Method Twenty seven rats with a model of complete spinal cord injury were assigned to one of the following groups: control (n=9), electrical stimulation (n=10), and exercise (n=8) groups. After a 2-week intervention period, they were sacrificed, and the pattern of apoptosis was analyzed by in situ DNA nick-end labeling (TUNEL), by DNA fragmentation assay, and by Western blot for Bax and Bcl-2 using specimens from the right hamstring muscles for all groups.
Results The electrical stimulation group had increased apoptosis compared to the control group possibly due to overwork weakness, but there was no statistical significance between the groups. Apoptosis decreased in the exercise group compared with in the electrical stimulation and control group. The expression of Bcl-2 was most prominent in the exercise group, and it was significantly reduced in the electrical stimulation and control group.
Conclusion These findings suggest that exercise could play an important role in decreasing apoptosis by the up-regulation of Bcl-2 protein expression and that electrical stimulation might cause overwork weakness in rat models of spinal cord injury.
Method A heterogeneous group of 18 prepubertal children with CP (age, 8.9±2.9 years; GMFCS level, IV and V) participated. Patients underwent a dual-energy X-ray absorptiometry scan of the lumbar spine (L1-L4) and proximal femur, and the Z scores were calculated by using data obtained from the control group who were normal children (age, 8.8±2.9 years). We divided the patients into 2 groups: group A standing for 2 hours a day, 5 days a week; group B standing for 30 minutes a day, 1 or 2 days a week. We measured BMD after 1 year and compared it to baseline measurements.
Results BMD was significantly higher on L2-L4 vertebrae, femoral neck and trochanter area after exercise in group A (p＜0.05). There was no significant difference in BMI after exercise in the group B (p＞0.05). BMD according to static weight-bearing exercise for 1 year were significantly different between groups A and B on the L1, L4 vertebrae, femoral neck and trochanter area (p＜0.05).
Conclusion This study suggests that weight-bearing exercise may be an important part of a rehabilitation protocol to maintain and improve BMD in children with spastic quadriplegic CP.
Method Eighty four children with CP were participated in this study. Non-speech mechanism function was investigated with a simple scale of oral motor status (OMS) and a feeding-swallowing evaluaton protocol for children (FEP-C). Higher score represents more severe in dysfunction in both tests. As well, Gross motor function classification system (GMFCS), the nutritional status based on body mass index were assessed in these subjects. GMFCS level I to III were grouped into high functioning group while GMFCS level IV and V were grouped into low functioning group.
Results Fifty seven (67.9%) individuals with CP showed dysphagia symptoms (OMS sore ≥1). The mean scores of non-speech mechanism function in low functioning group were higher than in high functioning group (p＜ 0.05). The mean scores of both OMS and FEP-C were higher in individuals with underweight (p＜0.05). Compared to high functioning individuals with CP, underweight was more prevalent along with higher scores in oral motor function in low functioning group. OMS scores were significantly correlated with the mean scores of non-speech mechanism in all subareas (p＜0.05).
Conclusion Non-speech mechanism function was closely related with GMFCS level. As well, this study revealed that the oromotor function and nutritional status in these individuals with CP related with non-speech mechanism function.
Method26 cerebral palsy children with spastic hip adductor muscles went under inhalation general anesthesia by anesthesiologist for phenol block of obturator nerve. After induction with thiopental sodium and sustained with sevoflurane by face mask without the use of muscle relaxant, the vital signs including heart rate, blood pressure and oxygen saturation were closely monitored throughout the procedure. The obturator nerve block was carried out with 5% phenol using a stimulator. Modified Ashworth scale (MAS) and range of motion of hip were measured before and after the procedure to compare the effects of nerve block.
ResultsNo significant differences were observed from the vital signs before, during and after the procedure. The MAS score improved from average 2.50±0.71 to 1.12±0.32. The range of motion increased from 24.31±12.32o and 25.88±12.28o right and left relatively to 39.62±10.10o and 40.96±11.14o.
ConclusionBoth spasticity and range of motion of hip adductor muscles improved significantly after obturator nerve block with 5% phenol under inhalation general anesthesia in the operating room with face mask, and no adverse effects or complications were seen in all 26 cerebral palsy children. Therefore phenol nerve block under inhalation general anesthesia in operation room for cerebral palsy children with poor cooperation or positioning difficulty due to spasticity should be considered as a useful method.
Method112 patients diagnosed as CMT were enrolled and we reviewed the patients' charts and radiologic findings, retrospectively. We reviewed the sex, gestational age, birth weight, mode of delivery, age at diagnosis, mass thickness, ratio of mass thickness, mass site, plagiocephaly, clavicle fracture, the frequency of rehabilitation treatment.
ResultsThe patients with a plagiocephaly or a clavicle fracture had been needed significantly longer rehabilitation and ratio of mass thickness and rehabilitative duration had a positive linear relationship and diagnostic time and the duration of rehabilitative treatment showed a positive correlation. However, rehabilitation frequency did not equate to a shorter rehabilitation period and mass site did not correlate with the duration of rehabilitation treatment. Also, the group treated with manipulation with additional ultrasound treatment showed no significant difference to the group treated with only manipulation. In this study, 2 patients received surgical treatment, which was SCM tenotomy of the affected side in conjunction with rehabilitation therapy.
ConclusionThis study showed that plagiocephaly, clavicle fracture, mass ratio, and diagnosis time are clinically significant in determining rehabilitative treatment. So, it is imperative to make a timely diagnosis and objectively evaluate the tilting of the head and neck, as well as checking the mass ratio and identifying the presence of clavicle fractures.
MethodThe subjects were 79 hemiplegic stroke patients (39 males, 40 felames, mean age 61.9 years). We measured the BMD of the subjects, compared the BMD of affected sides with that of unaffected sides, and evaluate the BMD in connection with stroke duration and affected sides.
ResultsThe reduction of the BMD in affected sides was highly correlated with the duration of hemiplegia, but the correlation was not shown in the case of those in unaffected sides. In addition, the difference of BMD in affected sides between those in unaffected sides had an obvious negative correlation with the stroke duration of left hemiplegia, but not with that of right hemiplegia.
ConclusionStroke patients have a high prevalence of osteoporosis and this findings were particularly prominent in people who suffer from left hemiplegia. Early rehabilitative care, including weight-bearing exercise and outdoor ambulation, is essential for left side hemiplegic patients in order to prevent possible complications.
MethodSprague-Dawley rats were randomized to sham ischemia procedures followed by TBI, IPC followed by TBI, and IPC followed by sham TBI. IPC was induced by 20 min of right common carotid artery occlusion 24 hour prior to TBI, and experimental injury was induced using lateral fluid percussion model of moderate severity. We measured metabolic changes with 1H-MRS and conducted motor function and 4 arm maze tests to identify neurobehavioral deficits and cognitive deficits, respectively, at 1 day to 4 weeks post-injury.
ResultsThe NAA/Cr ratios in the affected hemisphere were significantly lower in TBI than in IPC-TBI group at 2 (p=0.006) and 4 (p=0.012) weeks and in the unaffected hemisphere at 4 weeks (p=0.030). TBI group also showed a trend towards reduction in NAA/Cho ratio in the affected hemisphere at 4 weeks (p=0.054).
ConclusionBrief IPC 24 hours before moderate lateral fluid percussion brain injury increases the resistance to brain damage and that is associated with changes in brain metabolites. These findings indicate that IPC induces neuroprotection against TBI in rat brains.
Method A total of 32 stroke patients were enrolled, 23 of them were ESWT group and 9 were control group. ESWT was applied 1 session/week, total 3 sessions and 12 patients were applied at biceps muscle belly and 11 patients were applied at biceps musculotendinosus junction. Patients were evaluated using modified Ashworth scale (MAS), modified Tardieu scale (MTS), Korean-modified Barthel index (K-MBI) at baseline, immediately, 1 week and 4 weeks after ESWT.
Results MAS and MTS were significantly improved immediately after ESWT, but were not significantly changed at 1 week, 4 weeks in ESWT group. The scores of K-MBI improved but were not different between ESWT group and control group. The treatment effect was greater in musculotendinous junction group than muscle belly group in MTS and MAS immediately after ESWT. We could not find out any significant factors affecting the effects of ESWT.
Conclusion Spasticity after chronic stroke improved immediately after ESWT, but was not changed significantly at 1 week and 4 weeks after ESWT. Further studies about ESWT parameters for spasticity and factors affecting treatment effect are needed.
MethodThe adult patient who were admitted to the ICU and taken ventilator care with endotracheal intubation were included. The time after admission was 48 to 144 hours. In case of axonal neuropathy of peripheral nerve, if affected nerves were in different two limbs or different three nerves were affected, CIP was diagnosed. If some nerves got abnormal results but did not satisfied the above criteria, the patient was classified as peripheral neuropathy group. The days of using neuromuscular blockade, continuous insulin infusion, catecholamine, vasopressor, corticosteroid, benzodiazepine, parenteral nutrition and fact for continuous renal replacement therapy, SOFA (sequential organ failure assessment) score were evaluated to find the risk factors.
ResultsEighteen patients were included. Six patients were CIP and another six were peripheral neuropathy. Risk factors for CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition (p＜0.05). There was no difference on mortality rate among the three groups.
ConclusionThe result of early electrodiagnosis on ICU patients for CIP diagnosis revealed that risk factors of CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition.
Method Fifty-nine subacute hemiparetic stroke in-patients participated in this study. All patients were randomly assigned to one of two groups: the control group and the experimental group. Both groups received the same conventional physical therapies for 4 weeks. The experimental group received an additional core strengthening program (CSP). Korean mini-mental state examination (K-MMSE) and Korean Modified Barthel Index (K-MBI) were performed on admission. CSP was performed for 30 minutes a day, 3 days per week for 4 weeks. We selected nine exercises available for stroke patients, and divided them as three steps according to the degree of difficulty. Because of the muscle weakness in stroke patients, a physical therapist often helped them during exercise. Outcome measurement included trunk control test (TCT), trunk impairment scale (TIS), and Berg balance scale (BBS) and we compared both groups before and after the period of training.
Results There were no significant differences in baseline general characteristics and initial values between the two groups. After rehabilitation therapy, both groups showed significant improvements in BBS, TIS, and TCT (p＜0.05). Following 4 weeks of therapy, changes of BBS, TIS score in the experimental group were significantly higher than those of the control group (p＜0.05). However, the change of TCT score was not significantly different.
Conclusion Analysis of different clinical parameters showed that better outcomes in BBS, TIS scores were achieved from CSP. This study suggests that CSP conducted for 4 weeks may be beneficial as a therapeutic technique for use in improvement of trunk balance in patients with subacute hemiparetic stroke.
Method Fifty patients were assigned at random to receive intra-articular shoulder injection. The treatment groups were divided into two groups: BoNT-A group, 200 IU of BoNT-A and 2 ml of normal saline; triamcinolone acetonide (TA) group, 20 mg of triamcinolone and 2 ml of 2% lidocaine. Uptake ratio of quantitative three phase bone scintigraphy (QTPBS) was calculated by dividing the radioactivity count on the affected side by that on the unaffected side. Shoulder pain was assessed by visual analogue scale (VAS) and neuropathic pain scale (NPS). Range of motion (ROM) of shoulder joint and functional independence measurement (FIM) of upper limb were evaluated. All of them were measured before injection, and 4 weeks after injection.
Results After 4 weeks, the uptake ratio of blood pool phase was significantly decreased in hands of BoNT-A group than TA group. VAS, ROM and upper extremity FIM was similarly improved in both groups. Pain intensity and cold pain of NPS were similarly decreased in both groups. Hot pain and dull pain of NPS decreased more significantly in BoNT-A group than TA group.
Conclusion In the short-term, intra-articular BoNT-A shoulder injection maybe has the therapeutic effect on acute CRPS I related stroke. And the uptake ratio of blood pool phase of the hand of QTPBS may be useful to assess the therapeutic effect of CRPS after acute stroke.
Method The current study was conducted using a questionnaire developed by our rehabilitation team. Five hundred seven cancer patients participated in the survey.
Results The percentage of patients with more than one problem from each physical, psychological, and socioeconomic categories were 87.1%, 48.2%, and 50.9% respectively. Cancer patients with needs of rehabilitation services related to physical, psychological, and socioeconomic problems comprised 77.1%, 84.6%, and 84.8%. However patients who had information about rehabilitation services related to physical, psychological, and socioeconomic problems were 22.7%, 44.7%, and 24.5%. The percentage of patients with actual rehabilitation problems needing rehabilitation services related to physical, psychological, and socioeconomic problems were 65.1%, 52.1%, and 63.6%, but only 18.2% of patients with physical problems and 5.3% of patients with psychological and socioeconomic problems received such services. The prevalence of rehabilitation problems and rehabilitation needs was very high not only in the group still receiving cancer treatment but also in the group which had completed cancer treatment.
Conclusion The results of this study suggest that cancer patients have various kinds of physical, psychological, socioeconomic problems differing between cancer types and cancer treatment states with high levels of rehabilitation needs. We contend that the results of this study camay not only be able to aidin the development of appropriate cancer rehabilitation programs but also be used as a basis for policy studies.
MethodA retrospective analysis of the medical records, electrodiagnostic, and imaging findings of 12 patients (4 HD, 2 LMA, 6 BAD) was done. For patients whose last clinic follow-up exceeded 6 months a telephone survey was done to see if there were any symptom changes.
ResultsThe clinical, electrodiagnostic, and imaging findings of the HD and BAD patients were similar to previous studies. Except for a later onset, age disease duration was too short to distinguish LMA from HD or other motor neuron diseases. One patient in the BAD group progressed to amyotrophic lateral sclerosis (ALS) and another died due to undetermined respiratory failure. These two patients showed abnormalities in their lower extremities, thoracic paraspinal, and craniocervical muscles on needle electromyography. Except for another patient, none of the other three patients showed abnormalities in their lower extremities, thoracic paraspinals, or craniocervical muscles on needle electromyography.
ConclusionHD and BAD can be considered as separate disease entities. However, a longer follow-up period than previously recommended is necessary to differentiate BAD from ALS. Follow-up period was too short to determine whether LMA can also be considered as a separate disease entity.
Method Subjects included 50 hands of 33 patients with CTS with electrophysiologic evidence of CTS and 50 hands of 39 adults with no evidence of CTS. CuSP was measured on abductor pollicis brevis (APB) and adductor digiti minimi (ADM) by stimulation of digit 3. All subjects were examined with ultrasonography (US). Using US, the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve were calculated under carpal tunnel. Analysis of differences between the control group and the CTS group was performed using ANOVA.
Results Differences of CSA, FR, latency, and duration of CuSP in both APB, ADM muscles were observed between the two groups. Correlations were observed in the patient group in latency and duration of the APB muscle and only in duration of the ADM (p=0.048, r=0.159; p=0.035, r=−0.315; p=0.039, r=−0.293) muscle. Correlations were found only in duration of ADM (p=0.011, r=0.358) in the control group with respect to CSA. However, there was no correlation with FR.
Conclusion There seems to be a significant correlation between the CSA of the median nerve and the latency and duration of CuSP in patients with CTS. In addition, there seems to be a significant difference of CSA, FR, and latency in both APB and ADM between the two groups. CuSP and CSA might be useful for study that reflects intact small fibers in patients with CTS.
Method Thirty-six Bell's palsy patients within four days of disease onset were recruited and disease severity was assessed using the House-Brackmann grading system on the first visit, on the second visit (14 days later) and one year later. TMS at the labyrinthine segment was performed only on the first visit, while ENoG was done on the first and second visit.
Results The amplitude ratio of magnetically evoked muscle responses between the affected side and the healthy side was correlated significantly with the clinical course and the final outcome which were documented using the House- Brackmann grade, whereas ENoG was not on the first visit. On the other hand, ENoG on the second visit was correlated significantly with the final outcome.
Conclusion In the early period of Bell's palsy, magnetically evoked muscle responses by TMS reflect neural insult more accurately than ENoG. TMS could be a useful measuring tool for the diagnosis and prognosis of Bell's palsy in the acute stage.
MethodTwenty-three subjects with chronic low back pain were allocated randomly to repetitive magnetic stimulation group (n=13) and transcutaneous electrical nerve stimulation group (n=10). Each treatment consisted of 10-minutes sessions each day, totally 10 sessions over 2 weeks. Subjects were evaluated pre-treatment and post-treatment at 8 hours and 2 weeks. Outcome was measured with the Oswestry disability index, McGill pain questionnaire, and daily mean pain numeric rating scale.
ResultsAt 8 hours and 2 weeks post-treatment, transcutaneous electrical nerve stimulation therapy group showed a significant improvement in the mean pain numeric rating scale. Two weeks post-treatment, transcutaneous electrical nerve stimulation therapy group showed a significant improvement in the Oswestry disability index. But there were no significant therapeutic effect of repetitive magnetic stimulation therapy group at all period.
ConclusionThis study showed that repetitive magnetic stimulation therapy may be less effective than transcutaneous electrical nerve stimulation therapy for the treatment of chronic low back pain.
Method Sixrteen physically active elderly men and women (age 64.40±3.66) were recruited. The subjects underwent a 12-week knee flexor/extensor isokinetic exercise program of concentric contractions at a velocity of 180 degrees/sec of the both knee twice a week for 12 weeks. Training was carried out on the isokinetic dynamometer. The subjects were evaluated with muscular strength at 90 degrees/sec, endurance at 180 degrees/sec, cardio-pulmonary function, balance, mood and life quality at baseline, 4-week, 8-week and 12-week.
Results Six of 16 people gave up in the middle of the course, 10 people completed a muscle strengthening exercise program. Muscular strength, balance, mood and life quality improved.
Conclusion Isokinetic exercise of the knee joint muscle was carried out and showed the result of multivalent effect in old age. Therefore strengthening exercise in aged persons was thought to be provided for welfare policy of an aging society as well as personal health improvement.
Method One hundred and twenty six knees of 63 patients were studied. The degree of protrusion for each knee of patients was measured during standing by US. Radiographs were examined in order to determine whether the participants had radiographic osteoarthritis, graded using the Kellgren-Lawrence (K-L) grade. Clinical assessment was performed by recording a visual analogue scale (VAS). Correlation was obtained between the difference of VAS and MMP in the same patient. Assessment of pain, stiffness, and disability were performed by comparison of K-WOMAC index and MMP in a patient.
Results Mean protrusion (mean±S.D.) for knees with each K-L I, II, III, and IV grade were 0.27±0.52 cm, 0.38±0.60 cm, 0.55±0.76 cm, and 0.75±0.08 cm, respectively. The difference was significant (p＜0.05). Significant correlation was observed between MMP and VAS in K-L grades II (p=0.002, r=0.500) and III (p=0.002, r=0.684), also between ԤMMP and ԤVAS (p=0.000, r=0.558). With the K-WOMAC index, MMP were correlated with pain and stiffness (p＜0.01), but not with disability score.
Conclusion The degree of MMP measured by US is associated with K-L grade in knee OA patients. The degree of MMP can be a reliable indicator, like K-L grade, for radiological severity of knee OA. MMP has been correlated with VAS and with subscore of pain and stiffness, but not disability in the K-WOMAC index.
Method Twenty-four patients who had cervical disc herniation in magnetic resonance imaging (MRI) were evaluated. The patients were divided into 2 groups; patients with unilateral cervical radiculopathy in electrodiagnosis (RAD) and patients without definite radiculopathy (HIVD). Twenty six controls without disc herniation were also evaluated. Cervical multifidus muscles from C4-5 to C7-T1 levels were detected in T1 axial MRI, and total cross-sectional area (CSA) of multifidus muscle (TMA) and pure muscle CSA (PMA) were measured.
Results The ratios of TMA in involved side to TMA in uninvolved side (ITMA/UTMA) and PMA in involved side to PMA in uninvolved side (IPMA/UPMA) in HIVD and RAD groups was significantly lower than those in control group especially at C7-T1 level (p＜0.05). We divided the levels of cervical spine into three parts according to lesions found in MRI or electrodiagnosis; above lesion level, at lesion level and below lesion level. Abnormal cases of IPMA/UPMA were not different among levels in HIVD group, but RAD group showed that most of abnormal cases were below lesion (60%).
Conclusion Asymmetric multifidus atrophy was seen in patients with cervical disc herniation and radiculopathy. The ratio of pure muscle CSA between involved and uninvolved sides might be a useful parameter to differentiate patients with unilateral cervical radiculopathy from patients without radiculopathy.
MethodTwenty patients with acute (pain duration ＜2 months) and chronic (pain duration ＞3 months) musculoskeletal pain were recruited. Pain intensity was assessed using 3 measures: ratings of average pain on a visual analogue scale (VAS), ratings of average pain on the short form McGill pain questionnaire (SF-MPQ), and ratings of pain on the present pain intensity (PPI) verbal rating scale. Quality of life and anxiety were assessed using 2 measures: the SF-36 (medical outcomes study 36-item short-form health survey) and the STAI (state-trait anxiety inventory).
ResultsThe SF-36 scale was lower and state anxiety scale was higher in chronic pain group. The SF-36 and the state anxiety scale revealed significant difference between the acute and chronic groups (p＜0.05), but there was no significant difference between the the groups regarding pain intensity and the trait anxiety scale.
ConclusionPatients with chronic pain showed low well-being status and increased anxiety level compared to acute pain patients. According to the above results, proper management of chronic pain might be helpful for enhancing their psychosocial function.
Method 14 healthy people performed cardiopulmonary exercise test by means of Bruce protocol. The omnidirectional PATs were placed onto the right wrist and ankle, and the temperature sensing PATs were placed onto the right arm and lower leg. Simultaneous measurement of body motion was continuously recorded during cardiopulmonary exercise test. Then we checked total calorie expenditure and duration above moderated intensity activity (＞3 METs) from each PATs and gas analyzer.
Results Total calorie expenditures of PAT were significantly underestimated than gas analyzer, except the temperature sensing PAT applied onto the leg, but all of them showed significant correlation. The duration above moderate intensity activity of the PAT did not show significant difference comparing with gas analyzer, except the omnidirectional PAT applied onto the arm, but all of them showed significant correlation.
Conclusion Both omnidirectional PATs and temperature sensing PATs could estimate the total calorie expenditure and the duration above moderate intensity activity. But it is necessary to apply exercise-specific protocol to PAT to enhance the accuracy of estimating energy expenditure during periods of exercise.
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