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To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population.
A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests.
SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers.
This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.
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To confirm a relationship between the pharyngeal response and bolus volume, and examine whether increasing the fluid bolus volume can improve penetration and aspiration for stroke dysphagic patients.
Ten stroke patients with a delayed pharyngeal response problem confirmed by a videofluoroscopic swallowing study (VFSS) were enrolled. Each subject completed two swallows each of 2 mL, 5 mL, and 10 mL of barium liquid thinned with water. The pharyngeal delay time (PDT) and penetration-aspiration scale (PAS) were measured and the changes among the different volumes were analyzed.
PDTs were shortened significantly when 5 mL and 10 mL of thin barium were swallowed compared to 2 mL. However, there was no significant difference in PAS as the bolus volume increased.
The increased fluid bolus volume reduced the pharyngeal delay time, but did not affect the penetration and aspiration status.
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To evaluate the diagnostic value of plain abdominal radiography in stroke patients with bowel dysfunction.
A total of 59 stroke patients were recruited and assigned into constipation or non-constipation group. Patients were interviewed to obtain clinical information, constipation score, and Bristol stool form scale. The total and segmental colon transit time (CTT) was measured using radio-opaque markers (Kolomark). The degree of stool retention was evaluated by plain abdominal radiography and scored by two different methods (Starreveld score and Leech score). The relationship between the clinical aspects, CTT, and stool retention score using plain abdominal radiography was determined.
Average constipation score was 4.59±2.16. Average Bristol stool form scale was 3.86±1.13. The total and segmental CTTs showed significant differences between the constipation and non-constipation groups. There was statistically significant (p<0.05) correlation between the total CTT and constipation score or between Starreveld score and Leech score. Each segmental CTT showed significant correlation (p<0.05) between segmental stool retention scores.
The stool retention score showed significant correlation with constipation score as well as total and segmental CTT. Thus, plain abdominal radiography is a simple and convenient method for the evaluation of bowel dysfunction in stroke patients.
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To investigate changes in lumbar multifidus (LM) and deep lumbar stabilizing abdominal muscles (transverse abdominis [TrA] and obliquus internus [OI]) during transcutaneous neuromuscular electrical stimulation (NMES) of lumbar paraspinal L4-L5 regions using real-time ultrasound imaging (RUSI).
Lumbar paraspinal regions of 20 healthy physically active male volunteers were stimulated at 20, 50, and 80 Hz. Ultrasound images of the LM, TrA, OI, and obliquus externus (OE) were captured during stimulation at each frequency.
The thicknesses of superficial LM and deep LM as measured by RUSI were greater during NMES than at rest for all three frequencies (p<0.05). The thicknesses in TrA, OI, and OE were also significantly greater during NMES of lumbar paraspinal regions than at rest (p<0.05).
The studied transcutaneous NMES of the lumbar paraspinal region significantly activated deep spinal stabilizing muscle (LM) and the abdominal lumbar stabilizing muscles TrA and OI as evidenced by RUSI. The findings of this study suggested that transcutaneous NMES might be useful for improving spinal stability and strength in patients having difficulty initiating contraction of these muscles.
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To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI).
Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography.
The constipation scores ranged from 1 to 13, and the average was 4.19±3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13±1.45. CTTs were 19.3±16.17, 19.3±13.45, 15.32±13.15, and 52.42±19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4±0.7, 1.8±0.86, 2.83±0.82, 2.14±1, and 10.19±2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28±0.7, 2.8±0.8, 2.35±0.85, and 8.45±1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05).
Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.
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To validate the Motor Impairment Scale (MIS) of the Korean long-term care insurance (LTCI) system by comparing with the service time offered for aiding activities of daily living (ADL) and the ADL score.
A total of 407 elderly subjects without dementia who had used LTCI services were included in this study. Spearman correlations and multivariate linear regression models were employed to determine the relationship of the upper and lower limb MIS (U-MIS and L-MIS, respectively) to the service time and ADL. Stratified analyses for the facility group (n=121) and the domiciliary group (n=286) were performed.
There were significant differences in characteristics between facility group and domiciliary group. The MIS was significantly correlated with service time in facility group (Spearman p=0.41 for U-MIS, Spearman p=0.40 for L-MIS). After adjusting for age, sex, and cognition score, U-MIS was an independent predictor for service time in facility group (p=0.04). In domiciliary group, no significant correlation was found between the MIS and service time. The MIS correlated with all of the ADL items and total ADL score in both groups. After adjusting for other factors including age, sex, and cognitive score, U-MIS and L-MIS were independent variables for explaining the total ADL score in both groups.
The validity of the MIS as an evaluation tool in the physically-disabled elderly is higher in facility group than in domiciliary group. As an easy, objective, and simple method, MIS can be a useful tool in the LTCI system of Korea.
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Central pontine myelinolysis is a rare neurologic disorder that is defined by demyelination of longitudinally descending tracts and transversly crossing fibers in the basis pontis. Frequently observed clinical manifestations of this disorder include sudden weakness, dysphagia, loss of consciouness and locked-in syndrome. However, there have been a few studies that reported a benign course of this disease, which include cerebellar signs, such as ataxia, intention tremor, and dysarthria. Here we report on a 53-year-old male with a history of liver cirrhosis who showed the cerebellar type of central pontine myelinolysis. The patient was diagnosed with central pontine myelinolysis based on clinical presentations and magnetic resonance imaging findings after a liver transplantation. Conventional magenetic resonance imaging (MRI) revealed the preservation of the corticospinal tract and abnormal pontocerebellar fibers. However, these findings were not sufficient to define the pathophysiology of our patient. Electrophysiologic analysis and diffusion tensor imaging (DTI) were performed to investigate cerebellar signs in this case. Delayed central motor conduction time (CMCT) to the tibialis anterior muscle with transcranial magnetic stimulation (TMS) was observed, which indicated demyelination of the corticospinal tract. Also, diffusion tensor imaging showed abnormal pontocerebellar fibers, which might have been caused by cerebellar dysfunction in our patient. A combination of TMS and DTI was also used to determine the pathophysiology of this disease.
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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 correlations of scores on the Timed Up and Go (TUG) test and the Single Leg Stance (SLS) test with stability scores on the Biodex Balance System (BBS) in healthy adults.
The postural balance of 73 participants was measured on the TUG and SLS tests and with the Overall Stability Index (OSI) on the BBS. The participants were divided into groups by age and by times on the TUG and SLS. The correlations between TUG or SLS and OSI scores were analyzed by groups.
TUG scores were significantly correlated with OSI scores in age under 65 years, TUG over 10 seconds and SLS over 30 seconds groups (level 12). TUG scores were also correlated with OSI in total (level 10) and TUG under 10 seconds groups (level 2). However, there were no significant relationships between SLS and OSI scores.
OSI scores on the BBS are significantly correlated with TUG scores, especially at the easy levels. According to the findings of present study, relatively easy BBS levels are considered to assess the postural balance in healthy adults.
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To compare the voice onset time (VOT) differences of Korean stops in the initial and intervocalic positions between the aphasic patients with peculiarities of aspiration and a control group.
We examined 15 aphasic patients (nine males, six females) who had suffered a stroke (average age 49.7 years) and 15 healthy controls (average age 47.4 years). An aphasia examination was made by an aphasia battery of three standard tests and VOT was analyzed instrumentally. Stop consonants in the initial and intervocalic position were measured to categorize them according to aphasia types, place of articulation, and manner of articulation.
VOT of the aphasic patients with peculiarities of aspiration had a greater difference than that of the controls, indicating that the temporal non-coordination between the laryngeal adjustment and oral articulators of aphasic patients happens due to the VOT of stops in the initial and intervocalic positions (p<0.05).
VOT of stop consonants in the initial position produced by aphasic patients tends to be proportional to their breathing. It can cause glottal width and make aphasic patients' VOT duration longer. Lastly, the method to measure the VOT of aphasic patients is more significant for the types of phonation than for the places of articulation, and makes it possible to induce abnormal VOT.
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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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Method: Thirty-nine adults with CP were participated. They took the radioopaque markers for 3 successive days. Then, abdominal X-ray was taken on the fourth day. The total and segmental colon transits were estimated by the simplified assessment of a single-film technique by Metcalf et al. The amounts of nutrients intake for 3 days were recorded and nutritional factors were analyzed by ESHAⰒ Food Processor. Then, daily intakes of the nutrients were compared with Recommended Dietary Allowance of Korean Nutrition Society.
Results: Colon transit time were more than 2 times delayed in adults with CP as compared with those of normal controls. Colon transit time was significantly prolonged in non- functional ambulators (p＜0.05). Colon transit time tended to be delayed in subjects with spastic type, but not related with the degree of cognitive function. On the evaluation of daily nutrients intake, several nutritional factors were inadequate in adults with CP.
Conclusion: Adults with CP had the problems in colonic motility and nutritional intake. Also, delayed colon transit time was significantly related with poor mobility, and possibly related with spasticity. (J Korean Acad Rehab Med 2003; 27: 192-197)
Method: 16 hemiplegic patients who could walk without assistive devices were included in this study. We used insole foot-pressure system to measure weight bearing ratio of both feet during walking. We assessed walking speed and pressure ratio during straight or circular walking at their comfortable gait speed.
Results: Pressure ratio of affected foot showed negative correlation with walking time irrespective of walking direction. Pressure ratio of affected foot and walking time during circular walking to the affected side was significantly higher and slower respectively than that to the intact side.
Conclusion: Asymmetrical weight bearing of both feet during walking is highly correlated with walking ability in hemiplegic patients and pressure ratio of affected foot may be simple and useful determinant of walking ability. (J Korean Acad Rehab Med 2003; 27: 173-177)
Objective: The purposes were to determine the baseline colon transit time (CTT) and to assess the effect of dietary fiber (psyllium husk) on neurogenic bowel function in chronic spinal cord injured (SCI) persons.
Method: Eleven chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were participated. Personal interview were carried out for all studied subjects at pre and post treatment period. The baseline colon transit time (CTT) were measured for the right (rCTT), left (lCTT), rectosigmoid (rsCTT) colons as well as for the entire colon using radio-opaque markers. After 4 weeks treatment of psyllium husk, the subjects were reevaluated for their CTTs and the results were compared to the pretreatment values.
Results: The mean age of the subjects was 33.9⁑11.0 years and the level of injury ranged from C3 to T10. The mean duration after SCI was 22.6 months (6∼47 months). The rCTT, lCTT, rsCTT and tCTT were not affected after the treatment of psyllium husk. Also their bowel care patterns and satisfaction were unaffected by the treatment.
Conclusion: The results of this study suggest that the use of psyllium husk in chronic spinal cord injured persons do not show the same effect on bowel function as has been previously reported in general population with idiopathic constipation. (J Korean Acad Rehab Med 2002; 26: 533- 538)
Objective: The aims of this study is to determine the influence of the imbalance between sympathetic and parasympathetic nervous input to colon transit control in spinal cord injured patients and the effect of the anticholinergic medication for neurogenic bladder on colon transit time.
Method: Eighty-six patients with cervical and thoracic cord injury were enrolled. The colon transit time (CTT) according to the severity and lesion of injury and also the administration routes of oxybutynin were compared by independent t-test.
Results: Total CTT was 56.7 hours, with right CTT 16.9 hours, left CTT 21.3 hours and rectosigmoid CTT 18.5 hours. The rectosigmoid CTT of the patients with the lesion at T6 or below were prolonged than that of the patients with the lesion above T6 (p＜0.05). According to administration route of oxybutynin, instillation group showed more shortened rectosigmoid CTT than oral route group (p＜0.05).
Conclusion: The imbalance between parasympathetic and sympathetic outflow from the spinal cord has play an important role in colon transit control of spinal cord injured patients. The management of neurogenic bowel and bladder considering colon transit time is needed for the effective management of spinal cord injured patients. (J Korean Acad Rehab Med 2002; 26: 292-298)
Objective: To evaluate the colonic motility and nutrients intake in children with spastic cerebral palsy (CP) and to compare the results with those of normal children.
Method: Thirty-eight children with spastic CP were participated in this study. They took the radioopaque markers for 3 successive days. Then, abdominal X-ray was taken on the fourth day. Total and segmental colon transits were estimated by the simplified assessment of a single-film technique by Metcalf et al. The amounts of nutrients intake for 3 days were recorded and nutritional factors were analyzed by ESHAⰒ Food Processor. Then, daily intakes of the nutrients were compared with Recommended Dietary Allowance of the Korean Nutrition Society.
Results: Total and segmental colon transit time were more
than 2 times delayed in children with spastic CP as compared with those of normal controls. Total colon transit time was significantly prolonged in quadriplegic and non-ambulatory children (p＜0.05). On the evaluation of daily nutrients intake, most of nutritional factors were inadequate in children with spastic CP.
Conclusion: The children with spastic CP had the problems in colonic motility and nutritional intake. Also, delayed colon transit time was significantly related with poor mobility. Therefore, early intervention for these problems will be required in spastic CP, especially quadriplegic and non- ambulatory children. (J Korean Acad Rehab Med 2002; 26: 19-25)
Objective: To calculate the colonic transit time (CTT) and to evaluate the effect of combined therapy of cisapride and lactulose on neurogenic bowel dysfunction in patients with chronic spinal cord injury.
Method: This study was prospectively designed. Right (rCTT), left (lCTT), rectosigmoid (rsCTT), and total (tCTT) colonic transit times were measured using the radio-opaque marker technique in twenty patients with spinal cord injury (SCI group), of which mean age was 39 years (range: 13∼67 years) and median duration after SCI was 15 months (4∼252 months). Ten ambulatory stroke patients (mean age 49 years, median duration, 12 months) were also evaluated as control group. All CTTs in both groups were compared by unpaired Student's t-test. In SCI group, the therapeutic effect of combined administration of cisapride (10 mg p.o. t.i.d) and lactulose (134.0 g/100 ml, 30∼45 ml per day p.o.) was statistically analyzed by paired Student's t-test.
Results: Total (p＜0.0001) and segmental CTT (p＜0.01) except right colon were significantly delayed in SCI group when compared to the control group. In SCI group, tCTT of non-ambulatory patients (n=13) and rCTT, lCTT, rsCTT and total CTT of ambulatory patients (n=7) were significantly decreased after the combined drug therapy (p＜0.05). In ambulatory SCI patients, duration after injury showed negative correlation with tCTT (Pearson's correlation coefficient r=0.8407, p=0.0178).
Conclusion: Combined therapy of cisapride and lactulose can improve tCTT in SCI patients with neurogenic bowel dysfunction.
Objective: To evaluate changes of colon transit time according to prokinetic medication and characteristics of the anorectal manometry in patients with neurogenic bowel due to spinal cord injury.
Method: Twelve patients with cervical and thoracic cord injury were enrolled, and classified into complete and incomplete spinal cord injury according to the severity of injury. The colon transit time before and after prokinetic medications were measured. The anorectal manometry was performed after the first study of colon transit time.
Results: The colon transit time of pre-prokinetic medications were 17.1⁑12.6 hours for the right colon, 26.9⁑13.2 for the left colon, 21.5⁑14.0 for the rectosigmoid colon, and the total transit time was 65.5⁑5.3 hours. The time of post-prokinetic medications was 14.3⁑7.6 hours for the right colon, 25.8⁑10.3 for the left colon, 7.4⁑5.3 for the rectosigmoid colon, and the total transit time was 33.1⁑11.5 hours. The rectosigmoid colon transit time and total colon transit time were significantly different between pre- and post-prokinetic medications (p＜0.05). In the anorectal manometry, mean resting anal pressure was 33.3⁑10.7 mmHg and maximal resting anal pressure was 99.0⁑43.4 mmHg. There were no difference in the colon transit time and anorectal manometry between complete and incomplete injured patients.
Conclusion: The difficulties of defecation in spinal cord injured patients were not only due to uncontrolled anal sphincter but also due to dysfunction of colon motility. The prokinetic medications were effective in reducting the rectosigmoid and total colon transit time.
Objective: The videofluoroscopic swallowing study (VFSS) has been accepted for standard method of dysphagia evaluations. But there is no research for oropharyngeal effects depending on the change of viscosity.
Method: The 10 normal subjects without dysphagia symptom or history were participated. 4 test foods were selected according to viscosity which was measured by line spread test (LST); thick semiblended diet: LST 1 cm, Yoplait: LST 2.44 cm, tomato juice: LST 3.67 cm, 35% diluted barium: LST 4.15 cm. Each foods were swallowed 3 times during VFSS. We measured oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time (PTT), and cricopharyngeal opening time (CPOT)
Results: There was linear correlation between OTT and LST (cm)(r=0.965, P＜0.05). As the score of LST increased, PDT tended to increase linearly, but there was no statistical significance (r=0.949, P=0.509). PTT and CPOT had no significant correlation with viscosity.
Conclusion: The viscosity affected OTT and PDT. The test foods of VFSS and dysphagia diet shoud be selected by viscosity measures.
Objective: To investigate the patterns of the temperature effect on motor nerve conduction parameters according to various warming methods and to obtain the most valuable method of warming in clinical setting.
Method: Twenty normal subjects were studied. After limb cooling in cold water, the cooled hands were warmed by hot pack, fan heater, and whirl pool. The median motor responses were recorded at abdnctor pollicis brevis after the stimulation at the wrist during warming at 1 min interval until the temperature increment reached plateau. We measured the temperature changes and conduction parameters were measured at each examination.
Results: The time constants for temperature increment and distal motor latency, duration, area of compound muscle action potentials showed shorter tendency by hot pack and whirl pool than by fan heater (p＜0.05). For the measurement of distal motor latency, time constant of whirl pool (2.49⁑1.21 min) was shorter than that of fan heater (7.12⁑3.12 min) or hot pack (5.96⁑1.98 min) (p＜0.05).
Conclusion: These findings suggest that the use of whirl pool is the most effective method for warming of the cooled limb.
Objective: The aims of this study were to evaluate the common gastrointestinal problems, diet and bowel care patterns, and to estimate the colon transit time in spinal cord injury (SCI).
Method: Fifteen chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were studied by measuring the colonic transit time and interviews. The colon transit time was studied by using radioopaque markers.
Results: Mean total colonic transit time was 43.79 h with right colonic transit time 13.71 h, left colonic transit time 20.36 h, and rectosigmoid colonic transit time 9.71 h. The right colonic transit time was delayed in 35.7% of the subjects, left colonic transit time in 64.3%, and rectosigmoid colonic transit time in 21.4%. The common gastrointestinal problem in SCI were constipation (66.7%). The defecation difficulty (73.3%) was the most significant subjective symptom. Delayed colonic transit time was shown in 80% of perceived 'constipation' group. The average time spent for the defecation was 64.7 minutes per day. 73.3% of the subjects did not control the diet.
Conclusion: Spinal cord injured persons of upper motor neuron type neurogenic bowel in Korea showed significantly delayed colonic transit time than non SCI adults, similar delayed colon transit time as Western SCI persons who consume less fibers in daily diets.
Objective: The purpose of this study was to determine the difference of temperature effects on the nerve conduction variables and to obtain correction factors for temperature in demyelinated and normal peripheral nerves.
Method: The compound muscle action potentials (CMAPs) were recorded with wrist stimulation during cooling and warming in 10 control subjects and 13 subjects with demyelinating neuropathies. The temperature of cooling and warming were 18oC and 40oC, respectively. The time of cooling and warming were 60 minutes and composed of successive 4 sessions of 15 minutes. The skin temperature of thenar area, latency, amplitude, duration, and area of CMAPs were measured before and after each session of 15 minutes of cooling or warming.
Results: The time constants of parameters of CMAPs were of higher tendency in cooling than in warming. The time constants of latency of CMAP were higher in subjects with demyelinating neuropathy than in controls (p＜0.05): 33.3⁑4.0 minutes versus 27.2⁑2.2 minutes in cooling; 30.0⁑7.8 minutes versus 19.6⁑3.3 minutes in warming. The temperature correction factor of latency of CMAPs was 0.23⁑0.03 msec/oC in control and 0.33⁑0.06 msec/oC in subjects with demyelinating neuropathies (p＜0.05).
Conclusion: When studying a subject with demyelinating neuropathies, we should warm the extremity for more sufficient time than in normal subject, or may applicate a differenct temperature correction factors.
Objective: Inappropriate neural control of the quadriceps femoris muscle group has been implicated in patellofemoral pain syndrome (PFPS) and the methods of biomechanical assessment of PFPS has been developed recently. The aims of the present investigation were to evaluate the effects of therapeutic exercise in the alleviation of PFPS and to develope objective clinical test for PFPS.
Method: We investigated the onset time of the isometric contraction of vastus medialis oblique muscle (VMO) and the vastus lateralis muscle (VL) under four different conditions: knee flexion and extension in weight bearing (standing) and non-weight bearing (sitting on chair) situations. For each condition, onset times of EMG activities and onset times for VMO and VL were determined from five trials of isometric contraction. In addition, we compared knee flexor and extensor torques in control group and subjects with PFPS. To evaluate the effects of the exercise we compared the onset time difference (onset time of VL-onset time of VM) and quadriceps muscle torque at pre- and post- exercise in PFPS groups.
Results: In PFPS group, onset time of VMO during knee extension was significantly longer than the onset time of VL and the knee extensor torque was considerably weaker in comparison with normal group. Although onset time difference was not changed after exercise program, there were significant increase in knee extensor torque in subjects with PFPS.
Conclusion: The role of exercise in the rehabilitation of quadriceps functions is to reduce the pain, to strengthen the knee extensor, and further accurate diagnostic tools and methods for the result of therapeutic exercise in PFPS are needed.
Objectives: This study was designed to measure sympathetic skin responses (SSRs) following magnetic stimulation of the cervicothoracic spine and to evaluate its clinical usefulness.
Methods: Fifteen healthy volunteers who had no dysautonomic symptoms or signs and a patient with C6 spinal cord transection participated in this study. To evoke SSR, we stimulated the C7 spinous process (SP) and T2 SP with 90 mm circular coil (Magstim 200). We recorded the sensory nerve action potential (SNAP) from the right middle finger to ascertain whether the C7 dorsal root was depolarized by the C7 SP stimulation. The same stimulation intensity by which SNAP had been obtained was used to evoke the SSR by the C7 and T2 SP stimulation. The recording of SSR was done in both palms. SNAP was recorded by the magnetic stimulation on the C7 SP in all subjects.
Results: By the C7 SP stimulation, the latency of SSR was 1.35 sec in the right palm, 1.33 sec in the left palm and by the T2 SP stimulation, the latency was 1.24 sec, 1.23 sec in order. The right-left difference was not found by each SP stimulation, but the latency of SSR by the T2 SP stimulation was faster than that by the C7 SP stimulation (p＜0.01). The latency difference of C7 and T2 SP stimulation was 0.11 sec in the right palm, 0.10 sec in the left palm. In a case of C6 cord transection, SSR was evoked neither by the right median electric stimulation, nor by the C7 SP magnetic stimulation. However, SSR was successfully evoked by the T2 SP stimulation.
Conclusion: We believe that the latency difference of C7 and T2 spinous process stimulation reflects the central conduction time of SSR.
Flatfoot is a common foot disorder. Some modifications by orthotic shoes for the flatfoot have been prescribed, however their effectivenesses are not fully proven yet. We have tried to validate the effectivenesses of conventional orthotic shoes for the flatfoot patients. We assessed the static and dynamic pressure, dynamic pressure-time integral, and relative impulse with and without wearing orthotic shoes. Thirteen subjects with the flatfoot were included in this study. The results showed the positive effects of orthotic shoes for the subjects. Especially the dynamic pressure-time integral values revealed the significantly reduced values at the medial side of midfoot, which meant the functional improvement of flatfoot status. We have concluded that the use of conventional orthotic shoes for the flat foot patients would be effective for properly selected patients, if there is no other associated abnormality.
Muscle functions are limited in patients with osteoarthritis of knees. In patients with osteoarthritis, isokinetic testing of knee musculature reveals decreased peak torque and increased walking time(50-ft). The purpose of this study was to demonstrate deficiency in muscular performance of knee, and the relationship between walking time and isokinetic parameters of muscular strength, endurance and pain of knee in patients with osteoarthritis of knees. The subjects were divided into a control group and the study group. The control group consisted of 40 persons without a knee pain, and the study group consisted of 30 patients with osteoarthritis of knees. The peak torque of patients in the study group was decreased by 16∼21%, compared to that the control group. There was a negative relationship between the walking time and the endurance of knee extensors(r=0.7195). These findings suggest that exercises to increase the strength and endurance of extensors and flexors of knees should be emphasized in the rehabilitation program for the osteoarthritis of knees.
The central somatosensory conduction time(CCT) was measured by recording the cerebral and spinal evoked potentials following median nerve stimulation in 24 traumatic brain injury patients. The findings of evoked potential study correlated to the functional independence measure(FIM), mini mental status examination(MMSE) and Glasgow outcome scale(GOS).
The CCT of head injured patients was prolonged compared to that of the controls. The CCT with stimulation of the affected side was significantly prolonged compared to that with non- affected side. Abnormal CCT was related to the poor functional status measured by FIM and GOS. There`s no significant difference between groups of absent evoked potential and prolonged CCT by FIM score.
These results suggest that the CCT correlates with the functional status of head injured patients. Follow up studies are required to evaluate whether the CCT could be a valuable prognostic indicator or not.
The purpose of this study was to measure the foot pressure distribution of normal children. Static and dynamic pressure, dynamic pressure-time integral, relative impulse, static pressure distribution between forefoot and heel, and the percentage of contact time in each phase of the gait cycle were measured from 68 normal children by the in-sole pressure measurement system. The measurements were perfomed while standing and walking with their comfortable speed using the in-sole pressure measurement system.
The sites of the greatest static pressure, dynamic pressure-time integral and relative impulse were obtained from the 2nd and the 3rd metatarsal head areas. And the dynamic pressure was obtained from in the lateral heel area. The forefoot to heel load ratio was about 6 to 4 in the static state. The contact time was greatest during the push-off phase., In-sole pressure measurement system, Static pressure, Dynamic pressure,
We studied diabetic central neuropathy(DCN) that is not well-known neurologic disorder, for confirming its existence and then presenting objective diagnostic criteria and methods. Thirty-six diabetics(NIDDM: 30, IDDM: 6), mean age 53.1 years, 21 males and 15 females, were compared with 36 controls, mean age 51.5 years, 18 males and 18 females, electrophysiologically. First, we diagnosed peripheral polyneuropathy(PN) in diabetics by means of Diabetic Neuropathy Staging(DNS) developed at the University of Michigan and classified diabetics into two groups; group I indicates diabetics with PN, group II diabetics without PN. Second, we studied central(cortico-cervical and cortico-lumbar) motor conduction time(CMCT) by means of magnetic motor-evoked potentials(MEP) and central somatosensory conduction time by means of somatosensory-evoked potentials(SEP) stimulating on median and posterior tibial nerves.
There were no significant differences(p>0.05) statistically in cortico-cervical CMCT between diabetics and controls. There were significantly more prolonged(p<0.01) in cortico-lumbar CMCT between diabetics and controls. In median nerve-evoked 3-channel SEP, N13-N20(cortico-cervical) interpeak latency was significantly more prolonged(p<0.01) in diabetics than controls. In tibial nerve-evoked 2-channel SEP, P38-N22(cortico-lumbar) interpeak latency was significantly more prolonged(p<0.01) in diabetics than controls. In 30 patients(83.3%) of 36 diabetics, the study revealed central conduction delay in view of that above 2 or more abnormalities representing central conduction delay, that is, central neuropathy. In 10 patients(33.3%, M:7, F:3) of diabetics with central neuropathy(30 patients), even though they had no PN, central conduction delay was revealed.
Conclusively, in view of representing central conduction delay in 83.3% of patients, we believe that more active evaluations are needed in diabetics representing nonspecific central neurologic symptoms, for example, psychomotor slowing or cognitive dysfunctions, and MEP and SEP are useful in diagnosing DCN.
Dysphagia is a disorder of the swallowing mechanism and presents a major problem in the rehabilitation of stroke patients. In the present study, computerized laryngeal analyzer (CLA) was used for noninvasive assessment of the pharyngeal phase of the swallowing mechanism. Laryngeal elevation was measured with pressor sensor placed on the skin over the thyroid cartilage. In the study, CLA was applied at each posture of neck flexion, neutral, and extension in stroke group and control group. Significant differences were found in each of these parameters measured in control group and stroke group. The quantitative measurements may aid the physician in choosing the appropriate therapy during the course of recovery.
The onset latency of swallowing was delayed in stroke group than control group at all posture of neck(p<0.05). The pharyngeal transit time (PTT) was longer at extension than flexion and neutral posture of neck in stroke group(p<0.05). The PTT was longer in stroke group than control group at all posture of neck, but not significant(p>0.05). The amplitude of swallowing was decreased in stroke group at extension and neutral posture of neck compared to those of control group(p<0.05), but there was no significant difference between stroke group and control group in neck flexion (p>0.05).
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