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To follow up the long-term functioning in a community through assessing personal background and status based on the International Classification of Functioning, Disability and Health (ICF) after a stroke, by using a Korean version of World Health Organization Disability Assessment Scale II (K-WHODAS II).
We surveyed 146 patients diagnosed at the first-onset of acute stroke and discharged after Inha University Hospital, and 101 patients answered the K-WHODAS II survey. We analyzed the relationship of six functioning domains of K-WHODAS II with K-MMSE (Korean version of Mini-Mental State Examination) and K-MBI (Korean version of Modified Barthel Index) at admission and discharge, and personal background. All subjects were divided into five groups, according to the disease durations, to assess the functional changes and the differences of K-MMSE and K-MBI at the admission and discharge.
K-MBI and K-MMSE at admission and discharge showed no significant differences in all five groups, respectively (p>0.05), reflecting no baseline disparity for long-term follow-up. All subjects showed positive gains of K-MBI and K-MMSE at discharge (p<0.05). The six functioning domains and total scores of K-WHODAS II had decreasing trends until 3 years after the stroke onset, but rose thereafter. Higher scores of K-MBI and K-MMSE, younger age, women, working status, higher educational level, and living with a partner were correlated with lower scores of K-WHODAS II (p<0.05).
The long-term functioning after stroke was affected not only by cognitive and motor status in hospital, but also by certain kinds of personal background. K-WHODAS II may be used to monitor functioning status in a community and to assess personal backgrounds in subjects with chronic stroke.
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To investigate the short-term effects of bipolar radiofrequency applied to sacral nerves to treat neurogenic detrusor overactivity in patients with spinal cord injury.
Ten patients with spinal cord injury with neurogenic detrusor overactivity were recruited. These subjects were randomized to two groups: intervention (n=5) and control (n=5), members of which received conventional treatment. Voiding diary, International Consultation on Incontinence Questionnaire (ICIQ) and the urinary incontinence quality of life scale (IQOL) data were obtained and an urodynamic study (UDS) was performed before and after intervention. In the intervention group, percutaneous bipolar continuous radiofrequency (CRF) was performed on both the S2 and S3 nerves in each patient.
In a comparison of daily frequency and number of urinary incontinence and ICIQ and IQOL scores at baseline and at 1 and 3 months after intervention, all variables achieved a significant effect for time (p<0.05). Regarding UDS parameters, pre/post intervention differences between baseline and 3-month post-intervention for volume at maximal detrusor pressure during filling and reflex detrusor volume at first contraction were significantly different between the two groups (p<0.05). However, pre/post intervention differences in maximum cystometric capacity and maximum detrusor pressure during filling were not significant between the two groups (p>0.05).
Percutaneous bipolar CRF applied to sacral nerves might be an effective therapy for neurogenic overactive bladder that reduces urinary incontinence and improves quality of life.
To estimate hours of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA of people with chronic SCI.
Seventy nine persons with SCI living in Busan and Gyongsangnam-do were recruited. They completed a self-administered questionnaire, which consisted of items about personal characteristics, type of LTPA, hours of LTPA, LTPA intensity, and LTPA satisfaction.
Most participants (92.4%) did not work. The respondents reported a daily mean of 3.13 hours (±1.47) of LTPA; however, 3.8% reported no LTPA whatsoever. Years post-injury, income sources, and type of medical payment emerged as a predictors of LTPA. Years post-injury were positively correlated with amount of leisure activity. In the case of self income, LTPA was longer than for groups with different income sources (e.g.partner, parents). For patients receiving workers' compensation insurance, LTPA was longer than for patients receiving non-WC insurance. Most LTPA was done at a moderate intensity. The three most frequently reported types of LTPA were wheeling (26%), sports (19%), and stretching exercise (15%). There was overall dissatisfaction with LTPA.
Daily LTPA hours were longer than previously reported, but wheeling accounted for a large part of the activity. Intensity of activity was generally moderate. The employment rate was very low. Clearly, participating in regular LTPA for health purposes is very important to people with chronic SCI, but it is also important for them to have jobs.
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To evaluate the effect of semiconditional electrical stimulation of the pudendal nerve afferents for the neurogenic detrusor overactivity in patients with spinal cord injury. Forty patients (36 males, 4 males) with spinal cord injury who had urinary incontinence and frequency, as well as felt bladder contraction with bladder filling sense or autonomic dysreflexic symptom participated in this study.
Patients with neurogenic detrusor overactivity were subdivided into complete injury and incomplete injury groups by ASIA classification and subdivided into tetraplegia and paraplegia groups by neurologic level of injury. Bladder function, such as bladder volumes infused to the bladder until the first occurrence of neurogenic detrusor overactivity (Vini) and the last contraction suppressed by electrical stimulation (Vmax) was measured by water cystometry (CMG) and compared with the results of each subgroup.
Among the 40 subjects, 35 patients showed neurogenic detrusor overactivity in the CMG study. Among these 35 patients, detrusor overactivity was suppressed effectively by pudendal nerve afferent electrical stimulation in 32 patients. The infusion volume until the occurrence of the first reflex contraction (Vini) was 99.4±80.3 ml. The volume of saline infused to the bladder until the last contraction suppressed by semiconditional pudendal nerve stimulation (Vmax) was 274.3±93.2 ml, which was significantly greater than Vini. In patients with good response to the pudendal nerve afferent stimulation, the bladder volume significantly increased by stimulation in all the patients.
In this study, semiconditional electrical stimulation on the dorsal penile afferent nerve could effectively inhibit neurogenic detrusor overactivity and increase bladder volume in patients with spinal cord injury.
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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.
Method: Thirty-one breast cancer patients who had undergone curative surgery were randomly assigned to an exercise group (n=16) and a non-exercise group (n=15). Exercise therapy was consisted of aerobic activity such as bicycle ergometer for 30 minutes, twice a day, five times each week for 2 weeks. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells.
Results: The baseline study did not show any statistical difference between exercise group and non-exercise group. Mean NKCA of day 7 decreased in both groups compared with that at postoperative day 1 (p＜0.05). At day 14, the difference of the mean NKCA between two groups was not significant, but the mean NKCA of the exercise group without metastasis demonstrated a significant increase compared with that of the non-exercise group without metastasis (p＜0.05).
Conclusion: This study suggested that early moderate exercise had a beneficial effect on the function of NK cells in early stage of breast cancer patients after curative surgery. A further study will be needed to evaluate long-term effect of exercise on NK cell. (J Korean Acad Rehab Med 2003; 27: 250-254)
Method: 15 healthy persons who were pain-free and didn't have the history of neuromuscular disease were participated in this study. Measurements were taken in three different sitting positions (relaxed, erect and forward head posture) with staring forward and arms hanging at the side. Paraspinal myoelectrical activities were measured by surface electrodes in paracervical, paralumbar, sternocleidomastoid (SCM) and levator scapular (LS) muscles. Simultaneously whole spine lateral X-ray including skull was taken. We measured cranio-cervical spinal alignment indicies (craniovertical, craniocervical, cervicohorizontal and upper cervical angles) introduced by Huggare and Gonzalez, lower cervical angle, lumbar lordosis angle and myoelectrical activity of each muscle in three different sitting positions.
Results: The analysis of relationship between lumbar lordosis and cranio-cervical spinal alignment index showed significant results. The more the lumbar lordosis increased, the head forward displacement decreased. But, the myoelectrical activities of paraspinal muscles were not influenced by the posture.
Conclusion: Maintaining lumbar lordosis is very important to correct forward head posture and research for the distraction force loaded to soft tissue of the neck in forward head posture is needed. (J Korean Acad Rehab Med 2003; 27: 126-130)
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: It is a widely accepted belief that paraspinal muscles tend to show spontaneous activity on needle electromyography early on in a radiculopathy and distal muscles become abnormal later on. But most studies have shown the limitations of using symptom duration when interpreting electrodiagnostic findings in radiculopathy. The purpose of this study was to determine the relationship between symptom duration and abnormal spontaneous activity in S1 radiculopathy confined to abnormal H-reflex.
Method: A retrospective study that collected the informations on symptom duration and spontaneous activity in paraspinal muscle and gastrocnemius for 112 patients with S1 radiculopathy diagnosed by unilateral H-reflex abnormality was undertaken.
Results: Abnormal spontaneous activity in paraspinal muscle had shown a significant negative correlation with symptom duration, that is a tendency to decrease its expression over symptom duration. On the contrary abnormal spontaneous activity in gastrocnemius muscle was rare at first a few weeks and became to show after 7 weeks. Patients with symptom duration over 1 year had higher incidence of having no abnormal spontaneous activities both in paraspinal and gastrocnemius muscle.
Conclusion: These results suggested that symptom duration had a potential role in the diagnosis of S1 radiculopathy when H-reflex were abnormal unilaterally.
Objective: To evaluate the effects of facet joint injection in the conservative management of osteoporotic spinal compression fractures
Method: Among 27 patients with osteoporotic spinal compression fractures which were confirmed by plain radiography and bone densitometry (dual energy x-ray absorptiometry), 9 patients were control group and 18 patients received facet joint injection treatment. Facet joint injection of thoracolumbar spine was done under fluoroscopic guide with 1% lidocaine 1 ml and triamcinolone 10 mg at each joint above and below the level of compression fracture at both side. Main outcome measures were visual analog scale (VAS), spinal movement (modified Schober's and lateral bending test), and physical activity from bed-ridden state (grade I) to outdoor activity without pain (grade V). The treatment outcomes were assessed before injection, 2 weeks and 4 weeks after injection.
Results: There were significant decrease in VAS at 2 weeks and 4 weeks after injection in the study group (p＜0.05). Physical activity was significantly improved at post injection 2 weeks and 4 weeks (p＜0.05). There were no significant differences between the two groups in spinal movement.
Conclusion: These results suggest that facet joint injection of thoracolumbar spine is useful method in the conservative management of painful osteoporotic compression fractures.
Objective: To evaluate the relationship of the respiration patterns and the abdominal muscle activities during various speech productions in the adults with athetoid cerebral palsy (CP).
Method: Subjects were 7 athetoid CPs and 7 healthy controls. Respirography and abdominal muscle activities were recorded by use of the pneumobelt and the surface EMG during their performances of six kinds of non-speech and speech tasks.
Results: The followings were observed in the athetoid CP.
1) Respiratory phase was irregular and variable in the intensity and period of revolution. The frequency of the respiratory phase was not different from the control in usual respiration, but higher in deep breathing. The time to persist one vowel phonation was shorter.
2) Inappropriate and frequent inspirations were occurred during speech task and the number of syllables was fewer and irregular for one speech breath.
3) The abdominal muscle activities were abrupt, irregular, inconsistent with the respiratory phase during all kinds of non-speech and speech tasks.
Conclusion: These findings suggest that the abnormal respiration patterns and abdominal muscle activities contribute to the abnormal speech production of athetoid CP and their incoordination is similar to athetoid movement of the extremities. We should consider the athetoid speech production as well as the dysarthria in the athetoid CP.
Objective: To evaluate the change of abnormal spontaneous activities according to the clinical and radiologic findings, and to the time course after onset in hemiplegic upper limb.
Method: We scored abnormal spontaneous activities of hemiplegic upper limb muscles (infraspinatus, deltoid, extensor carpi radialis, abductor pollicis brevis, abductor digiti minimi) in 100 hemiplegic patients without peripheral neuropathy. The abnormal spontaneous activities were evaluated according to their radiologic findings and to Brunnstrom stage and the presence of reflex sympathetic dystrophy (RSD), and the time course after the onset (A cross-sectional study). In addition we repeatedly examined 40 hemiplegic patients until 12 weeks after the onset to define the pattern of change (A prospective study).
Results: There was no significant difference in the score of abnormal spontaneous activities according to the radiologic findings. The score of abnormal spontaneous activities decreased while Brunnstrom stage progressed. In both the cross-sectional and prospective studies, we found that the abnormal spontaneous activities decreased according to the time course after the onset in the limb without RSD, but sustained in the limb with RSD.
Conclusion: Abnormal spontaneous activities decreased according to the progression of Brunnstrom stages. The hemiplegic patients with RSD showed more profuse and sustained abnormal spontaneous activities at needle EMG study of hemiplegic upper limb than the patients without RSD.
Objective: The aims of this study were to know the effects of long time bed immobilization on the heart rate variability and to know the correlation between the heart rate variability and other anthropometric parameters.
Method: The subjects of this study were 60 normal sedentary persons as control group and 22 patients who had been immobilized for a long time because of musculoskeletal problems without any systemic diseases. The heart rate variabilities were measured through the R-R interval variation at rest, deep breathing and valsalva maneuver. These values were compared between control and patient group and were analysed for correlation with age, weight, height, body mass index (BMI), amounts of smoking (pack years), spans of immobilization and physical activity scale (PAS).
Results: The mean heart rate variability of patients were 0.132⁑0.072, 0.216⁑0.109, and 0.289⁑0.171 in rest, deep breathing and valsalva maneuver respectively which were lower than the corresponding 0.176⁑0.085, 0.314⁑0.146, and 0.322⁑0.174 of normal control group. The heart rate variabilities were negatively correlated with age, BMI and amounts of smoking but positively correlated with the height. The physical activity scale of preimmobilization state was negatively correlated with resting heart rate variability but was positively correlated with heart rate variability during deep breathing and valsalva maneuvering state.
Conclusion: The long bed immobilization significantly decreased the heart rate variability and the heart rate variability could be used as a useful tool to measure the effects of immobilization on the heart.
Objective: The purposes of this study were to examine overall quality of life (QOL) in long term stroke survivals and to identify variables that predict QOL after stroke.
Method: Subjects were 51 stroke patients (male; 28, female; 23) with stroke onset at least 6 months previously. Interview, measurement of depression and QOL were performed at outpatient clinic after discharge. Review of medical records included characteristics of stroke and communication disorders. Interview questionnare included caregiver, religion, education level, occupation and income. Depression and functional status was measured by the Beck depression inventory (BDI) and modified Barthel index (MBI), respectively. QOL was measured with the use of 5-item (activity, daily living, health, support, outlook) version of the Quality of Life Index (QLI) and its range of scores is 0∼10. We compared QLI scores according to various factors obtained from medical records and questionnaire.
Results: Mean duration after onset of stroke was 33.6 months (range, 6∼216 months). The mean score of QLI were 7.0⁑2.1. Low MBI score, communication disorder and depression had a negative effect on QOL (p＜0.05). Sex, age, occupation, caregivers, religion, education level, income, duration after stroke onset and side of hemiplegia had no effect on QOL (p＞0.05).
Conclusion: Low MBI score, depression and communication disorders would be negative predictors of QOL and identification of these factor may assist stroke patients in coping their personal and social life.
Objective: To assess the abnormal spontaneous activities in needle electromyography (EMG) according to the type of herniated lumbar disc and anteroposterior the diameter of dural sac in magnetic resonance imaging (MRI).
Method: We performed the MRI on 120 patients with low back pain (LBP) and measured the midline anteroposterior diameter of dural sac in a MRI axial view. Fifty patients with a disc protrusion or extrusion in MRI were reviewed for the clinical findings on physical examination and assessed for the abnormal spontaneous activities (ASA) in needle EMG.
Results: Seventy cases with a normal finding in MRI did not have differences in a dural sac diameter regardless their age or sex. Fifty cases with a protrusion or extrusion in MRI showed that the dural sac size decreased more in an extrusion than in a protrusion, and more in a paracentral type than in a central type. The incidence of ASA in a needle EMG increased more in an extrusion than in a protrusion, and more in a paracentral type than in a central type. The incidence also increased according to the decrement of a dural sac diameter. The incidence of ASA were 100% in a group with both motor and sensory signs, 94% in a group with a motor sign, 86% in a group with a sensory sign, 26% in a group without motor or sensory sign.
Conclusion: We concluded that the abnormalities in needle EMG must be correlated with the direction of herniated lumbar disc and anteroposterior diameter of the dural sac in MRI as well as clinical findings.
Objective: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV).
Method: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0o and 70o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls.
Result: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p＜0.05), whereas the normalized low frequency power showed a significant increase(p＜0.05). But for the left and right hemiplegia groups, there were no significant changes of normalized high and low frequency power under the orthostatic stress(p＞0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress.
Conclusion: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.
Objective: The purpose of this study was to determine the validity and the reliability of the Activity Index to ascertain its value in the functional evaluation of stroke patients.
Method: The Activity Index consists of sixteen variables divided into three main parts(mental capacity, motor activity, and ADL function) with a total value ranging from 16 to 92 points. A group of 96 stroke patients were included in this study. To determine the validity, kappa statistics between the Functional Independence Measure and the Activity Index were measured.
Results: In the validity study, the kappa statistics between the Functional Independence Measure and Activity Index were 0.79 and 0.84 for an initial total score and a discharge total score respectively, indicating a reasonable agreement between the two tests. In the reliability study, the Cronbach's alpha coefficient was 0.97 for the total score indicating a good internal consistency.
Conclusion: The Activity Index demonstrated an acceptable validity and reliability for the evaluation of functional capacity of stroke patients in clinical practice.
The purpose of this study was to collect the informations on the current status and the needs of the physically disabled elderlies in the rural community along with the prevalence rate of these population. One study group for the study of disability status evaluation was 139 physically disabled elderlies living in the main island of Kangwha, and the other group for the study on prevalence of disability was 542 elderlies living in Songhae myun. The prevalence of physical disability was 6.5% in Songhae myun. The neurologic disorder was the most frequent diagnosis among the physically disabled elderlies followed by the musculoskeletal disorder. The time for the medical service delivery was delayed; 45.3% of the subjects received medical service more than one month after the onset of disability. Only 18.0% of the disabled elderlies received the public disability service, and 15.8% of the subjects was waiting for further service. The most common need from the subjects was the medical service, followed by the service from the institution such as a nursing home and the financial support. Registration rate of the disabled was very low(7.7%). There were only three physical therapists for the rehabilitation services in studies areas.
This study revealed that the public concepts for the disability and the rehabiltation service were inadequate. We hope that this basic data can be used for the planning of rehabilitation services in this community.
Since the myofascial trigger point(MFTrP) has been described fifty years ago, its underlying pathophysiology has been remained unclear. The diagnosis also depends on the characteristic pain, tenderness and physical findings, which is very subjective. In recent years, some physicians investigated the objective findings of MFTrP, using the pressure algo meter and thermography. We investigated the electromyographic findings of MFTrP to evaluate the clinical usefulness of local twitch response(LTR) and sympathetic skin response(SSR), and to evaluate the electrophysiologic characteristics of MFTrP.
21 patients, diagnosed as myofascial trigger point syndrome on upper trapezius and so on, were evaluated for the triggering pain with visual analog scale(VAS), pressure threshold(THpr) using pressure algometer(Dolorimeter), LTR with concentric needle electrode and SSR on the palm. There was a significant negative correlation between VAS and THpr, but no significant correlation with electromyographic findings of LTR. Thus LTR could support the existence of MFTrP electrod iagnostically, but, could not explain the clinically correlated severity of MFTrP. There were only 3 patients showing abnormal SSR, who were all complaining the sympathetic symptoms on the affected arm with reffered pain. Even though referred pain to arm and hand existed, SSR was normal because suggested autonomic dysfunction of MFTrP is localized mechanism.
Among the 13 patients underwent the trigger point block, 8 patients who showed no residual LTR immediate after MFTrP block, had a great symptomatic improvement of MFTrP in a week, but 5 patients who showed the residual LTR did not. Regardless of complaint of pain and soreness immediate after block, loss of LTR would be predicted as a good treatment result.
In some cases, spontaneous EMG activity exist within the 3-4mm sized focus of MFTrP, although the taut band of MFTrP is 3-4cm length and depth. But this focus of MFTrP is a electrophysiologic changes within a muscle, not a structural changes seen by ultrasonography.
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