Magnetic stimulation of the motor system is a new painless, noninvasive neurophysiologic technique enabling examination of the central motor pathways in awake persons.
Fifty five healthy adults were studied.
The mean central motor conduction time w as 5.82 ± 0.67 msec, 6.31 ± 0.39 msec, 6.81 ± 0.61 msec and 13.53 ± 1.52 msec when recording from biceps brachii, extensor digitorum brevis, abductor digiti quinti and tibialis anterior respectively and all those showed no significant difference in both side.
The onset latencies obtained by magnetic root stimulation were always shorter than the peripheral motor conduction time estimated by F-wave study, and the difference is 0.78 ± 0.67 msec in the abductor digiti quinti and 3.01 ± 1.05 msec in the tibialis anterior. And motor evoked potential was not elicited in the tibialis anterior muscle by cervical stimulation. Therefore the origin of the responses in the sine was due to excitation of the peripheral nerves or roots and not spinal cord.
With increment of height, the mean latencies of motor evoked potentials become significantly prolonged (p<0.01), but central motor conduction time showed no change.
In order to investigate the significance of somatosensory evoked potential test in the evaluation of recovery of peripheral nerve lesions and to establish the recovering pattern of somatosensory evoked potential test in peripheral nerve lesions, we analyzed forty-two patients with peripheral nerve lesions by sensory nerve conduction study, motor nerve conduction study, electromyography (EMG) and somatosensory evoked potentials (SEP) from the scalp overlying the contralateral somatosensory cortex in response to electrical stimulation of peripheral nerves. SEPs of peripheral nerves were classified according to the various methods to predict the outcome and to evaluated the relationship of patterns of SEP and regeneration state of injured nerves.
In the prediction of outcome of neurological recovery, most helpful method was needle EMG and in the order of SEP, motor nerve conduction study and sensory nerve conduction study respectively. There was a good correlation between the neurological recovery and the presence or absence of SEP (P<0.005) within three months after the injury. Among the classification methods of SEP, the grades of second method and third method correlated better with the state of regeneration of peripheral nerves than that of first method.
It is suggested that SEPs from the peripheral nerves when interpreted in combination with conventional EMG may give useful additional information about the state of regeneration and the prediction of outcome in the patients with peripheral nerve lesions.
To evaluate the present stroke rehabilitation program and to obtain the guide line for future program, the functional improvement in Activities of Daily Living (ADL) were evaluated by the scores of Barthel Index and PULSES Profile in 33 stroke patients (20 men and 13 women) who underwent inpatient rehabilitation treatment in the Department of Rehabilitation Medicine, Chungnam National University Hospital from March 1990 to March 1991.
The results were follows:
1) The age of onset was ranged from 15 to 76 years (mean: 53.4 years.)
2) The hemorragic strokes were more common than ischemic strokes and left side motor weakness were found in 20 cases (60.6%).
3) The time interval between the onset of the stroke and the initial rehabilitative treatment ranged from 9 to 617 days (mean: 110.5 days).
4) The duration of rehabilitation treatment ranged from 6 to 282 days (mean: 56.5 days).
5) The average improvement in Barthel Index score between admission and discharge was 23.2% (42.9 at admission, 66.1 at discharge), which was statistically significatnt (p<0.001).
6) The changes in Barthel Index score by items were statistically significant in all items. Walking on a level surface showed most improvement, bathing self, least improvement.
7) The average improvement in PULSES Profile score between admission and discharge was 3.3 (15.5 at admission, 12.2 at discharge), which was statistically significant (p<0.01).
8) The change in PULSES Profile score by items were statistically significant in all items. Lower limb functions showed most improvement, sensory components, least improvement.
9) In regard to initial functional dependency, all patients who had been total dependency, severe dependency, moderate dependency have shown statistically significant improvement and one step decrement in dependency.
According to the above results, present stroke rehabilitation program is thought to be very helpful for the stroke patients to improve function in all areas of ADL, and further studies with more detailed scales are required to document the functional changes in initially less dependent patients.
Diagnostic approaching method using postural reactions by Vojta was introduced to Korea in early 1980' through Kinderzentrum München in West Germany. But the clinical date about postural reactions are still rare.
We have reviewed the results of postural reactions, physical growth and functional development of 194 infants under 1 year of age who visited us with complaint of delayed development.
The findings of physical growth in relation to standard growth percentile, functional development according to Münchener Functionelle Entwicklungs Diagnostik were compared between A and B groups, classified by the results of postural reactions.
Group A infants had 0∼3 abnormal postural reactions in 7 items and group B infants had 4∼7 abnormal postural reactions.
Results were as follows.
1) The number of infants who showed delayed physical growth under 3rd percentile at least one component among body weight, length, head circumference, chest circumference was 43 (22.2%) in 194 infants.
In group A (88 infants), 12 infants had one or more components under 3rd percentile. In group B (106 infants), 31 infants (29,2%) had one or more components under 3rd percentile.
2) The number of infants who showed delayed functional development was 110 (56.7%) in 194 infants.
In group A, 16 infants (18.2%) were delayed and in group B, 94 infants (88.7%) were delayed.
According to these results, it is suggested that the finding of postural reactions is related to the patterns of physical growth and functional development.
To evaluate that effect of exercise in spinal cord injuried patients, the continuous exercise program during 5 months was applied to 9 patients with spinal cord injury, then they were investigated of cardiopulmonary function and level of blood lactate and lipid between pre and post-exercise program.
The results obtained as follows;
1) As a result of exercise loading test,
(1) Maximal heart rate and VO2 max, as the cardiopulmonary function show no significant change between pre and post-exercise program.
(2) Blood lactate concentration represent meaning value that 4.73 ± 2.81 mM and 8.60 ±3.78 mM before and after exercise program, therefore show improvement of capacity of anaerobic exercise (p<0.05).
2) As the blood lipid components before and after exercise program:
(1) Total cholesterol revealed insignificant result that 147.8 ± 29.0 mg/dl and 160.8±40.4 mg/dl (p>0.1).
(2) Blood triglyceride appeared insignificant decrement that 302.2 ± 211.7 mg/dl and 183.3 ± 131.5 mg/dl (p>0.1)
(3) HDL-Cholesterol revealed meaning increment that 28.4±5.7 mg/dl and 37.6 ± 3.5 mg/dl (p<0.001).
(4) The C-ratio was diminished significantly that 5.29 ± 1.02 and 4.25 ± 0.87 (p<0.05).
Therefore, a continuous exercise in spinal cord injuried patients bring about improvement of ability of anaerobic exercise and prevention of arterosclerosis and ischemic heart disease.
Under the assumption that the amplitude, area of the F-wave will be good parameters as well as latency in F wave study.
We studied electronic averaging technique of F wave in the sciatic nerves of rabbits to get more information about nerve lesion by standardization of F wave.
To determine the most reasonable numbers of averaging, we studied 10, 20 and 50 numbers of averaging in unilateral sciatic nerves of 23 rabbits. There was no statistical significant differences of latency, amplitude, area among 10, 20 and 50 numbers of averaging. Considering about more information with less discomfort and study time, we determined 20 numbers of averaging to be adequate.
To determine the usefulness of averaged F wave, we studied 20 averaged F wave of 14 sciatic nerves of rabbits with crushing injury. There was good correlation between amplitude of proximal M waves and total area of distal 20 averaged F waves and less correlation between negative area of proximal M waves and that of distal 20 averaged F waves.
We concluded that electronic averaging of F wave were convenient, not time consuming and reproducible with more information about conduction block than conventional minimal latency.
Cerebral palsy is a disorder with variable nature, distribution and severity of motor dysfunction and the prediction of the eventual outcome of motor function is not easy. This study was carried out to determine the motor developmental age as a percentile and prognosticate the ambulatory ability.
The 354 children with cerebral palsy, ages 3 months to 14 years were included for motor age determination and 48 cerebral palsied children, ages ranging from 7 months to 10 years were re-examined until 10 years old for predicting walking ability related to the sitting age.
The results were as follows;
1) The type distribution was 22.7% of spastic diplegia, 16.2% of spastic quadriplegia, 51.4% of athetoid and 9.7% of mixed type.
2) The 9 stages of motor development were head control, elbow support, roll over, sitting when sat, crawl, sitting alone, pull to stand, walk with support, and walk alone. The age of 10, 50, 75, and 90 percentiles was studied in each stages and compared with each type.
3) The age of 50% of the cerebral palsied children walk alone was 63.6 months in spastic diplegia, 67.2 months in spastic quadriplegia, 84.1 months in athetoid and 93.6 months in mixed type.
4) All children who sat by 2 years became independent ambulators whereas 78% of those sat between 2 and 3 years achieved ambulatory function and only 52% among who sat after 3 years became independent ambulators.
The urinary tract infection is the most common complication in the patients with spinal cord injury.
The objectives of this study are to analyze the clinical aspects of the urinary tract infection and to evaluate the clinical usefulness of the Leukocyte esterase (LE) and Nitrite tests as a screening test for the urinary tract infection in the patinets with spinal cord injury.
The subjects of this study were 48 patients with spinal cord injury who were admitted in the Department of Rehabilitation Medicine, Wonju Christian Hospital from January 1, 1989 to June 30, 1991. Among them, 17 patients were performed the LE and Nitrite tests by using Ames Multistix and urine culture.
The results were as follows:
1) The incidence of the urinary tract infection was 77.1% in 48 patients and it was greater in the complete lesion and the quadriplegics than that of the incomplete lesion and the paraplegics.
2) The most common causative organism of urinary tract infection was Enterococcus, followed by Escherichia Coil.
3) The LE test had sensitivity of 40.4% and specificity of 98.8%. The Nitrite test had sensitivity of 45.4% and specificity of 98.8%. The low sensitivity of these tests was due to many false negative results in the enterococcal infection.
The conclusion of this study is that the LE and Nitrite tests had limited value as a screening test for the urinary tract infection in the patients with spinal cord injury.
Low back pain is distressing much of patients and known as common troubles against daily living. The cause of low back pain is not clear in 44.5%, which is the most frequent of all. If bad postures can lead to bad daily activities and habbits, it may facilitate the recurrence of low back pain. This study was designed to evaluate the daily habbits and characteristics of house structures in low back pain patients, thus to help them preventing low back pain.
The subjects of this study were 200 out-patients who visited Yongdong Severance Hospital Dept. of Rehab. OPD clinic from low back pain.
The major results were as follows
1) Chronic low back pain patients were 82%.
2) 44.5% showed no clear cause of pain.
3) Average height of male was 170.5 cm and female was 158.8 cm.
4) Average height of kitchen table was 79.9 cm and wash stand was 71.5 cm.
5) Sleeping habbit of floor mat was 62.5%.
As life long bleeding occurs in hemophiliacs, current concepts in the management of hemophilia is a continuous multidisciplinary team approach.
The purpose of this study is to explore the status of rehabilitation of hemophiliac patients in Korea and emphasize the importance of multidisciplinary team approach.
The study was done retrospectively through a medical record research of 120 hemophiliac patients admitted to Severance Hospital, Seoul, Korea between Jan. 1, 1986 and Dec. 31, 1990.
Since recent rehabilitation medicine was introduced to this hospital, the comprehensive multidisciplinary approach team has been consisted of the hemophiliac patient, his family, physiatrist, orthopedic surgeon, pediatrist, nurse, physical therapist, clinical psychologist and social worker.
Even though deficient coagulating factor replacement, continuous exercise, early mobilization after bleeding event, psychosocial support are the important components of a comprehensive rehabilitation program, patients are seldom managed by a multidisciplinary team. Therefore, education for comprehensive multidisciplinary rehabilitational management is required for the physician, hemophiliac patient and his family.
Subacute sensory neuropathy (SSN) is clinically well defined paraneoplastic syndrome. But there is few reports about SSN that is not associated with malignancy. The authors experienced a case of SSN without evidence of malignancy and report the case with clinical, pathologic and electrophysiologic findings.
The patients presents with profound impairment of kinesthetic sense, mild dysfunction of cutaneous sense, and sparing of motor fuction and with pseudoathetoid involuntary movements of the extremities. She was bed-ridden and totally dependent in self in self care activity before starting rehabilitation process. After about one month of rehabilitation process, she achieved independent ADL and transfer activities. Until now there is no evidence of malignancy with more than 2 years follow up.
Sensory extension of the musculocutaneous nerve (lateral antebrachial cutaneous branch, LACB) is injured seperately in rare and its clinical usability has been ignored at most. One original case is reported here. Twentysix year-old male visited EMG laboratory, complaining the paresthesia, numbness and hyperalgesia on left lateral antebrachial area after electrical burn on left Erb's point and near bicipital tenomuscular junction of the elbow. His sensory conduction of left musculocutaneous nerve (MCN) was not responsive and its somatosensory evoked potential was weak (much low amplitude) but relatively spared initial peak latency, and other nerve conductions including musculocutaneous motor nerve were within normal limit. In follow-up study 7 month later, symptoms on left forearm, were normalized nearly but no specific change in the peripheral conduction was seen in left LACB. Only one change in electrodiagnostic study was visible in somatosensory evoked potential (SEP) of left LACB. Amplitudes in left LACB SEP became higher and more prominant by still low. It was concluded that the sensory extension of left musculoctaneous nerve was injured isolatedly in condition of intact motor nerve innervating brachial muscles an its injury was severe axonotmesis combined with secondary demyelination near bicipital tenomuscular junction of the elbow by electric burn. Sensory branch of MCN arising from C5 and C6 roots innervate C6 dermatomal area and we tried its SEP, not reported until now, and present its clinical usability. And so we think that sensory branch of MCN may be useful in cervical radiculopathy and brachial plexopathy because of the benefits that its SEP is possible to check the sensory root of C6 and/or C5 and its peripheral conduction study is easer, more accurate and not discomfortable than motor. Sensory branch of the musculocutaneous nerve may be more available clinically than its present utility.
Huntington's chorea is the most common hereditary chorea, which is inherited as autosomal dominant trait, which develops in the middle age. Its symptoms are progressive choreic movement, emotional and personality disturbance and dementia. Eventually, the patient progressively becomes incapable of leading the activity of daily living. We present here the case of two patients with Huntington's chorea, who complained of involuntary movement on their extremities, faces as well as affective disorder such as emotional and personaltiy disturbance.
Oculopharyngeal Muscular Dystrophy, a clinically well-defined and autosomal dominant myopathy, is a disorder characterized by progressively bilateral ptosis and dysphagia of later life and a high incidence in the French-Canadian population.