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To investigate the length of hospital stay (LOS) after stroke using the database of the Korean Health Insurance Review & Assessment Service.
We matched the data of patients admitted for ischemic stroke onset within 7 days in the Departments of Neurology of 12 hospitals to the data from the database of the Korean Health Insurance Review & Assessment Service. We recruited 3,839 patients who were hospitalized between January 2011 and December 2011, had a previous modified Rankin Scale of 0, and no acute hospital readmission after discharge. The patients were divided according to the initial National Institute of Health Stroke Scale score (mild, ≤5; moderate, >5 and ≤13; severe, >13); we compared the number of hospitals that admitted patients and LOS after stroke according to severity, age, and sex.
The mean LOS was 115.6±219.0 days (median, 19.4 days) and the mean number of hospitals was 3.3±2.1 (median, 2.0). LOS was longer in patients with severe stroke (mild, 65.1±146.7 days; moderate, 223.1±286.0 days; and severe, 313.2±336.8 days). The number of admitting hospitals was greater for severe stroke (mild, 2.9±1.7; moderate, 4.3±2.6; and severe, 4.5±2.4). LOS was longer in women and shorter in patients less than 65 years of age.
LOS after stroke differed according to the stroke severity, sex, and age. These results will be useful in determining the appropriate LOS after stroke in the Korean medical system.
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To describe inpatient course and length of hospital stay (LOS) for people who sustain brain disorders nationwide.
We interviewed 1,903 randomly selected community-dwelling patients registered as 'disabled by brain disorders' in 28 regions of South Korea.
Seventy-seven percent were initially admitted to a Western medicine hospital, and 18% were admitted to a traditional Oriental medicine hospital. Forty-three percent were admitted to two or more hospitals. Mean LOS was 192 days. Most patients stayed in one hospital for more than 4 weeks. The transfer rate to other hospitals was 30-40%. Repeated admissions and increased LOS were related to younger onset age, higher education, non-family caregiver employment, smaller families, and more severe disability.
Korean patients with brain disorders showed significantly prolonged LOS and repeated admissions. Factors increasing burden of care influenced LOS significantly.
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To provide the latest statistics about the length of hospital stay (LOS) and the number of hospitals where the patient was admitted (NHA) for patients with spinal cord injury (SCI) and to investigate the correlated demographic characteristics.
In total, 277 patients with SCI who were members of the Korea Spinal Cord Injury Association were included in the analysis. The survey was conducted by self-completed questionnaires to collect data on LOS, NHA, and demographic variables.
Mean LOS was 13.5±9.7 months and the mean NHA was 2.7±1.4. Patients who suffered from SCI by traffic accidents showed a longer LOS and larger NHA than those with other causes. The mean LOS for patients with traumatic SCI was longer than that whose cause of injury was disease. Patients discharged in the 2000s had a longer LOS and a larger NHA than those discharged earlier. Other factors such as gender, age at the time of injury, neurological category, and ambulation capability did not result in a significant difference in either LOS or NHA.
The mean LOS of domestic patients with SCI was longer than the values reported in foreign studies. Interestingly, neither neurological category nor functional status were related to LOS. These findings suggest that other factors such as socio-psychological factors, other than the medical state of the patient, have an effect on the LOS of patients with SCI in Korea.
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Method: The study included 27 children with hemiplegic cerebral plasy and 12 normal control group who were taken Bell-Thomson's view x-ray for measuring of leg length. The patient group was divided into the group with LLD and the group without LLD. Then we evaluated the relationship between the rate of leg length shortening (LLS) and clinical factors.
Results: Of the total 27 cerebral palsy children, 18 children (66.7%) had LLD, whose average rate of LLS was 2.0 percent. Nine children didn't have LLD, whose average rate of LLS was 0.6 percent. There was no specific relationship between the rate of LLS and the age, muscle power or spasticity, but there was negative correlation between the rate of LLS and the score of gross motor functional measure (GMFM).
Conclusion: It is necessary to define the LLD in children with hemiplegic cerebral palsy by the rate of LLS and to be concerned about the LLD due to its possible correlation with poor functional outcome. (J Korean Acad Rehab Med 2003; 27: 850-854)
Objective: The purpose of this study was to know the correlation between resting calcaneal stance position (RCSP) and height-length (H/L) ratio of foot.
Method: Both feet of 173 persons who visited the Department of Rehabilitation Medicine, Chungnam National University Hospital were included in the study. Their mean age was 23.6 years old. H/L ratio, RCSP and navicular angle of 346 feet were measured. All people were divided into 3 groups, such as, normal foot (2o≤RCSP≤2o), rear foot valgus (RCSP＜2o) and rear foot varus (RCSP＞2o) according to the angle of RCSP. And the relationship between RCSP and H/L ratio were evaluated. Independent T-test, ANOVA and Pearson correlation of SPSS was used for statistical data processing.
Results: The mean H/L ratio of rear foot valgus was 0.2206, noraml foot 0.2440 and rearfoot varus 0.2625. H/L ratio and navicular angle showed significant increase in each RCSP groups in order of rear foot angle.
Conclusion: H/L ratio and RCSP showed strong positive correlation and the value of H/L ratio in normal group was 0.2440⁑0.0114 (Mean⁑S.D.). H/L ratio is easily acceptable parameter in human mechanics or orthotic field of rehabilitation. (J Korean Acad Rehab Med 2002; 26: 591-597)
Objective: The purpose of this study was to determine prevalence of flatfoot and to investigate relationship between flatfoot and the practice of wearing footwear.
Method: Four hundred-one subjects were interviewed and evaluated with foot printing for flatfoot and measured with foot and shoe tracing for foot and shoe size.
Results: The prevalence of flatfoot in the subject was 18.7%, and flatfoot was significantly associated with weight, body mass index, and obesity. Only parental parameter significantly associated with flatfoot. There was no significant relation between flatfoot and the other parameters such as footwear type before entrance into a primary school, present footwear type, duration of wearing footwear each day, and age when footwear first worn.
Conclusion: The flatfoot was related with obesity, body mass index, weight, and parent parameter.
Objective: To evaluate the clinical utility of the dynamic gastrocnemius length, calculated with gait analysis after phenol or botulinum toxin block in spastic cerebral palsy.
Method: Gastrocnemius muscles were injected with phenol or botulinum toxin. Kinematic gait parameters including dynamic gastrocnemius length were surveyed with 3-dimensional gait analysis system before and after the procedure.
Results: The dynamic gastrocnemius lengths improved significantly after block of calf muscles, except 3 cases which showed severe genu recurvatum. The vertical displacement of the center of gravities and the maximal ankle dorsiflexion angles after the block were not significantly different from those before the block.
Conclusion: Dynamic gastrocnemius length calculated with gait analysis can be used as a tool to determine the efficacy of spastic calf muscle block, in the absence of severe genu recurvatum. In case of associated severe genu recurvatum, other parameters may be substituted.
Objective: The aim of this study was to develop objective evaluation method of spasticity which reflects the characteristics of lengthening velocity-dependent stretch reflex of spasticity.
Method: Kinematic analysis for knee angle and rectus femoris muscle lengthening parameters, and dynamic EMG were performed simultaneously during pendular movement of spastic lower leg for thirty two patients with spasticity and ten normal control subjects. Angular parameters consist of angular relaxation index (ARI), maximal angular velocity (MAV), angular threshold (AT) and angular velocity threshold (AVT). And lengthening parameters consist of lengthening relaxation index (LRI), maximal lengthening velocity (MLV), lengthening threshold (LT) and lengthening velocity threshold (LVT).
Results: 1) ARI, MAV, AT, and AVT according to Modified Ashworth scale (MAS) were 1.32⁑0.11, 303.84⁑45.11 deg/sec, 44.19⁑13.81 deg, 262.15⁑33.54 deg/sec in MAS I, 1.16⁑0.16, 279.92⁑42.94 deg/sec, 30.33⁑6.02 deg, 247.65⁑35.92 deg/sec in MAS II, and 0.95⁑0.14, 241.31⁑19.98 deg/sec, 20.55⁑2.68 deg, 209.11⁑48.11 deg/sec in MAS III (P＜0.05). 2) LRI, MLV, LT, and LVT according to MAS were 1.27⁑0.11, 0.58⁑0.07, 1.164⁑0.14, 0.53⁑0.05 in MAS I, 1.12⁑0.09, 0.53⁑0.05, 1.150⁑0.08, 0.42⁑0.04 in MAS II, and 0.99⁑0.10, 0.44⁑0.01, 1.137⁑0.15, 0.36⁑0.02 in MAS III (P＜0.05). 3) There were significant correlation between various pendulum test parameters and MAS.
Conclusion: Muscle lengthening parameters as well as knee angular parameters were sensitive parameters reflecting the degree of spasticity. LVT is the most sensitive parameter among all parameters (p＜0.01).
Objective: To investigate waveform changes of compound muscle action potentials (CMAPs) related to voluntary muscle contraction and alteration of muscle length and to evaluate the effect of peripheral neuropathy on temporal and spatial summations of CMAPs.
Method: The influence of voluntary muscle contraction and alteration of muscle length on CMAP was studied in 37 median nerves of 21 patients with median neuropathy.
Results: In patients with no apparent axonopathy, temporal summation was partially disturbed without significant change of spatial summation. Shortening of muscle length or voluntary contraction produced a physiologic improvement of spatial and temporal summations. There was a decrease in temporal and spatial summations, more prominent in temporal summation, with lengthening of the muscle. In axonopathy, spatial summation was markedly deteriorated with partial reduction of temporal summation. Spatial summation was not affected by the change of muscle length or voluntary contraction. Temporal summation was improved by muscle shortening or voluntary contraction and was decreased by muscle lengthening.
Conclusion: Peripheral neuropathy has an effects on physiological spatial and temporal summations of CMAPs. Temporal summation is preferentially decreased in cases without axonopathy. When axonopathy is apparent, spatial summation is profoundly disturbed with partial reduction of temporal summation.
Objective: This study was designed to evaluate the relation of leg length discrepancy on ankle muscle strength.
Method: Twenty four adult women were tested (12 leg length equality and 12 leg length discrepancy). Leg length was measured by tape ruler from anterior superior iliac spine to medial malleolus, three times by three different trained examiners. The muscle strength (bilateral ankle dorsiflexors and plantarflexors) was measured by using Cybex 340 dynamometer at 30 degree/sec and 120 degree/sec.
Results: The mean value of leg length discrepancy was 0.89⁑0.24 cm. In leg length discrepancy group, the peak torque of ankle plantarflexor were 44.50⁑20.94 Nm in long leg and 51.83⁑12.75 Nm in short leg at 30 degree/sec angular velocity (p＜0.05).
Conclusion: We concluded that there were significant increase in plantar flexor peak torques of short leg than those of long legs at 30 degree/sec (P＜0.05). Perhaps the difference of the muscle strength might be due to compensatory mechanism of short leg in propulsion during gait.
The influence of voluntary muscle contraction and alteration of muscle length on compound muscle action potential (CMAP) was studied in 20 healthy volunteers. The CMAPs were evoked by a supramaximal stimulation and recorded by a surface electrode array. Onset latencies were not significantly changed regardless of the muscle length and contraction. On shortening of the muscle there was a decrease in an area and duration of CMAP with no significant changes in an amplitude. During muscle contractions, there was an increase in amplitude and a decrease in area and duration. On a lengthening of the muscle with relaxation, the amplitude of CMAP decreased with an increased area and duration. During a voluntary contraction, there was a decrease in amplitude, area, and duration. The results are considered due to a peripheral factor such as an alteration of temporal or spatial summation rather than a central mechanism. We conclude that in nerve conduction studies, it is important to monitor the finger position and muscle relaxation to differentiate the waveform changes from the muscle length or contraction and those from the nerve lesions.
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