Citations
To assess the effectiveness of the resting foot splint to prevent ankle contracture.
We performed a randomized controlled trial in 33 patients with brain injury with ankle dorsiflexor weakness (muscle power ≤grade 2). Both groups continued conventional customized physical therapy, but the patients in the foot splint group were advised to wear a resting foot splint for more than 12 hours per day for 3 weeks. The data were assessed before and 3 weeks after the study. The primary outcome was the change in ankle dorsiflexion angle after 3 weeks.
Before the study, there were no differences between groups in gender, age, time post-injury, brain injury type, initial edema, spasticity, passive range of ankle dorsiflexion, Fugl-Meyer score (FMS), or Functional Ambulation Classification. A significant improvement in ankle dorsiflexion angle, and FMS was found after 3 weeks in both groups. The splint group showed more spasticity than the control group after 3 weeks (p=0.04). The change of ankle dorsiflexion angle, foot circumference, spasticity, and FMS after adjusting initial value and spasticity were not significantly different between the 2 groups.
Wearing a resting foot splint for 3 weeks did not affect joint mobility in patients with subacute brain injury regularly attending personalized rehabilitation programs. Further studies of larger sample sizes with well controlled in spasticity are required to evaluate the effects of the resting foot splint.
Citations
To find a multiple amputee more severe than a triple amputee is not easy. This is a report of a 36-year-old patient with right knee disarticulation, left trans-femoral amputation and right elbow disarticulation due to peripheral ischemic necrosis, when he was applied vasopressor in septic shock condition. His left hand was also 2nd, 3rd, 4th, and 5th distal interphalangeal joint disarticulation status, and it was more difficult for him to do rehabilitation program, such as donning and doffing the prostheses. For more efficient rehabilitation training program, we first focused on upper extremities function, since we believed that he might need a walking aid for gait training later. After 13 weeks of rehabilitation program, he has become sit to stand and walk short distance independently with an anterior walker. Although he still needs some assistance with activities of daily living, his Functional Independence Measure score improved from 48 to 90 during the course of 13 weeks.
Citations
Focal myositis is a rare, benign inflammatory pseudotumor of the skeletal muscle of unknown etiology. In Korea, there is no case report of focal myositis, which is not combined with connective tissue disease. We present an unusual case of focal myositis with ankle contracture, involving more than two muscles. A 26-year-old man visited our clinic complaining of right ankle contracture and leg muscle pain. Physical examination revealed no muscle weakness or any other neurological abnormality. T2-weighted magnetic resonance imaging of the right leg demonstrated diffuse high signal intensity of the right gastrocnemius, flexor digitorum longus, and tibialis anterior muscles. Needle electromyography showed profuse denervation potentials with motor unit action potentials of short duration and small amplitude from the involved muscles. All these findings suggested a diagnosis of focal inflammatory myositis and the patient was put under oral prednisolone and physical therapy.
Citations
Objective: To develop and evaluate newly designed orthosis to control contracture of the shoulder and the forearm in the spastic upper limb.
Method: Subjects were 6 hemiplegic patients and 1 tetraplegic patient who showed the features of spasticity. Volar wrist hand orthosis was modified to attach a plastic stick which can be easily separated. The orthosis was applied in supinated position for 8 weeks. The shoulder and elbow range of motion was measured every 2 weeks for 8 weeks.
Results: The subjects with spasticity showed significant improvement in the shoulder abduction (p＜0.05), adduction (p＜0.05) and external rotation (p＜0.05) after applying modified volar wrist hand orthosis for 8 weeks. The forearm supination was well maintained for 8 weeks.
Conclusion: The newly designed orthosis showed significant effects in the improvement of the shoulder abduction, adduction and external rotation and the forearm supination of spastic upper limbs.
Congenital Achilles tendon contracture is an autosomal dominant disease which is relatively rare. The disease manifests itself as 'toe walking'. Since the clinical condition is relatively benign, it is easy to be overlooked by the clinicians. To the patients, it presents problems of ambulation and activities of daily living. We present a case of 23 year old man who has been walking on his toes. The patient had a difficulty in squatting and tieing shoes and performed poorly gym activities. The patient's father and brother also walked on toes, which made the patient become indifferent to his condition. Upon physical examination, plantarflexion contractures of both ankle joints were 10 degree and the knee were 5 degree. We could not find any abnormal findings in motor or sensory function tests of both lower limbs. Deep tendon reflexes on patella and ankle were within normal range. There were no abnormalities in ankle X-ray, electromyography, blood sample test including muscle enzymes. Gait analysis showed increased ankle plantarflexion moment during entire gait cycle, increased knee flexion during terminal stance, and decreased both knee flexion during initial swing.
Objective: To evaluate clinical features in general and possible complications in Duchenne muscular dystrophy (DMD) which could be used for comprehensive rehabilitation management.
Method: One hundred and seventy-two patients with DMD were followed over 3 year period to provide clinical profile causing impairment and disability. We measured height, weight and manual muscle testing (MMT) when the patients visited the hospital. And we could measure pulmonary function, electrocardiogram (EKG), and intelligence quotient (IQ) test in cooporative patients.
Results: The median height and weight of DMD boys were normally distributed before age 12, but during the second decade height was markedly reduced, and weight was no longer normally distributed. The MMT measurement showed loss of strength in a fairly linear fashion according to increasing age, and extensor of lower extremities were weaker than flexors showing typical contractures of legs. There was a direct relationship between pulmonary function and MMT scores of upper extremities. There was a high occurrence (40%) of abnormal EKG, but none of the patients had a history of cardiovascular complication. DMD children suffered wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression, and 50.9% of them were below average on the IQ test.
Conclusion: These data on DMD subjects provide clinicians with useful information regarding the prevalence and severity of measurable impairment at different stages of the disease.
Objective: To study the effect of pregnancy on knee joint contracture in the rat, because the laxity of peripheral joint increases during pregnacy.
Method: We evaluated the difference of contracture between the pregnant and non-pregnant female rats after 3 week of knee immobilization using a wire. The femorotibial angle at immobilization status was 30o. After immobilization, the femorotibial angle were measured using X-ray after removal of wire at 50 g and 100 g weighted state on the tibia. To study the change of fibroblast in immobilized knee joint ligament, immunohistochemical staining for actin was performed using α-smooth muscle actin antibody (DAKO, Denmark).
Results: The femorotibial angles were 116.7⁑9.2o and 97.3⁑18.0o after wire removal, in the immobilized pregnant and nonpregnant rats respectively. The femorotibial angles at 50 g and 100 g weighted state were 136.8⁑7.2o and 144.7⁑3.8o, respectively in the immobilized pregnant rats and 129.4⁑12.7o and 136.3⁑8.9o in the immobilized non-pregnant rats. The angles of pregnant group were significantly larger than those of non-pregnant group (p＜0.05). In immobilized pregnant and non-pregnant rats, the α-smooth muscle actin was moderately expressed in fibroblast of anterior and posterior cruciate ligaments of the knee by immunohistochemistry, while there was no expression of α-smooth muscle actin in fibroblast of the ligaments in the non-immobilized knee.
Conclusion: Joint contracture develops to a lesser degree in pregnant rats than in non-pregnant rats and α-smooth muscle actin is expressed in fibroblast of contractured knee ligaments.
Traumatic knee contracture is a common complication after an operative procedure. It occurs mainly due to an intraarticular adhesion and results in a significant knee dysfunction and disability. Patients with a contracture have different ways of recovery, however there is no reliable clinical data regarding a recovery to the full range of motion after knee injury. A proper therapeutic plan is needed to the physiatrists during a rehabilitation of the traumatic knee contracture. The purpose of this study was to obtain a clinical insight into the course of recovery to the normal range of motion after a traumatic knee contracture. One hundred and fourty-seven cases of traumatic knee contracture patients who underwent an operative treatment at the Department of Orthopedic Surgery, St. Mary's Hospital between the years of 1992 to 1996, were reviewed. Knee contractures were most frequent in the second and third decades with a traffic accident being the most common cause. A factor that influenced regaining a normal range of motion was the injury type with an earlier recovery in the order of an injury to the meniscus, cruciate ligament, collateral ligament, a complex injury, and a bone fracture. Persistent contracture groups showed a higher incidence of bone fractures around the knee and open surgeries, while there was no discrepancy in sex, age, and operation time. In conclusion, the results of this study are expected to give some insights to clinicians and to help them in treating patients with the traumatic knee contracture after operation.
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