Objective This study was designed to evaluate the effect of functional electrical stimulation on swallowing function in stroke patients with dysphagia. Method: The subjects were 22 stroke patients with dysphagia. Functional electrical stimulation was applied to skin over anterior neck for thirty minutes and then, the patients were trained to swallow at the time of maximal stimulation. Swallowing function was evaluated by functional dysphagia scale using videofluoroscopic swallowing study with semisolid material before and 2 weeks after electrical stimulation. Results: There were no significant differences in oral phase scores, the scores of triggering of pharyngeal swallow, re-sidue in piriform sinuses, and coating of pharyngeal wall after swallow of pharyngeal phase. However, the scores of laryngeal elevation and epiglottic closure, residue in valleculae and pharyngeal transit time were significantly decreased (p＜0.05). The score of pharyngeal phase was negatively correlated with the pulse intensity. The score of oral phase was negatively correlated with the cognitive function. Conclusion: The results of this study showed that the functional electrical stimulation can be used as an additional treatment method for stroke patients with dysphagia. (J Korean Acad Rehab Med 2006; 30: 417-423)
Objective To investigate whether drooling in patients with traumatic brain injury (TBI) is due to hypersalivation or cognitive dysfunction or disability. Method: The subjects were 24 TBI patients with drooling and 17 TBI patients without drooling and 20 unaffected healthy volunteers who had no known physical or mental disabilities. All participants had no known history of diabetes mellitus, hypertension, thyroid dysfunction or chronic alcoholism. And, we excluded the subjects who take the anticholinergics, beta-agonist or steroid. Salivary pH and flow rate were compared between the TBI groups and the control group. We also measured Korean mini-mental state examination (K-MMSE) and disability rating scale (DRS) and compared mean values between TBI groups. Results: There was no statistical difference in the mean salivary pH and flow rate between the tested groups. The drooling severity and frequency showed no correlation with salivary flow rate in all groups. The drooling severity and frequency showed significant correlations with K-MMSE, but not with DRS in TBI groups. Conclusion: The results of this study suggested that the cause of drooling in patients with TBI may not be the hypersalivation and functional disability, but cognitive dysfunction. (J Korean Acad Rehab Med 2006; 30: 424-429)
Objective To evaluate effects of short stretch bandage and electrical stimulation therapy (EST) for the complex regional pain syndrome (CRPS) in hemiplegic patients Method: 10 hemiplegic CRPS patients after stroke or traumatic brain injury were included in the study. We established CRPS from clinical symptoms and triphasic bone scan. Short stretch bandage was applied on affected limb and changed every 24 hours for 2 weeks. EST was tried for 10 minutes twice per day. It was applied at finger and wrist flexor muscles. We measured hand volume of pre- and posttreatment using hand volumeter. Also compared pre- and posttreatment pain-free range of motion (ROM) of metacarpophalangeal (MCP) joint and third proximal inter-phalangeal (PIP) joint circumference. Results: Mean difference of hand volume between the affected and the unaffected prior to treatment was 20.5⁑4.9 ml (7.9⁑2.3%). After treatment, mean volume change was 15.5⁑4.9 ml (5.5⁑1.8%) (p＜0.05). Mean change of pain-free ROM was 8.0⁑4.8 degree (10.9⁑7.1%), mean change of PIP joint circumference was 3.1⁑1.4 mm (5.9⁑2.4%) (p＜0.05). Conclusion: Short stretch bandage and EST complex therapy is effective for the reduction of paralyzed hand edema and pain in hemiplegic CRPS patients. However further control study is required. (J Korean Acad Rehab Med 2006; 30: 430-435)
Objective To study the after effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex on cortical excitability Method: Twenty healthy volunteers received 1,000 stimuli of 10 Hz rTMS. Repetitive TMS was given over the 'motor hot spot' of the right first dorsal interosseus muscle using an intensity of 80% of resting motor threshold. We evaluated the amplitude of motor evoked potential (MEP) using single pulse TMS and intracortical inhibition and intracortical facilitation with paired pulse TMS paradigm. After baseline measurement, the amplitude was measured immediately after stimulation and 10, 20, 30 and 40 minutes afterrTMS. Results: The amplitude of MEP was significantly increased for 10 minutes after applying 1,000 stimuli of 10 Hz rTMS. Additionally, intracortical inhibition was significantly reduced and intracortical facilitation was significantly enhanced for 10 minutes after 10 Hz rTMS. Conclusion: These results showed that 1,000 stimuli of 10 Hz rTMS over primary motor cortex increased the corticospinal excitability for 10 minutes. In addition, 10 Hz rTMS induced a suppression of the intracortical inhibitory circuitry and facilitation of the excitatory circuity for 10 minutes. (J Korean Acad Rehab Med 2006; 30: 436-440)
Objective To compare the personally developed natural filling cystometry (NFC) and conventional retrograde filling cystometry (RFC) Method: NFC and RFC were performed on 15 patients with stroke. Results: Patients were classified into three groups according to their usual lower urinary tract symptom. Four patients without urinary symptom did not show any detrusor overactivity or detrusor underactivity during NFC or RFC. Of the nine patients with urinary frequency or urgency, five (55.6%) showed detrusor overactivity during NFC and two (22.2%) during RFC. Two patients with straining showed .detrusor underactivity during both tests. Conclusion: There was no significant difference of cystometric findings between NFC and RFC in case of patients without urinary symptom or with detrusor underactivity, but those patients with urinary symptom that is suspected of detrusor overactivity showed a more frequent detrusor overactivity during NFC than RFC. Therefore, NFC is thought to be a useful tool in evaluating the neurogenic bladder of stroke patients suspected of detrusor overactivity since it can detect detrusor overactivity which were less detectable in RFC. (J Korean Acad Rehab Med 2006; 30: 441-446)
Objective Authors investigated magnetic resonance imaging (MRI) and histological characteristics of photothrombotic infraction rat model (PIRM) on long term basis to provide a basis for further research. Method: Photothrombotic ischemia was induced in male Sprague-Dawley rats using Rose-bengal dye (20 mg/kg) and cold light. MRI was performed 1, 6, 12, 24 hours, 3, 7 days, 2, 3, 4, 6, and 8 weeks after photothrombosis and obtained T1- & T2-weighted and contrast-enhanced images. Also, T2* images were obtained after superparamagnetic iron oxide injection. After MRI, animals were sacrificed and the brain sections were stained for routine immunohistopathology. Results: MRI and histological analysis revealed well in-duced lesion in the cortex and showed biological course of infarction. However, PIRM showed rapid development of infarction lacking collateral circulation. Infarction size reached maximum 12 hours after induction, progressively decreasing over 4 weeks. Interstitial and cytotoxic edema were evident at 6, 12, 24 hours, but decreasing afterwards. Neurogenic inflammation appeared on 3rd day and reached maximum on 5∼7th day. Arachnoid membrane was characteristically invaded with inflammatory cells and later thickened with fibrosis. Conclusion: This study showed PIRM is ideal model to study subacute and chronic stages of cerebral infarction. (J Korean Acad Rehab Med 2006; 30: 447-454)
Objective To investigate the efficacy of single event multi- level chemoneurolysis (SEMLC), a combination therapy of botulinum toxin and phenol for cerebral palsy (CP) with quadriplegia. Method: Fifty seven CPs with quadriplegia and 38 CPs with diplegia were injected botulinum toxin into as many small and distorted muscles as dose permitted, and then, phenol to the rest of muscles under conscious sedation. At three weeks after this procedure, patients were assessed for modified Ashworth scale (MAS) and range of motion (ROM). Changes of activities of daily living (ADL) and satisfaction with this procedure were investigated. Those assessments were compared between quadriplegia and diplegia.Results: MAS was reduced and ROM was improved in quadriplegia as much as those in diplegia. While the mobility function in diplegia improved more, the basic ADL functions in quadriplegia improved more than that in diplegia. Most patients experienced a decrease in pain after injection. Caregivers of both groups were quite satisfied with the procedure although some reported unmet expectations. Conclusion: SEMLC enabled chemoneurolysis of enough levels of spastic muscles in CP with quadriplegia and lead to changes not only in spasticity and ROM but also in basic ADLs and pain. (J Korean Acad Rehab Med 2006; 30: 455-461)
Objective To investigate the effects of single event multi- level chemoneurolysis (SEMLC) on the upper extremity function along with the improvement of spasticity in children with cerebral palsy. Method: SEMLC using botulinum toxin and 5% phenol solution was done for the upper extremities of 22 children with spastic cerebral palsy. In control group, 17 children with spastic cerebral palsy were enrolled. The assessment of spasticity (modified Ashworth scale) and upper extremity function (quality of upper extremity skills test, QUEST) before and 4 weeks after treatment were examined. Results: The spasticity of upper extremity was significantly reduced in SEMLC group compared with control group (p＜0.05). The improvement of upper extremity function was significantly greater in SEMLC group than in control group (p＜0.05). Children with spastic triplegia showed the largest change of QUEST compared with other types, but it wasn't statistically significant. In SEMLC group, initial QUEST score and the degree of improvement of QUEST after treatment showed significant negative correlation (p＜0.05). Conclusion: This study revealed SEMLC of the upper extremity in cerebral palsy was the effective treatment which could improve the upper extremity function as well as reduce the spasticity itself. (J Korean Acad Rehab Med 2006; 30: 462-467)
Objective To identify the difference of postural control mechanisms between healthy children and children with spastic diplegic cerebral palsy (CP) Method: Nineteen children with spastic diplegic CP and 22 healthy children were enrolled. Pressure data were recorded while subjects stood on the dual force platform and net body coordinates of center-of-pressure (COP) were calculated. Outcome measurements included net body COP calculations for path length, medio-lateral and antero-posterior displacements, and correlation coefficients between parameters representing ankle, hip and transverse body rotation mechanisms. Results: Children with CP showed more medio-lateral and antero-posterior displacements compared to healthy children. The coordinate of net body COP showed more correlation with transverse body rotation parameters for both medio- lateral and antero-posterior rections, and less correlation with ankle mechanism parameters for medio-lateral direction in children with CP. The visual information did not show a significant influence on keeping balance during quiet standing in children with CP. Conclusion: This study revealed that the ankle control mechanism for medio-lateral balance control during quiet standing was less used in children with CP. The transverse body rotation mechanisms contributed more significantly to postural control during quiet standing in children with CP. (J Korean Acad Rehab Med 2006; 30: 468-474)
Objective The aim of this study was to evaluate the effect of orthopaedic surgery for correcting gait deviation on transverse plane with regard to the kinematic parameters in children with spastic diplegic cerebral palsy (CP). Method: Forty-one children with spastic diplegic CP were included. They were divided into 3 groups: femoral derotaional osteotomy (FDRO) group, multiple hip internal rotator lengthening (without FDRO) group and medial hamstring lengthening only group. Gait analysis was done before and at least 6 months after operation using Vicon 370 system (Oxford Metrics Ltd., Oxford, UK). Results: In FDRO group, average values of hip internal ro-tation and foot progression internal rotation were significantly improved (from 12.3o to 0.5o and from 6.5o to 11.2o), but pelvic rotation was not changed. In another 2 groups without FDRO, there was no significant change in all kinematic parameters on transverse plane after surgery. Conclusion: In children with spastic diplegic CP, there were improvements in kinematic parameters of hip and foot on transverse plane after FDRO. However, the lengthening of medial hamstrings and other hip internal rotator muscles without FDRO had no significant effect on kinematic parameters on transverse plane. (J Korean Acad Rehab Med 2006; 30: 475-480)
Objective Neuromuscular imbalance of vastus medialis obliquus and vastus lateralis muscles is one of the major causes of patellofemoral pain syndrome. This study was designed to evaluate the effect of the angular velocity on the electromyographic activities of vastus medialis obliquus and vastus lateralis during isokinetic cycling. Method: Fifteen healthy women (23.6⁑2.7 years) without any knee problem performed two sets of isokinetic bicycling using Motomed (RECK, Germany) at three different revolutions per minutes (30 RPM, 45 RPM, 60 RPM). Integrated electromyographic (iEMG) activities of vastus medialis obliquus and vastus lateralis were measured during cycling. Results: iEMG activities of vastus medialis obliquus increased as angular velocity increased (p＜0.05). The vastus medialis obliquus：vastus lateralis iEMG ratio at 60 RPM was significantly greater than the ratio at 30 RPM (p＜0.05). Conclusion: Preferential vastus medialis obliquus activation was achieved by isokinetic cycling at high angular velocity. This suggests the meaningful therapeutic protocol for the patients with patellofemoral pain syndrome in altering neuromuscular imbalance between vastus medialis obliquus and vastus lateralis. (J Korean Acad Rehab Med 2006; 30: 481-484)
Objective To compare the movement pattern of the hyoid during the pharyngeal swallowing between healthy young and old person through the motion analysis using the videofluoroscopic study. Method: Eight young and eight old volunteers without dysphagia were included in this study. Movement patterns of the hyoid (degree of anterior and superior displacement, the speed, trajectory and temporal speed curve of the hyoid) were analyzed through the videofluoroscopy and the motion analysis system. Results: The maximal anterior displacement and the maximal speed of the hyoid were decreased in the old group compared with the young. The trajectories of the young and old group showed asymmetrical pathway (returning pathway was different from the departing one). All groups showed two speed peaks at the temporal curve but the peaks at the old group were blunted. Conclusion: Decrease of the maximal anterior movement and the peak speed of the hyoid during the pharyngeal swallowing was found in the old group. It may be due to decrease in the contraction speed of the muscles related to the hyoid movement and elasticity of the laryngeal wall according to the aging. (J Korean Acad Rehab Med 2006; 30: 485-490)
Objective To assess the effect of vitamin K2 in addition to risedronate on postmenopausal osteoporosis Method: We enrolled 21 postmenopausal osteoporosis women (age: 65.2⁑7.8 years). Ten subjects received risedronate (35 mg, weekly) and vitamin K2 (45 mg, daily) and eleven subjects only received risedronate. They all received calcium citrate 2,130 mg and vitamin D 600 IU daily. The duration of treatment was 7.7⁑1.4 months. Bone mineral density (BMD) of lumbar spine and both femurs, serum osteocalcin and urine deoxypyridinoline were examined at baseline and after treatment. Results: After treatment, BMD, serum osteocalcin and urine deoxypyridinoline were improved in each group but there was no statistical difference between the groups. Conclusion: There was no evidence of the benefit of vitamin K2 in addition to risedronate in bone metabolism on postmenopausal osteoporosis. (J Korean Acad Rehab Med 2006; 30: 491-495)
Objective To evaluate the effects of etidronate disodium on bone and soft tissue, especially on bone mineral density, and mucosal changes of the aorta and esophagus. Method: Male Sprague-Dawley rats were randomly divided into 2 separate groups: one with etidronate disodium and one without etidronate disodium. Bone mineral density (BMD) in lumbar vertebrae, femur, and a simple X-ray of the whole body were obtained. The abdominal aorta and esophagus were assessed histopathologically in post treatment. Results: In post treatment for 12 weeks, the extent of decrease in BMD of the group with etidronate disodium was less than that of the group without etidronate disodium (p＜0.05). There was no evidence of aorta and heart valve calcification in the simple X-ray, nor was there intima-media thickening, atheroma formation and calcification in aorta and esophageal irritation findings in pathologic examinations in both groups. Conclusion: The results suggested that etidronate disodium had an inhibitory effect on bone mineral loss and had the esophageal tolerability and safety, but no difference in aorta calcification and antiarthrogenic effects, including aorta wall thickness in this study. (J Korean Acad Rehab Med 2006; 30: 496-501)
Objective To evaluate the effects of age, height, weight, body mass index (BMI), diabetes mellitus, osteoporosis, smoking and alcohol on postural sway (PS) and limb load asymmetry (LLA) in the rural inhabitants in Korea Method: Nine hundred and sixty inhabitants were included in this study. PS and LLA were recorded while the subjects were standing on two adjacent force platforms (MedianceⰒ; Human-Tech Inc, Korea) in a comfortable stance for 30 seconds. Bone mineral density was measured in the right calcaneus by ultrasonography (SaharaⰒ; Hologic Inc, USA). History of diabetes and smoking were taken through interview. Results: PS and LLA were correlated with age (p＜0.01). There were significant decreases in PS and LLA in the young age-group (p＜0.01). There was no significant difference in PS and LLA in terms of sex, osteoporosis, height, weight, BMI and smoking. There was a significant difference in LLA (p＜0.05) but no difference in PS between diabetic and normal groups. Conclusion: PS and LLA may be related with ageing. Diabetic group may have higher LLA than normal group. However, sex, osteoporosis, height, weight, BMI, and smoking may not affect on PS and LLA. (J Korean Acad Rehab Med 2006; 30: 502-507)
Objective This study was designed to evaluate the effect of ankle bracing (Aircast) on postural sway and limb load asymmetry (LLA) in normal adults. Method: 263 healthy subjects volunteered. These subjects were performed the balance test on three different conditions, 1st test fulfilled without ankle brace, 2nd test with aircast on one ankle and 3rd test with aircast on the other ankle. All subjects were divided into two groups; younger(＜65 years) and older (≥65 years) group. Postural sway and body weight distribution were recorded while the subjects were standing on two adjacent force platforms during 30 seconds trial. All subjects chose a comfortable stance with feet apart and asked to look straight ahead at a fixed point in a quiet room. Results: There were significant differences not only in LLA but also in postural sway between younger and older group. The difference of postural sway and LLA in older group was more prominent that in younger group (p＜0.05). Conclusion: The results indicated that ankle bracing improved postural sway irrespective of age. Moreover in older group, ankle bracing on one ankle that was in the absence of LLA improved postural sway by far. (J Korean Acad Rehab Med 2006; 30: 508-512)
Objective The purpose of this study was to invent a new communication device by utilizing the function of anal sphincter muscles that was another residual motor function to the last in amyotrophic lateral sclerosis (ALS) patients. Method: We designed a sensor which worked by changing intensity of the contraction and was enable severely paralyzed patients to communicate by means of self-regulation of the anal sphincter contraction. This device made sentences through combination of selected Korean letters deprived from sphincter contractions. Results: This device was composed of three parts. Anal sensor: the head part of the sensor regulated by sphincters was located in the rectum, signal processing module: the raw signal from the sensor was boosted up and set up on the baseline voltage equal to threshold by threshold detector, and device program: the icon mode which was composed of routine questions and requested to their care-givers. And in user-writing mode, patients could choose syllable elements using the sensor operating by sphincter. Conclusion: This system was designed for advanced ALS patients with only the available function of sphincter muscles and could give them another new option in selecting communication devices. (J Korean Acad Rehab Med 2006; 30: 513-521)
Delayed postanoxic encephalopathy causes relapse of cognitive impairment and movement deterioration in a few weeks after clinically complete recovery from initial anoxic or hypoxic insult. Delayed postanoxic encephalopathy is a rare condition, and its clinical symptoms are characterized by abulia, apathy, akinesia, confusion, agitation, parkinso-nism, chorea, dystonia and/or progressive neurologic deficits. We reported two distinguished cases caused by carbon monoxide intoxication and mixed respiratory and metabolic lactic acidosis. (J Korean Acad Rehab Med 2006; 30: 522-527)
We had treated 3 athletes after surgical repair of Achilles tendon rupture according to a functional rehabilitation protocol. We measured the range of motion of ankle joint, pain intensity by visual analogue scale (VAS) score, the difference of calf circumference between normal and affected side, strength of dorsiflexor and plantarflexor of ankle before and after rehabilitation. The range of motion, VAS score, calf circumference, strength of dorsiflexor and plantarflexor of the affected ankle were improved after rehabilitation. There were no re-ruptures. All three patients returned to the sports activities after about 5 months. The comprehensive rehabilitation after surgical repair of Achilles tendon rupture was necessary for successful return to the sports activities. (J Korean Acad Rehab Med 2006; 30: 528-533)
After slip down, a 64 years old female had pain on the left buttock and the back without weakness or sensory change. Physical examination revealed tender points on left buttock and quadratus lumborum muscle. Straight leg raising test was 40o/20o. After trigger point injection on tender points, her symptoms were improved. Magnetic resonance imaging showed central extruded disc at L3-S1. After systemic steroid therapy was started, fever was developed about 39.3oC and laboratory evaluation showed inflammatory sign. Systemic steroid injection was stopped. Physical examination revealed a palpable and painful mass on the left lower quadrant of the abdomen. Ultrasonography and computerized tomography of abdomen and pelvis showed a large (7⁓5 cm) irregular shaped cystic mass along left iliopsoas muscle. Percutaneous catheter was inserted for drainage. Thick turbid yellow-greenish pus (300 cc) was drained. Intravenous antibiotics were administered and the patient's symptoms gradually improved. Culture of the pus revealed Streptococcus agalactiae. (J Korean Acad Rehab Med 2006; 30: 534-536)
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