In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case—a 36-year-old man—with a literature review. The patient's muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29.
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Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.
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Method: 62 physiatrists and 42 hand surgeons were surveyed with self administered questionnaire. The questionnaire was made up of 5 categories: (1) whether physicians had experienced these procedures in the past three years, (2) if they have had no experience, what the reasons were, (3) whether physicians desired to be involved in these procedures, (4) what the solution to promote these procedures should be, (5) the attitudes and beliefs of physicians about these procedures. The last category was analyzed by odds ratio between physicians who desired to be involved in the procedure and who didn't. Results: Only two physiatrists and six surgeons had experienced these procedures in the past three years. However many physicians desired to be involved in these procedures. The main reason of not performing these procedures was a lack of referral between physiatrists and surgeons. The physicians who desire to practice upper extremity reconstruction surgery or related rehabilitation had higher confidence on the benefits of the procedures and thought that they had knowledge and skills for the procedure. Conclusion: In spite of positive attitude to the upper extremity reconstruction for tetraplegic patients, few physicians have experienced in these procedures. This phenomenon was due to a lack of referral between physiatrists and surgeons. Advancing cross-specialty relationships and educating related physicians could be solutions to promote these procedures. (J Korean Acad Rehab Med 2008; 32: 175-181)
Objective: It is known that Mechanical in-exsufflator (MI-E) can reduce pulmonary complications such as pneumonia, atelectasis in tetraplegia by increasing inspiratory and expiratory capacity. The aim of this study is to clarify the effectiveness of MI-E on pulmonary function and coughing capacity in tetraplegia.
Method: Thirty tetraplegic patients who had neither history nor radiologic finding of pulmonary disease were divided into two groups; control (n=15) and experimental (n=15) groups. Control group received conventional pulmonary rehabilitation, while experimental group received additional MI-E therapy for one month. The pulmonary function was evaluated by measuring percentage of predicted value of vital capacity (% VC), maximal insufflation capacity (MIC), unassisted peak cough flow (UPCF), volume assisted peak cough flow (VPCF), manual assisted peak cough flow (MPCF), manual and volume assisted peak cough flow (MVPCF). These data of pulmonary function before and after treatment were compared between two groups.
Results: 1) There are significant improvement of pulmonary function in both groups (p＜0.05) except UPCF in control group before and after treatment. 2) The experimental group showed more improvement in MIC, VPCF, MPCF and MVPCF than control group (p＜0.05).
Conclusion: MI-E therapy can be used as an effective therapeutic modality for the improvement of pulmonary function in combination with conventional pulmonary rehabilitation. (J Korean Acad Rehab Med 2002; 26: 403-408)
Objectives: To provide proper standards of handicapped driver's ability test in Korea and evolve new driving aids.
Method: Thirty-six cervical cord injured persons (C5∼C7) were evaluated with Baltimore Therapeutic Equipment work simulator to which a straight handle was attached. The isotonic torque on a straight handle was measured during forward and backward movement and isometric torque was measured at neutral position. Analysis of variance (ANOVA) was used to compare torque among three groups (C5∼C7).
Results: The forward and backward torque of C7 tetraplegics was significantly higher than that of C6 tetraplegics
(p＜0.05). All of 12 persons with C5 tetraplegia could not pass the test. Only 1 out of 12 persons with C6 tetraplegia and all of 12 persons with C7 tetraplegia could pass the test. But 9 out of 12 persons with C5 tetraplegia and all of 12 persons with C6 tetraplegia could operate brake and accelerator with servo-hand control.
Conclusion: All of the C5 tetraplegics and 92% of the C6 tetraplegics could not pass the handicapped driver's ability test of Korea. Therefore it is necessary to evolve driving aids for the C5 and C6 tetrapleigics and to modify this test. (J Korean Acad Rehab Med 2002; 26: 32-36)
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