The isometric torque of the knee flexor and extensor muscles were measured for 6 seconds at three knee joint positions(30°, 45°, 60°) in 60 normal, healthy men in three age groups from 22 to 49 years, using the Isokinetic Rehabilitation & Testing System(Model No. Cybex340).
The peak torque, the time to peak torque, and torque at each second were measured for each contraction. In addition, heart rate and blood pressure were recorded simulatneously at rest and immediately following contraction at 1 and 3 minutes.
Age had a significant positive correlation with mean peak isometric torque for both knee extensors and flexors at all examined joint angles except knee extensors at 30°(p<0.01). The onset time to peak torque had a significant positive correlation with age for only knee extensor(p<0.01).
The mean increment ratio was 21.1% for systolic blood pressure and 10.4% for diastolic pressure, and, in the younger ages, the increment of diastolic pressure was significantly lower than that of the older ages(p<0.01).
The mean heart rate increased promptly by 48.9% of its resting level and the increment of the youngest group was significantly higher than that of the older group
The incidence of stoke is strongly increasing and the stroke is the most frequent cause of disability in the elderly. However, the little information is available concerning the details of recovery in the first weeks after stroke. The predictions as to whether a patient will recover after stroke is very important to patient, family and physician.
To predict the outcome of stroke patient, we performed multiple regression analysis of 6 variables, measured in the beginning of rehabilitation, on 153 patients. The variables were gender, age, proprioception, motor assessment scale(MAS), visual perception score, and initial Barthel index score.
The gender, age, proprioception had no significant effect upon functional outcome in 1 month after stroke. The MAS, visual perception score, initial Barthel index score were correlated with functional outcome, and the equation of these was 17.38+0.81 MAS+0.22 Visual perception score+0.25 Initial Barthel index score.
Cisplatin induced peripheral neuropathy is recently recognized as dose-limiting side effect of cisplatin anticancer therapy.
We did physical examination and electrodiagnostic studies of 21 patients with cisplatin chemotherapy to find out the factors related with cisplatin neuropathy and to make a criterias of patients who need electrodiagnostic studies to detect cisplatin neuropathy.
We concluded as follow:
1) Cisplatin neuropathy is mainly sensory axonopathy.
2) Cumulative dosage of cisplatin is the most important factor related with cisplatin neuropathy
3) The patients recieving more than 300㎎/㎡ of cisplatin in cumulative dosage should be done electrodiagnostic studies.
The effects of whole body hot bath on blood sugar level was examined in alloxan diabetic rats treated with intermediate-acting insulin. Sixty diabetic rats were divided into four groups which were 1) control group, 2) hot bath treated group, 3) insulin treated group and, 4) hot bath & insulin treated group. Hot bath was done for 20 minutes at 40℃~42℃ at 10 A.M. in group 2 & 4 and insulin therapy was performed by injection of 2 unit intermediate-acting insulin (Protaphane Beef)subcutaneously in the abdominal wall at 9 A.M. in group 3 & 4, daily for 6 weeks. We measured blood sugar level weekly using by reflectance photometer Diascan and compared diurnal variation of blood sugar level on the 2nd and 4th weeks.
The results were as follows:
1) There was no significant difference of blood level between group 1 and 2.
2) The blood sugar level was more significantly decreased in group 3 and 4 than group 1 and 2.
3) The hypoglycemic effect was clear in group 4 as compared to group 3 in weekly change and diurnal variation on the 2nd and 4th weeks.
Taken together, the results suggest that hot bath treatment is not able to reduce the blood sugar level in diabetic rats, but facilitates the absorption and the hypoglycemic effect of intermediate-acting insulin continuously.
Aphasia of head injured patients impedes rehabilitation program and social reintegration.
To Characterise the pattern of aphasia after closed head injury, this study was done retrospectively through medical records and aphasia test records of 42 closed head injured patients who were admitted to Severance Hospital between March, 1985 and August, 1991.
The results were as follows:
1) The total 42 cases were composed of 32 males(76.2%) and 10 females(23.8%) and the traffic accidents were the most frequent cause of head trauma.
2) Among 42 patients, Broca's aphasics were the most common(17 cases, 40.5%) and the global aphasics were the oldest patients.
3) The severity of aphasia was classified as mild degree in 20 cases, moderate degree in 8 cases, and severe degree in 14 cases and the severe impaired aphasics were the most common in global aphasics.
4) The mean duration of unconsciousness was 64.9 days. The global aphasics and severely impaired aphasics had the longest mean duration of that.
5) Nineteen cases of aphasics had dysarthric problem, too.
6) There was no significant difference between type of aphasia and the lesion site of brain.
The identification of the carrier state in Duchenne muscular dystrophy is of prime importance for genetic counseling.
The presence of elevated serum creatine kinase(CK), lactic dehydrogenase(LDH), aspartate transaminase(AST) and alanine trasaminase(ALT) levels in 11 obligate carriers of Duchenne muscular dystrophy, 26 possible carriers and 36 carrier suspects were compared with these levels in 195 female normal controls.
Only serum CK levels among 4 serum enzymes were significantly elevated in each carrier group compared with the normal control group.
A negative correlation was found between age and the CK levels in normals, but not in any of the carrier groups. The CK levels in each carrier group showed non-statistical significant tendency to decrease with aging.
There were elevated CK levels in 63.6% of the obligate carriers, 26.9% of the possible carriers and 22.2% of the carrier suspects.
Higher CK levels were found in the carrier suspects younger than 10 years of age.
Peak torque, peak torque to body weight ratio, angle at peak torque, peak torque acceleration energy, average power, endurance ratio and peak torque ratio between antagonists during isokinetic exercise were studied in order to obtain the normal data of shoulder girdle muscles in 40 young healthy adults.
1) The values of peak torque and peak torque to body weight ratio at 60°/sec were greater than those of 150°/sec, which were statistically significant(p=.0001). 2) The values of peak torque acceleration energy and average power at 150°/sec were significantly greater in males than those of females(p=.0001). 3) The values of peak torque angle at 60°/sec and 150°/sec showed no significant differences between both sexes or sides. 4) The comparison of peak torque in antagonists at 60°/sec and at 150°/sec showed greater values in abductors and extensors than those of adductors and flexors respectively, which did not show significant differences. 5) There were significant correlation relationships between peak torque and peak torque acceleration energy and average power at 150°/sec(p<.05).
It has been reported that diabetic peripheral nerve conducts for several minutes longer than normal nerves during ischemia and retain abnormal preservation of the nerve action potential after 30 minutes on electrophysiological studies.
This study was done to see the effect of the local ischemia on the diabetic peripheral nerves and its usefulness as the earliest diagnostic tool in addition to routine electrophysiological tests of diabetic neuropathy. Median sensory nerve action potential(SNAP) and scalp-recorded somatosensory evoked potential(SSEP) were recorded during and after 30 minutes local ischemia in diabetic patients and in contols. In control group(n=20), there was the significant increment(34.8%) of latency and the decrement(42.4%) of amplitude of SNAP during 20 minutes ischemia and after 30 minutes SNAP was not evoked in 85% cases(17/20). The increment of latency of SSEP was 14.3% and the decrement of amplitude 29.6%. The SSEP was not evoked in all cases(20/20) during 30 minutes ischemia. In diabetic group(n=20) the increment of latency and the decrement of amplitude of SNAP were 19.2% and 13.6%, respectively, and those of SSEP were 3.7% and 9.2% respectively; it was significantly less changes than in controls during ischemia(p<0.05), and there was no one case that SNAP and SSEP were not evoked on 30 minutes ischemia.
Electrodiagnostic study in acute polyradiculoneuropathy is considered as the only objective diagnostic tool in diagnosis and predicting prognosis. Because of the temporal change in electrophysiologic findings and discrepancy in prognostic parameters, it has many limitations in applying it clinically. In order to get the most probable electrodiagnostic parameter for prognosis and suggestive protocol in electrodiagnostic study, 36 patients were analyzed clinically and with standard electrodiagnostic findings. There was no consistent parameter of prognosis throughout time but electrodiagnostic findings studied between 8 weeks and 12 weeks since the onset of the disease were well correlated with clinical features and prognosis. It is suggested that the protocol for electrodiagnostic study in acute polyradiculoneuropathy is the baseline study between 2 weeks and 4 weeks since onset and the F/U study for prognosis between 8 weeks and 12 weeks.
The application of suction cup surface electrode in place of commonly used taped metal disc electrode has been investigated in the median motor nerve conduction study. We evaluated the differences of parameters (distal latency, duration, amplitude and area) of CMAP between the group using disc type and suction cup electrode alternatively as active recording, reference and ground electrode.
The means of the distal latency (msec), duration (msec), amplitude (mV) and area (mVmsec) were 3.1, 14.1, 19.7, 64.2 in all disc electrode group, 3.1, 14.0, 19.8, 62.5 in group using suction cup electrode as ground, 3.1, 14.1, 19.4, 62.4 in suction cup as reference and ground, 3.1, 14.2, 19.7, 64.0 in suction cup as all three electrode. There was no statistically significant differences of the parameters of CMAP between the groups, therefore we concluded that the suction cup electrode could be used more comfortably and conveniently without any change of CAMP in the motor nerve conduction study.
Anterior interosseous nerve conduction study was done by using surface electrode on pronator quadratus and flexor pollicis longus. 43 healthy adults(21 male, 22 female) were tested. There were no significant differences in latency, amplitude between right and left, and male to female.
The results of nerve conduction study from pronator quadratus were; distance 19.9cm, latency 3.10±0.43msec, amplitude 5.70±1.51mV. The results of nerve conduction study from flexor pollicis longus were; distance 17.3cm, latency 3.04±2.14msec, amplitude 11.38±3.70mV. The results of nerve conduction study from pronator quadratus compared with the results from flexor pollicis longus came out as relatively longer distance, short amplitute but no significant difference in latency. Futhermore there were no relationship between the latency and amplitude in each method.
160 deep peroneal nerves in 80 Korean adults were evaluated for presence of accessory deep peroneal nerve. The subjects were 69 men and 11 women.
The presence of accessory deep peroneal nerve was determined by electrodiagnostic techniques The accessory deep peroneal nerve was seen in 39 nerves in 24 persons. Sexual incidence was 25% in male and 18% in female. Bilateral involvement was seen in 63% of positive cases. Awareness of this anomalous innervation is important for clinical and electrodiagnostic evaluation.
It is difficult to record successfully the action potential of the lateral femoral cutaneous nerve because of anatomic variations in the distribution of branches. The objective of this study was to show improved detection rate of the action potential of the lateral femoral cutaneous nerve using modified Butler's method, that is, the recording electrodes consisted of a pair of ring electrode instead of disc surface electrode to increase pick-up area.
Twenty male adults free of disease were examined with modified Butler's method. Their ages ranged from 23 to 58 years. The mean conduction velocity, the mean distal latency, and the mean amplitude were 49.07±4.07m/sec, 2.42±0.20msec, and 16.91±3.63㎶ respectively.
There is an increasing interest in the clinical features and late outcome of traumatic head injury which is one of the major causes of long term severe disability.
This follow-up study evaluated 30 patients with traumatic head injury who were discharged from Department of Rehabilitation Medicine two to five years ago in order to identify the late outcome and frequent residual symtoms after head injury. The results were as follows: 1) Mean age was 27 years old and seventeen cases(56.7%) were under 29 years of age. 2) The most common cause of head injury was traffic accidents, especially pedestrian accident. 3) The Glasgow Outcome Scale(GOS) and Disability Rating Scale(DRS) were highly correlated with each other at discharge and at follow-up. 4) The DRS reflects the improvements more sensitively than the GOS between discharge and follow-up period. 5) The problems most frequently reported by family at follow-up were gait disturbance(43.3%), poor hand function(23.3%) and speech disturbance(23.3%). 6) The most common psychologic complaints at discharge and follow-up were forgetfulness, poor concentration, unable to do two things simultaneously, loss of initiative and rapid mood change, etc. 7) Most survivors lived with their families and were dependent upon relatives for activities of daily livings and finances.
To compare the antidromic and orthodromic conduction of saphenous nerve, SNAP's(sensory nerve action potentials) were recorded at both legs of 31 normal adults.
Three methods were used: 1) stimulation at the medial side of the knee and recording at the medial side of mid-tibia, 2) stimulation at the medial mallelous and recording at the medial side of mid-tibia, 3) stimulation at the medial side of mid-tibia and recording at the medial mallelous. Latency and duration of SNAP's were practically same in all the methods, which meant that there was no difference in conduction velocity between antidromic and orthodromic methods. The mean value of the amplitude in method 1, 2, and 3 were 8.06, 4.29, 5.33㎶, respectively. Among 62 tests, we could not get SNAP in 2 tests of the third method. The first method of saphenous nerve conduction seems to be the most practical.
Myofascial pain syndrome is one of the major causes of chronic pain and trigger point injection is often used in clinical situation for treatment of myofascial pain syndrome. Recently, measurement of pressure threshold using pressure algometer was introduced as an useful and reliable mean to detect the trigger point and evaluate the effect of treatment in patients with myofascial pain syndrome.
Authors examined the changes of pressure thresholds over 46 myofascial trigger points among 22 patients before and after trigger point injection therapy with procaine and also tested McGill pain questionnaire, visual analogue scale(VAS), and verbal rating scale(VRS).
Mean pressure thresholds before, immediately after, and three to seven days after trigger point injection were 0.39kg/㎠, 1.75kg/㎠, 2.4kg/㎠, respectively. There was statistically signficant increment of pressure threshold after trigger point injection therapy. VAS and VRS scores showed statistically significant decrement after trigger point injection and there were correlations between changes of VRS and pressure threshold before and after trigger point injection therapy.
The syndrome of cervical radiculopathy usually follows a stereotyped pattern. With aging, degeneration of disc and cervical spine are known to occur. The symptoms and objective signs generally clear-cut and indicative of the level of radiculopathy. Generally, plane roentgenographic evaluation is an essential part of the diagnostic work-up of a patient with suspected cervical spondylosis or disc herniation causing root compression. However, there is no consistent relationship between plane X-ray changes and radiculopathy in degenerative cervical spine. The needle EMG is useful in confirming the presence of an organic radiculopathy, in delineating the specific root involved, and in differentiating radiculopathy from other types of neurologic disorder.
The study is carried out to investigate the comparative evaluation of the cervical radiculopathy with the clinical symptoms, radiologic findings and needle EMG findings. The results were as follows,
1) The incidence was higher in men and increasing with aging, but there was no significant differences related to the side of involvement.
2) The most common level of cervical radiculopathy was the 7th cervical root(57.4%, 51/89 cases).
3) Pain was the prominent symptome in the 7th, 8th cervical radiculopathy and motor weakness in the 5th, 6th cervical radiculopathy.
4) The muscles which showed clinical weakness commonly were deltoid, triceps, and abductor pollicis brevis, abductor digiti quinti in the 5th, 7th, and 8th cervical radiculopathy, respectively.
5) In plane X-ray, the degenerative changes of cervical spine showed in 85.4%(71/89 cases) and the most common feature was narrowing of the 5th and 6th cervical intervertebral spine (46.1%, 41/89 cases).
6) In needle EMG, positive sharp wave and fibrillation potentials were found in the 46.1%(41/89 cases) and the motor unit potential changes were showed in the 53.9%(48/89 cases).
The purpose of this study was to demonstrate that the mechanism and the effect of TENS on skin temperature change or sympathetic activity change in thermographic finding and for the evaluation of it's mechanism.
The subjects of this study were 41 patients with HNP, or SCI, or peripheral nerve injury who visited the department of Rehabilitation Medicine, Soon Chun Hyang University College of Medicine from August, 1990 to Jun, 1991
The results were suggested that the possibility of another mechanisms of TENS, except the central serotonergic sympathetic inhibition, such as another intraspinal pathway, or central sympathetic activation, but we could not find which time these mechanisms were inhibited or activated in this study.
Postherpetic neuralgia may be severe, continous and hard to control. During the past years, many challenges have made to ameliorate it. Although there was no encouriging evidences that treatment with antiviral agents, corticosteroids, local and regional anesthesia were effective, recent studies with respect to antidepressants, neuroleptics, anticonvulsants and TENS have shown some considerable effects. In this study, We randomly divided twenty-two patients suffering from postherpetic neuralgia into two groups. Thirteen patients were treated by infrared, 6 times per week for 4 weeks, as a control. Visual analogue scale was used as a tool for pain evaluation, which was checked weekly during 1 month and the difference from before-treated and after-treated mean score was compared by paired t-test at each week. Visual analogue score in TENS-applied group had statiically significant decrement of score from the 2nd week in portable TENS treated group, but there is no significant decrement in the control group. Hospital-visiting days in TENS treated group were 5.5 days and the other were 23.8 days. We concluded that self-administrated portable TENS has beneficial effect on postherpetic neuralgia patients. Not only one's pain but also hospital-visiting days were decreased and there was no adverse effect.
Trigger Points are 2~5mm in diameter, hyperirritable palpable taut band in a tissue, when compressed, is locally tender, if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion of proprioception. Thermography is a diagnostic procedure that measure infrared energy emitted by the skin, Trigger points manifest on the thermogram by hot-spot, which are disc-shaped, 5-10cm in diameter. The referred pain zone is variously identified as cold, as cold or hot, and as hot. Thermography is extremely sensitive to both false positive and false negative, which are of great interest in any evaluation of thermography. There would be virtually no validity to comparing pain-temperature change correlations between peoples because pain ratings are entirely subjective. Thermography is a simple, non-invative, safe adjunctive physiological procedure which may be reliable tool for diagnosis and management of musculoskeletal conditions. In those applications, thermography does not stand alone as a primary diagnostic tool, may aid in the interpretation of the significance obtatined by other test. The medical utilization of the thermographic test for the localization and verification of pain attains added importance because of the potential legal implications of the result.
The heterotopic ossification is one of the complications of spinal cord or brain injury and is not life threatening but can be disabling. In most cases the hip joint is involved and occurs in the connective tissue of skeletal muscle close to a joint.
It's major problem is the restricted motion of the joint. But, femoral nerve entrapment by heterotopic ossification is rarely reported.
We experienced one case of femoral nerve entrapment by heterotopic ossification in a patient with recurrent cerebral vascular accident and reported the case with clinical, radiologic, and electrodiagnostic findings.
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