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Neurogenic heterotopic ossification (NHO) is a process of benign bone formation and growth in soft tissues surrounding major synovial joints and is associated with central nervous system (CNS) injuries. It is a common complication in major CNS injuries, such as traumatic brain injury, spinal cord injury, and stroke. Here, we report the case of a 72-year-old male, who experienced a traumatic brain injury and painful chronic NHO around the left hip joint. Three applications of extracorporeal shock wave therapy (ESWT) were administered to the area of NHO, which resulted in pain relief and an improvement in the loss of motion in the left hip joint. Improvements were also noted in walking performance and activities of daily living, although the size of NHO remained unchanged. Therapeutic effects of ESWT lasted for 12 weeks.
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Apraxia of eyelid opening (AEO) is a syndrome characterized by the patient's difficulty in initiating eyelid elevation spontaneously. Most of the reported cases were associated with extrapyramidal diseases. We report a case of AEO presented after traumatic brain injury, not with extrapyramidal diseases, and improved by dopaminergic treatment. A 49-year-old man underwent a traffic accident and was transferred to the emergency room in an unconscious state. Brain computed tomography (CT) revealed a subdural and epidural hemorrhage at right temporal and bilateral frontal lobes, and he received burr-hole trephination. After receiving comprehensive treatment including occupational therapy, cognition and mobility gradually improved, but he could not open his eyes voluntarily. With dopaminergic treatment (levodopa/benserazide 200/50 mg), he started to open his eyes spontaneously, especially when eating and undergoing physical training. This case showed that AEO may occur after brain injury and that dopaminergic treatment is beneficial also in AEO patients without extrapyramidal diseases.
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Kernohan-Woltman notch phenomenon (KWP) is an ipsilateral motor weakness due to compression of the contralateral cerebral peduncle. We report two cases of KWP following traumatic brain injury. In case 1, ipsilateral hemiplegia was noted after right subdural hemorrhage. Although magnetic resonance imaging showed no abnormal signal changes on cerebral peduncle, diffusion tensor tractography (DTT) revealed interruption of corticospinal tract (CST) at lower level of the midbrain level. In case 2, there was abnormal signal change of the right cerebral peduncle contralateral to the primary lesion and we could not reconstruct right CST. Case 1 showed unsatisfactory motor recovery even after 15 months, and follow-up DTT showed no change. In case 2, follow-up DTT was not performed, but her ipsilateral hemiparesis had almost disappeared during the 15 months. DTT would be useful in detecting ipsilateral hemiparesis due to KWP and the clinical course may differ according to the lesion characteristics.
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To evaluate the effects of electric cortical stimulation in the experimentally induced focal traumatic brain injury (TBI) rat model on motor recovery and plasticity of the injured brain.
Twenty male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT) and on a Rotarod task (RRT) for 14 days. Then, the TBI model was induced by a weight drop device (40 g in weight, 25 cm in height) on the dominant motor cortex, and the electrode was implanted over the perilesional cortical surface. All rats were divided into two groups as follows: Electrical stimulation (ES) group with anodal continuous stimulation (50 Hz and 194 µs duration) or Sham-operated control (SOC) group with no electrical stimulation. The rats were trained SPRT and RRT for 14 days for rehabilitation and measured Garcia's neurologic examination. Histopathological and immunostaining evaluations were performed after the experiment.
There were no differences in the slice number in the histological analysis. Garcia's neurologic scores & SPRT were significantly increased in the ES group (p<0.05), yet, there was no difference in RRT in both groups. The ES group showed more expression of c-Fos around the brain injured area than the SOC group.
Electric cortical stimulation with rehabilitation is considered to be one of the trial methods for motor recovery in TBI. However, more studies should be conducted for the TBI model in order to establish better stimulation methods.
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To report the defecation patterns of brain-injured patients and evaluate the relationship between functional ability and colon transit time (CTT) in stroke patients.
A total of 55 brain-injured patients were recruited. Patient interviews and medical records review of pattern of brain injury, anatomical site of lesion, bowel habits, constipation score, and Bristol scale were conducted. We divided the patients into constipation (n=29) and non-constipation (n=26) groups according to Rome II criteria for constipation. The CTTs of total and segmental colon were assessed using radio-opaque markers Kolomark® and functional ability was evaluated using the functional independence measure (FIM).
Constipation scores in constipation and non-constipation groups were 7.32±3.63 and 5.04±2.46, respectively, and the difference was statistically significant. The CTTs of the total colon in both groups were 46.6±18.7 and 32.3±23.5 h, respectively. The CTTs of total, right, and left colon were significantly delayed in the constipation group (p<0.05). No significant correlation was found between anatomical location of brain injury and constipation score or total CTT. Only the CTT of the left colon was delayed in the patient group with pontine lesions (p<0.05).
The constipation group had significantly elevated constipation scores and lower Bristol stool form scale, with prolonged CTTs of total, right, and left colon. In classification by site of brain injury, we did not find significantly different constipation scores, Bristol stool form scale, or CTTs between the groups with pontine and suprapontine injury.
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To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on recovery of the swallowing function in patients with a brain injury.
Patients with a brain injury and dysphagia were enrolled. Patients were randomly assigned to sham, and low and high frequency stimulation groups. We performed rTMS at 100% of motor evoked potential (MEP) threshold and a 5 Hz frequency for 10 seconds and then repeated this every minute in the high frequency group. In the low frequency group, magnetic stimulation was conducted at 100% of MEP threshold and a 1 Hz frequency. The sham group was treated using the same parameters as the high frequency group, but the coil was rotated 90° to create a stimulus noise. The treatment period was 2 weeks (5 days per week, 20 minutes per session). We evaluated the Functional Dysphagia Scale (FDS) and the Penetration Aspiration Scale (PAS) with a videofluoroscopic swallowing study before and after rTMS.
Thirty patients were enrolled, and mean patient age was 68.2 years. FDS and PAS scores improved significantly in the low frequency group after rTMS, and American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale scores improved in the sham and low frequency groups. FDS and PAS scores improved significantly in the low frequency group compared to those in the other groups.
We demonstrated that low frequency rTMS facilitated the recovery of swallowing function in patients with a brain injury, suggesting that rTMS is a useful modality to recover swallowing function.
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To evaluate the motor innervation of trunk muscles in traumatic brain injury patients.
Twenty patients (12 men and 8 women) with traumatic brain injury were enrolled in this study. Their mean age was 41 years. Motor evoked potentials (MEPs) were performed on the motor cortex. Electromyographic activities were recorded from the bilateral rectus abdominis muscles, the external oblique abdominal muscles, and the 4th and 9th thoracic erector spinae muscles. The onset latency and amplitude of contralateral and ipsilateral MEPs were measured. All patients were assessed by the Korean version of the Berg Balance Scale (K-BBS) to investigate the relationship between the frequency of MEPs in trunk muscles and gait ability.
The mean frequency of ipsilateral MEPs was 23.8% with more damaged hemisphere stimulation, while the contralateral MEPs showed a mean frequency of 47.5% with more damaged hemisphere stimulation in traumatic brain injury patients. The latencies and amplitudes of MEPs obtained from the more damaged hemisphere were not significantly different from those of the less damaged hemisphere. There was no correlation between the manifestation of MEPs in trunk muscles and gait ability.
The ipsilateral and contralateral corticospinal pathways to trunk muscles are less likely to be activated in traumatic brain injury patients because of direct injury of the descending corticospinal motor tract or decreased excitability of the corticospinal tract from prefrontal contusion.
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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: Fifty subjects with brain injury were enrolled and classified into two groups, experimental (n=25) and control group (n=25). Control group received conventional reha bilitation therapy including physical and occupational therapy. Experimental group received additional computer- assisted cognitive training using CogRehabKⰒ software consisted of 10 level-completing programs, 3 times per week, 30 minutes per session, for 4 to 6 weeks. All patients were assessed their cognitive functions using Seoul Computerized Neuropsychological Test (SCNTⰒ, Maxmedica, 2001), minimental status examination (MMSE), digit span, and Wechsler memory scale before and after treatment. Functional independence measure and geriatric depression scale were also applied for evaluation of functional and mood status.
Results: Before the treatment, two groups showed no difference in their cognitive functions. After 4 to 6 weeks of treatment, the experimental group showed significantly higher performance in forward digit span, forward visual span, auditory continuous performance test, and visual continuous performance test in CNT and MMSE than control group (p＜0.05).
Conclusion: We conclude that the CogRehabKⰒ may be useful as an additional tool for the cognitive rehabilitation in patients with brain injury. (J Korean Acad Rehab Med 2003; 27: 830-839)
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.
after a traumatic brain injury. Conventional brain MRI presented no specific abnormality in case 1 and 2, a focal encephalomalacia in the left anterior thalamus in case 3, and contusional hemorrhages in the left temporal and parietal lobes in case 4. But DTI disclosed microstructural abnormalities on descending motor pathway including the posterior limb of the internal capsule or the cerebral peduncle of the midbrain in all cases. (J Korean Acad Rehab Med 2003; 27: 446-450)
Objective: To evaluate the effect of donepezil on cognitive function in patients with brain injury who had cognitive impairment.
Method: Twenty one subjects with brain injury (18 males, 3 females) were enrolled and classified into two groups, experimental and control group. There was no significant difference between two groups in age, postonset duration, and level of education. For the experimental group, one tablelet of AriceptⰒ (5 mg of donepezil per tablet) was administered daily for 6 weeks. The baseline and follow up cognitive assessments were performed before and 6 weeks after. Mini- mental Status Examination (MMSE), Computerized Neuropsychologic Test (CNT), Judgement of Line Orientation (JLO), and visuospatial Wechsler memory test were used for the assessment of cognitive function.
Results: In baseline study, two groups showed no difference in their cognitive function. After 6 weeks, the experimental group showed significantly higher performance in forward digit span, verbal learning test, backward visual span, visual learning test, non-verbal Wechsler memory test, and judgement of line orientaion than control group (p＜0.05).
Conclusion: These results suggested that the administration of AriceptⰒ was beneficial in improving the cognitive function, especially verbal and visual memory and visuospatial perception in patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 374-378)
Objective: This study was to investigate the relationship between genotype of Apolipoprotein E (Apo E) and severity of disability after brain injury as well as serum lipid profile.
Method: One hundred thirty-five brain injured patients (mean age 54.6⁑16.7 years, 90 male and 45 female) were enrolled. There were 34 patients with ischemic Stroke, 61 hemorrhagic stroke, and 40 traumatic brain injury. Apo E genotype was determined by polymerase chain reaction and polyacrylamide gel electrophoresis. The serum concentrations of total cholesterol, triglyceride, and HDL-cholesterol were measured. The outcome of brain injury was assessed by functional independence measure (FIM) scores.
Results: Most frequent Apo E genotype was E 3/3 (72%). In hemorrhagic stroke patients with ε4 allele, FIM score at admission was significantly lower than that of the patients without ε4 allele (p＜0.05). In traumatic brain injury patients with ε4 allele, FIM score change was significantly smaller than that of patients without ε4 allele (p＜0.05). The level of total serum cholesterol was lower in the ischemic stroke patients who have ε2 allele in comparison with the patients without that allele.
Conclusion: The presence of ε4 allele is considered to have relationship with the severity of disability and functional outcome in the patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 243-248)
Objective: To evaluate the effect of computer-assisted cognitive rehabilitation program on cognitive function of the patients with brain injury.
Method: Twenty seven subjects with brain injury (23 males, 4 females) were enrolled and classified into two groups, experimental and control group. There was no significant difference between two groups in age and postonset duration. Control group received conventional rehabiliation therapy including physical and occupational therapy. Experimental group received additional computer- assisted cognitive training using PSS CogRehab software (USA, 1995), 3 times per a week, 30 minutes per session, for 4 weeks. The PSS CogRehab software consisted of foundation, memory, visual spatial and problem solving categories with 45 indivisualized training programs. These
45 programs are arranged according to the degree of difficulty. All patients were assessed their cognitive function using Computerized Neuropsychological Test (Mirae engineering, 1999) before treatment and at 1 month after treatment.
Results: Before the treatment, two groups showed no difference in their cognitive function. After 1 month treatment, the experimental group showed significantly higher performance in forward digit span, forward visual span, auditory continuous performance test and visual controlled continuous performance test than control group (p＜0.05).
Conclusion: Computer-assisted cognitive training would be useful as a additional tool of cognitive rehabilitation in patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 1-8)
Objective: Traumatic brain injury is related to the acute stress response, and this can be accompanied by an elevated serum glucose level. So we estimated the influence of hyperglycemia on neurologic, functional status and outcome.
Method: We studied the 139 traumatic brain injured patients who had been admitted to the department of neurosurgery from 1996 to 2000, retrospectively. We reviewed initial serum glucose level, postoperative glucose level, and Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS). We compared these values with functional independence measure (FIM) scores. Patients were divided into two groups according to the initial serum glucose level, then we analyzed the correlation between glucose level and GCS, GOS, FIM.
Results: The correlations of early hyperglycemia with GCS, GOS, initial FIM scores were significant (p＜0.01). But serum glucose levels were not correlated with plateau FIM scores (p＞0.05). Patients with unfavorable neurologic outcome after 10 days from head injury had significantly high serum initial and postoperative glucose levels than those with favorable neurologic outcome (p＜0.01).
Conclusion: In patients who had received rehabilitation therapy with moderate or severe head injury, early hyperglycemia were significantly correlated with initial FIM scores, GCS, GOS, but not with the plateau FIM scores.
Objective: To examine the correlation between Berg balance scale (BBS) which is tool for assessing the clinical balance function and sensory organization test (SOT) of computerized dynamic posturography (CDP) in brain injured patients.
Method: Thirty patients with brain injury were assessed on the BBS and SOT of CDP. BBS consists of 14 items and each item is graded on a five point ordinal scale (0∼4), yielding a total of 56 points. According to its characteristics, each item was divided 3 groups, which were sitting, standing and position change. Six equilibrium scores (EQ) were determined by SOT of CDP (EquiTest SystemⰒ, Version 5.08) under 6 conditions, and somatosensory, visual, vestibular ratios were analyzed by 6 EQ scores.
Results: EQ 5 was correlated with reaching forward item (r=0.513), turning 360 degrees item (r=0.537), stool stepping item (r=0.529) of BBS (p＜0.01). EQ 6 was correlated with turning 360 degrees item (r=0.498) of BBS (p＜0.01). Sum of standing item group scores was correlated with EQ 5 (r=0.478), EQ 6 (r=0.464), and sum of position change item scores was correlated with EQ 5 (r=0.622), EQ 6 (r=0.514)(p＜0.01). Vestibular ratio was correlated with BBS total score (r=0.552, p＜0.01).
Conclusion: We concluded that vestibular ratio of SOT was correlated with BBS, especially position change item group. Therefore BBS is a good tool for evaluating vestibular function in brain injured patients.
Objective: This research aimed to define the usefulness of the computerized neuropsychological test (CNT) for evaluation of cognitive deficit in the patients with brain injury.
Method: Twenty five subjects with brain injury (16 males, 9 females) were enrolled. Their mean age was 39.2 years. All patient were assessed their cognitive function using CNT. The CNT consisted of digit span, verbal learning test, visual span test, visual learning test, auditory continuous performance test, auditory controlled continuous performance test, visual continuous performance test, visual controlled continuous performance test, word-color test, hypothesis formation test and trail making test. Scores of each subtest on CNT analysed according to the brain lesion and involved hemisphere of the patients.
Results: In patients with left hemisphere lesion, scores in digit span and verbal-learning test were lower than that of right side lesion (p＜0.05). In contrast, patients with right hemisphere lesion showed significantly lower scores in visual span and visual-learning test (p＜0.05). The patients with frontal lobe lesion marked lower scores in verbal-learning and word-color test than the patients without frontal lesion (p＜0.01). Whereas the patients with parietal lobe lesion showed significantly lower scores in visual learning test (p＜0.05) than the patients without parietal lesion.
Conclusion: The cognitive deficit following the brain lesion could be characterized using CNT. CNT is considered to be used as a useful tool in the patients with brain injury for the assessment of their cognitive function.
Objective: To present one case of dysphagia associated with jugular foramen syndrome (Vernet syndrome) by trauma. The jugular foramen syndrome refers to paralysis of the IX, X and XI cranial nerves. Dysphagia due to jugular foramen syndorme without pseudobular palsy is rare in traumatic brain injury.
Case Summary: A 16-year-old boy with the left occipital skull fracture and skull base fracture was not able to take any food by mouth. There was no other significant symptom without dysphagia. Physical examination, laryngoscopic examination and electromyography revealed paralysis of the left IX, X and XI cranial nerves. Videofluoroscopic examination demonstrated atonic ballooned pyriformis sinus and closed upper esophageal sphincter. Brain CT and MRI showed fracture line in the left jugular foramen without brain stem or diffuse cortical lesion. Feeding gastrostomy was performed.
Conclusion: We report an unusual case of dysphagia due to jugular foramen syndrome in traumatic brain injury patient.
Objective: Day hospital program for the brain injured patients has been developed and conducted as a model project in the National Rehabilitation Hospital of Korea since August 1998. This article is to present our 1-year experience and evaluate the efficacy and effectiveness of the program.
Method: All patients treated in day hospital from August 1998 to July 1999 were included. Functional Independence Measure (FIM), ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status), Medical Outcome Study 36-item Short Form Survey (SF-36) were assessed at admission and discharge. Patient satisfaction was surveyed at discharge. Program cost was compared with that of inpatient control group.
Results: 1) Among 51 subjects (32 males, 19 females, mean age 57), 48 suffered stroke and 2 had traumatic brain injury. Average length of stay was 10 weeks and 45 patients (88.2%) were discharged to home. 2) FIM total score, motor subtotal score and cognitive subtotal score were all incresed significantly (p＜0.01). 3) ESCROW score was also improved significantly (p＜0.01). 4) SF-36 showed significant improvement in physical functioning, role limitation-emotional, mental health and general health (p＜0.05). 5) 95.1% answered satisfaction with the program and 73.2% reported health enhancement. 6) Program costs were significantly lower than the inpatient group (p＜0.01).
Conclusion: Day hospital seems to be a useful program for comprehensive rehabilitation for the brain injured, and needs to be pervaded throughout the country with proper payment.
Objective: The purpose of this study was to investigate the effect of dietary soluble fibers added to nasogastric tube-fed formulas and to compare the difference of the degree of diarrhea according to the amount of dietary soluble fibers in stroke or traumatic brain injury patients for comprehensive rehabilitative management.
Method: Fifty-two stroke or traumatic brain injury patients fed by nasogastric tube due to dysphagia were included. They received fiber-free formulas for the first 30 days and then they were randomly assigned to three groups, including the control (fiber-free) group, moderate fiber (3.5 gm fiber/L) group and high fiber (7 gm fiber/L) group. Each group received their respective formulas for the next 30 days. We compared diarrhea score and frequency.
Results: In the control group, the degree of diarrhea was not changed with time. In the moderate and high fiber groups, daily diarrhea score and monthly diarrhea frequency were low compared to the control group (p＜0.05). Also, the incidence of pseudomembraneous colitis was low in fiber groups.
Conclusion: We concluded that adding dietary soluble fibers to nasogastric tube-fed formulas may be helpful to reduce the diarrhea and the development of pseudomembraneous colitis. The proper fiber amount will be determined through the following more case studies.
Objective: The purpose of this study was to determine whether 1H magnetic resonance spectroscopy (MRS) is a potential tool for the detection of microscopic diffuse axonal injury (DAI) and for the evaluation of functional status of patients with traumatic brain injury (TBI).
Method: Seven patients with severe TBI and fourteen normal control volunteers were examined. Image guided spectra of localized in vivo 1H MRS were obtained from parietal white matter (PWM) and occipital gray matter (OGM) in which definite abnormality was not detected in MR imaging. The severity of TBI was evaluated by the initial Glasgow Coma Scale (GCS), and the functional status was evaluated by Functional Independence Measure (FIM) at the time of the MRS examination, approximately 2 months after onset.
Results: In PWM, the [N-acetylaspartate(NAA)/Creatine(Cr)] ratio was significantly lower, and the [Choline(Cho)/Cr] and [myo-Inositol(mI)/Cr] ratios were significantly higher in the patients with TBI than those of normal volunteers. There was no significant correlation between the ratios of metabolites and GCS scores. However, interestingly, a significant correlation between the [NAA/Cr] ratio in PWM and the FIM scores was observed.
Conclusion: We could conclude that decreased [NAA/Cr], increased [Cho/Cr], and increased [mI/Cr] ratios in PWM can be considered as markers for DAI. Localized 1H MRS has a potential to be used for the detection of DAI in vivo and evaluation of functional status of the patients with TBI.
Objective: To evaluate the effect of methylphenidate on cognitive function especially on working memory and visuospatial attention in the patients with traumatic brain injury (TBI).
Method: Eighteen subjects, 16 males and 2 females, with TBI were enrolled. Their mean age was 34.2 years old. A double-blind placebo-controlled study was designed. The baseline cognitive assessment was performed before the administration of drug. Two days after the baseline study, 20 mg of methylphenidate or placebo was administered. The second cognitive assessment was performed 2 hours after the treatment. The follow-up assessment conducted two days after the second test. Cognitive assessments consisted of 'one-back working memory task' and 'endogenous visuospatial attention task', designed using SuperLab Pro 2.0Ⱂ software.
Results: In one-back working memory test, there was significant improvement of response accuracy in methylphenidate group in comparison with placebo group (p＜0.01). Significant shortening of reaction time was also seen after the administration of drug in methylphenidate group (p＜0.05). In endogenous visuospatial attention test, significant improvement of response accuracy was noticed after the administration of drug in methylphenidate group (p＜0.05).
Conclusion: These results demonstrated that the administration of methylphenidate was beneficial in improving cognitive function following TBI. The effect was prominent in the accuracy of working memory.
Objective: To identify the clinical characteristics of the patients with hypoxic-hypotensive brain injury (HBI) and to compare the prognosis of HBI with patients with traumatic brain injury (TBI).
Method: Six patients with HBI and sixteen patients with TBI, who had been comatose for more than 8 hours, were enrolled. The functional status was evaluated by the Functional Independence Measure (FIM) score.
Results: The causes of HBI were: two respiratory arrest, three cardiac arrest, and one hypotensive shock. Most patients had memory disturbance, confusion, spasticity, contracture of joints, and weakness after the HBI. Other problems included dysphagia, ataxia or tremor, dementia, and concomitant medical problems. Among these clinical features, confusion and spasticity were serious obstacles in rehabilitation. The HBI patients had lower initial and discharge total FIM score, total FIM gain, total FIM efficacy, cognitive FIM efficacy, and motor FIM efficacy than the TBI patients. The HBI patients had a poor outcome due to more widespread brain damage, medical complications, and delayed rehabilitation treatments as compared with TBI patients.
Conclusion: We concluded that HBI patients had more diffuse and severe deficit than TBI patients.
Objective: To identify the incidence and characteristics of language disorders in patients with traumatic brain injury (TBI), and to understand the differences of language disorder according to the degree and lesion of brain damage and the outcomes after proper language training programs.
Method: The subjects were 24 adult TBI patients. Seventeen patients with language disorder were examined with language disorder screening test. The characteristics of the language disorders were evaluated according to the degree and lesion site of the brain injury. Prognosis of the language disorders was studied. The tests were performed at the initiation and termination of the language treatment program.
Results: The incidence of language disorders was 91.7%. At the initial evaluation, all items showed a low rate of correct response, but at the final evaluation, the statistically significant improvement was noted in all items. There was no difference between moderate and severe brain damages at final evaluation. Focal lesion group revealed higher rate of correct response than diffuse lesion group on comprehension, expression, reading, and calculation at final evaluation.
Conclusion: The TBI patients showed diffuse language dysfunction on fluency, comprehension, expression, reading, writing, and calculation. But the majority of these patients showed satisfactory recovery, especially the focal brain lesion showed the better outcome. These patients with focal lesion were needed precise language evaluation and more intensive language treatment program.
Mirror writing is script that runs in the direction opposite to normal, with individual letters also reversed. A Right handed woman suddenly developed mirror-writing. After traumatic brain injury without definitive lesions on MRI, she could not discriminate between right and left by herself. Several theories, including motor, visual dominance, spatial disorientation and supplementary motor hypotheses, have been proposed to explain such. We believe that availability of mirror engrams induce reversal of normal left-to-right writing pattern including mirror-writings.
Objective: Lower extremity orthoses are important in the rehabilitation of the patients with stroke and traumatic brain injury. But it is unknown how much they are used in the social activity after the discharge from the hospital. This study was carried out to investigate the status of using orthosis in social activity and complaints about orthosis.
Method: The questionnaires were given to 42 cases with stroke and 17 cases with traumatic brain injury.
Results: The user of lower extremity orthosis in social activity were 55.9%, and the causes of disuse were patient's poor condition, improved gait pattern, inappropriate design and defect of orthosis, and patient's refusal. The degree of satisfaction with orthosis for comfort, external appearance and weight were 79.3%, 86.2%, and 72.4%, respectively.
Conclusion: Physiatrists should give more attention in orthosis at follow-up of patients with stroke and traumatic brain injury and make efforts to improve function and external appearance of orthosis.
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