulder were abducted, elbow and wrist flexed to 90o. For the second position, all joints were kept constant except for the wrist where it was extended. Routine conduction study was performed in both wrist positions. All data were statistically analyzed.
Results: The average conduction velocities in the wrist flexed position were 61.6 m/sec for the forearm segment and 62.3 m/sec across elbow. With the wrist extended, the average was 62.6 m/sec and 64.1 m/sec, respectively. The differences in conduction velocities between two different wrist positions were statistically significant (p＜0.05). In the wrist flexed position, the average measured latencies were 2.3 msec with wrist, 5.4 msec below elbow, and 7.4 msec above elbow stimulation, compared to wrist extended which showed 2.4, 5.4 and 7.2 msec, respectively. The difference of latencies at wrist between the two wrist positions was statistically significant (p＜0.05).
Conclusion: The authors conclude that wrist position affect ulnar nerve conduction velocity.
Method: The subjects were 37 patients and 30 normal controls. The patient group was composed of 28 patients with L5 radiculopathy and 9 patients with S1 radiculopathy, which were confirmed by clinical, radiological, and electrodiagnostic studies. Tibialis anterior H-reflex (TA-H reflex) was recorded from maximally contracting tibialis anterior muscle by averaging technique and submaximal stimulation of common peroneal nerve. Sensitivities and specificities were delineated from the several diagnostic criteria.
Results: In the normal controls, mean side to side difference in the TA-H reflex latency was 0.66⁑0.48 msec and mean amplitude ratio was 75⁑16%. The diagnostic criteria of abnormal TA-H reflex were latency difference above 1.62 msec and amplitude ratio less than 42.2%. The abnormal TA-H reflexes were shown in 17 out of 28 patients with L5 radiculopathy and 1 out of 9 patients with S1 radiculopathy. Sensitivity and specificity of TA-H reflex as a diagnostic criteria of L5 radiculopathy were 61% and 89%, respectively.
Conclusion: Tibialis anterior H-reflex might be useful in the diagnosis of L5 radiculopathy.
Method: Thirty eight complete peripheral nerve injuries, diagnosed by motor and sensory nerve conduction studies (NCS) and needle electromyography (nEMG), were studied. Nerve injuries were grouped into two groups with and without SEP recorded at the time of initial evaluation. Outcome of nerve injuries was graded from 0 to 3 based on the results of NCSs and nEMG, followed up for more than six months. Grade 0 was designated for those with no evidence of recovery, and grade 3 for those with recovery in nEMG and both motor and sensory NCSs.
Results: At the time of initial electrodiagnosis, SEP study showed no response in 25 cases, but SEP could be observed in 13 cases, although they were attenuated or delayed. Recovery of nerve injury was observed in 22 cases, despite the findings compatible with complete injury in initial NCSs and nEMG. The group in which SEPs were recorded showed significantly higher grades of recovery, compared to no re sponse group.
Conclusion: In predicting the prognosis of complete peripheral nerve injuries, SEP study could be useful as a supplementary electrodiagnostic method.
Method: Fourteen lower limbs of 7 adult cadavers were anatomically dissected. The location and formation of the sural nerve (SN) in relation to the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN) were investigated. The length and diameter of the SN and contributing nerves were measured and the differences of the results were analyzed.
Results: Twelve SNs were formed by the union of the MSCNs and LSCNs, and 2 SNs were direct extensions of the MSCNs. The point of formation of the SN by union of the MSCN and LSCN was found in the middle third of the legs in 66.7% of SNs examined. The union sites of the SNs were located at 40.58⁑13.97% of the length of lower leg from the tip of lateral malleolus and 55.84⁑6.48% of the calf width from the medial border of the calf. There were significant statistical differences of diameter among nerves (p＜0.05) and no significant difference of length between MSCN and LSCN.
Conclusion: The results of this cadaveric study would increase the accuracy of the sural nerve conduction study and provide the locational information for precise surgical approach.
Method: Sciatic nerve of seventy rats was compressed with haemostatic forceps. The experimental group was divided into 4 subgroups according to the intensity and duration of injury: group 1, first degree compression for 5 seconds; group 2, first degree for 30 seconds; group 3, third degree for 5 seconds; and group 4, third degree for 30 seconds. Treadmill exercise was done for either 30 minutes or 2 hours a day, 5 days a week for 4 weeks. Histochemical study of soleus was done before nerve compression and 1 week, 4 weeks after compression.
Results: The fiber diameter of soleus was larger in the experimental group at 4 weeks (p＜0.05). The intensity of injury had greater impact on the recovery of fiber diameter than the duration. Thirty minute exercise was seen to have a earlier recovery of fiber diameter than 2 hours.
Conclusion: These results may provide the basic data to clarify the neurological recovery in relation to the severity of injury, and to help establishing adequate duration of exercise after nerve damage.
Method: Subjects included 30 hands of 25 carpal tunnel syndrome patients and 20 hands of 17 healthy adults with no electrophysiologic evidence of carpal tunnel syndrome. All subjects were examined with real-time ultrasonography. The ultrasonography was evaluated quantitatively with regard to the cross-sectional area and the flattening ratio of the median nerve and the palmar displacement of the flexor retinaculum. The analysis of difference between normal control group and carpal tunnel syndrome group was done by independent t-test.
Results: The carpal tunnel syndrome patients group had significantly increased cross-sectional area of the median nerve at distal radio-ulnar joint, pisiform and hamate. The carpal tunnel syndrome patients group had significantly increased flattening ratio of median nerve at hamate. The carpal tunnel syndrome patients group had significantly increased palmar displacement of the flexor retinaculum.
Conclusion: Based on the result of this study, the ultrasonography is useful in the diagnosis of the carpal tunnel syndrome.
Method: Fifty low back pain patients who enrolled in Bundang CHA rehabilitation center from April 2000 to November 2001 with variable duration of HIVD, spinal stenosis and failed back surgery syndrome were treated with spinal epiduroscopy. The patients were grouped according to the duration and the disease. The efficacy of treatment was assessed with visual analog scale (VAS), Oswestry low back pain (LBP) questionnaire and Pain Disability Index (PDI) before the treatment, at 1 day, 1 week, 3 months and 6 months after the treatment.
Results: VAS of all patients after spinal endoscopic epiduroplasty were significantly decreased (p＜0.05). PDI of all patients after spinal endoscopic epiduroplasty were significantly decreased (p＜0.05). Oswestry LBP questionnaire of all patients after spinal endoscopic epiduroplasty were significantly decreased (p＜0.05).
Conclusion: Spinal endoscopic epiduroplasty is one of the best treatment that can be applied to low back pain patients with variable duration of HIVD, spinal stenosis and failed back surgery syndrome.
Method: Seventy-one patients with lumbar discogenic pain and total 109 discography were studied. During contrast mediun injection, the patient's pain response was reported. The patients were invited to choose among the following options: 'no pain or only pressure feeling', 'dissimilar', 'similar', and 'exact'. And pain location was chosen among the followings: 'low back', 'buttock', 'anterior thigh', 'posterior thigh', and 'lateral thigh'. Correlation between degeneration and provocation response was analyzed. And discography level and provocation area were evaluated.
Results: Low back and buttock area was the most common provocation pain site, but it was not specific by disc level. And provocation pain frequently appeared in irregular and fissured types, but the existence of provocation pain was significantly low in ruptured type.
Conclusion: There was no correlation between provocation pain area and discography level. And existence rate of provocation pain in ruptured disc was very low. It might be due to low mechanical compression with little stimulation of nociceptor. We suggested that if patients have a ruptured disc with chemical irritation, provocation pain was not a good indicator of diagnosis of discogenic back pain.
Method: Thirty patients with MPS were assigned randomly to three groups, such as dry needling group (n=10), IMES group (n=10), and IMS group (n=10). In dry needling group, dry needling was applied to the trigger point of upper trapezius muscle. In IMES group, IMES was applied to the trigger point of upper trapezius muscle. In IMS group, IMS was applied to the trigger point of upper trapezius and parcervical muscles. Treatment were done three times a week for 2 weeks. Effects were assessed on 3rd day, 7th day and 14th day after treatment by visual analogue scale (VAS), McGill pain questionnaire (MPQ), and passive range of motion (PROM) of cervical spine.
Results: Significant changes of VAS and PROM were noticed in IMS group, compared with other groups. No significant difference of MPQ was noticed in IMS group, compared with other groups.
Conclusion: IMS may be more effective treatment modality than dry needling and IMES in patients with MPS of upper trapezius muscle.
Method: Buffered saline at pH 4, 6 or 7.2 were injected twice, 3 days apart, into the gastrocnemius muscles of thirty Sprague-Dawley rats. To quantify hyperalgesia, paw withdrawal response to von Frey filament (mechanical hyperalgesia) and acetone (cold hyperalgesia) were measured for the 4 weeks after injection. Also the locomotor performance with inclined plane board and treadmill, and electrophys iologic study were evaluated.
Results: Mechanical hyperalgesia that was produced by the single injection of saline lasted less than 24 hours. The repeated injection of acidic saline produced mechanical hyperalgesia for more than 4 weeks at injected side and 3 weeks at contralateral side. Cold hyperalgesia lasted for 1 week after injection bilaterally. The locomotor performance and nerve conduction studies were not changed after injec tion.
Conclusion: We have developed and characterized a model of muscular pain that was long lasting and widespread. This might prove useful for studying pain of muscular origin that may be similar to the chronic pain syndromes observed clinically.
Method: Using an isokinetic dynamometer we determined the peak torques of knee extensors and knee flexors at angular velocities of 30, 60 and 180 degrees/sec in normal people (120 males, 154 females in the age range 31 to 70 years) and using these peak torque values to calculate functional H/Q ratios and conventional H/Q ratios.
Results: Normative data were presented. As age increased, the magnitudes of the peak torques of most knee flexors and knee extensors decreased, but conventional and functional H/Q ratios were not found to be significantly correlated with age in either sex.
Conclusion: Normative data by decade age in both sexes were obtained. It is hoped that this data will be beneficial for the testing of knee joint function.
Method: 15 healthy adults were recruited as subjects. We applied two hot packs to the lumbar region for two consecutive days. On the first day, the body part was on the top of hot pack and on the second day, the hot pack was placed over the body part. We measured peak skin temperature, skin temperature elevation, time required to peak skin temperature, skin temperature after 20 minutes and visual analogue scale(VAS) of subjective feeling of heat (hot).
Results: In the peak skin temperature, the means were 44.4⁑0.70oC and 42.7⁑ 0.99oC in the supine and prone position, respectively. In the skin temperature elevation, the means were 11.2⁑1.1oC and 9.5⁑1.6oC, respectively. In the time required to peak skin temperature elevation, the means were 6'49"⁑15" and 10'33"⁑ 15", respectively. In the skin temperature after 20 minutes, the means were 42.4⁑ 0.7oC and 41.6⁑0.8oC, respectively. In the VAS of subjective feeling of heat (hot), the means were 8.66⁑1.11 and 5.72⁑1.48, respectively.
Conclusion: The patient's position is one of the important factors in determining temperature elevation. Therefore, it should be considered during application of the hot pack.
Method: A cross sectional study in 155 type II diabetic patients was done. The presence of LJM and shoulder adhesive capsulitis was sought. The diseases closely related to diabetes were recorded. The patients were assessed for retinopathy, nephropathy, and neuropathy.
Results: The prevalence of LJM and shoulder adhesive capsulitis in type II diabetic patients was 32.3% and 29.7%, respectively. Development of LJM and shoulder adhesive capsulitis was correlated with age and duration of diabetes. Higher blood HbA1c level was noticed in mild and moderate degree of LJM. The prevalence of shoulder adhesive capsulitis was shown association with LJM. The prevalence of LJM was associated with a history of myocardial infarction and chronic diabetic compli cations. The prevalence of shoulder adhesive capsulitis was associated with retinopathy, carpal tunnel syndrome, and autonomic neuropathy.
Conclusion: According to the results, around 30% of type II DM patients could have hand LJM and should adhesive capsulitis, which suggested more attention and effort to prevent the LJM and shoulder adhesive capsulitis were needed.
Method: To assess the status of arthritis-related information on the internet sites in Korea, we searched for Korean words which meant and were related with 'arthritis' using the 10 most famous Korean internet search engines. Identified internet site were assessed regarding the quality of content, authorship, design, and functionality.
Results: The number of identified web sites ranged from 24 to 214. The average search yielded around 83 web sites listing for 'arthritis'. The number of web sites listed for 'arthritis' was as many as that for 'hypertension', 'diabetes', 'cancer' or 'hepatitis and hepatoma'. The frequency of appearance in a search did not correlate well with the quality of associated web sites.
Conclusion: The quality of arthritis-related web sites in Korea varied. It is essential to develop a high quality information supplying web sites and to set up an evaluation tool for qualifying the medical information on internet.
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