Transcutaneous electrical nerve stimulation(TENS) is a well established clinical technique to alleviate acute & chronic pain. However, its mechanism of action remains unknown and the stimulation parameters used are based on subjective reports from patient.
In the present study, The analgesic effect of TENS in cold-induced pain was assesed using a range of 3 stimulating frequencies(40 Hz, 80 Hz, 100Hz) in 60 normal healthy subjects. The subjects are randomly allocated 1 of 5TENS treatment regimes; 40 Hz, 80 Hz, 100Hz, sham and control TENS. Pain threshold and tolerance measurement were taken during 6 experimental cycles each lasting 15 min. Two pre-treatment cycles were followed by 4 treatment cycles. TENS significantly elevated cold-induced pail threshold & tolerance when compared with sham and control groups. There is no significant difference in pain tolerance between different frequencies, but significant relationship in pain threshold between 40Hz & 100Hz. We can conclude that TENS is effective in alleviating pain with elevation of pain threshold as well as pain tolerance.
Autonomic neuropathy is known as a complication of diabetes mellitus. Conventional electromyograpic procedure was used to diagnose diabetic neuropathy, routinely. But these procedure was useful mainly to evaluate for large myelinated fibers and was not adequate to assess the degree of autonomic nervous system involvement(small unmyelinated C-fiber).
There was a simple, reliable and non-involve test to identify unmyelinated peripheral axonal dysfunction by the sympathetic skin response(SSR). The SSR was thought to be originated from the synchronized activation of eccrine sweat glands innervated by sudomotor sympathetic fiber. In our study, SSR was measured in 41 diabetic patients and 20 normal control subjects and studied correlation with cardiovascular autonomic function test and routine nerve conduction study and electromyographic findings. The SSR responses were detected in all control group(100%0 and 17 of 41 diabetic patients(41.5%) and the latency and amplitude of SSR were not differenct between control group and diabetic patients who showed response. The responses were divided into normal(presence) or abnormal(absence). The response was absent in severe peripheral neuroapthy, especially combined axonal damage(upper extremity: x2=12.000 DF=2, p=0.02, lower extremity: x2=13.418, DF=3, p=0.00381). And the response was also absent in combined sympathetic and parasympathetic damage in cardiovascular autonomic function test(x2=6.33108, DF=1, p=0.00186). The SSR may be a valuable method in the assessment of unmyelinated axonal damage(small unmyelinated C-fiber) and autonomic involvement in conjuction with other autonomic function test in diabetic neuropathic patients.
The purpose of this study was to look for physical growth retardation in infants with delayed development or with risk factors for cerebral palsy.
The subjects of this study were 524 infants under 1 year of age who visited the Department of Rahabilitation Medicine, Yonsei University College of Medicine with the problem of delayed development or with risk factors for cerebral palsy from December 1987 to December 1991. They were evaluated on the 7 postural reactions as suggested by Vojta. Additionally, the head circumference, chest circumference, height and body weigh were measured at each of the periodic follow-ups. Results were as follows: 1) Growth retardation was prominent in head circumference and body weight, and the higher the grade of central coordination disturbance, the greater the tendency of growth retardation. 2) The cerebral palsy group showed generally lower physical growth parameters than normal especially in head circumference at around the age of 12 months. 3) The parameters of physical growth in the normal development group approximated Korean standard values at around the age of 12 months, but persistent delays were seen in the cerebral palsy group in head circumference and body weight. According to the above results, physical growth retardation was frequently seen in infants with delayed development or with risk factors for cerebral palsy, and in the group whose members were diagnosed with cerebral palsy, physical growth retardation was persistently found. A further study should be planned to estabilish the influence of the central nervous system on physical growth.
The facet syndrome is a clinical disease entity of low back pain caused by abnormalities of the facet joint. This study was performed to evaluate the clinical effect of facet joint injections in patients who were suspicious of facet syndrome.
Eleven patients with hip and buttock pain, low back stiffness, local paralumbar tenderness, pain on extension, and absence of neurologic deficits, suggestive syptomes and signs of facet syndrome, had performed 44 facet joint injections in a prospective study. Facet joint arthrogrames were performed prior to intraarticular injections of local anesthetic and cortisone. Pain relief on intraarticular injections was used to comfirm the diagnosis and guide to utilize the therapeutics. The effect of facet joint injections was evaluated by the pain improvement ratio and classified as excellent in 45%, good in 45%, no pain relief in 9% at 2weeds, and 9%, 55%, 36% at 6months, respectively. The diagnosis of facet syndrome was possible in 10cases(90%) of excellent and good pain relief in 2 weeks and intraarticular injection was useful for therapeutics in 7 cases(64%) in 6 months.
From this study, this procedure is recommended for diagnosis and conservative therapy for suspicious of facet syndrome.
Cranial nerve injuries are a frequent complication in patients who have sustained a traumatic brain injury(TBA). The recognition of cranial nerve injuries and their patterns of recovery will help in the management of TBI patients. The purpose of our study was to evaluate the prevalance of cranial nerve injuries following TBI. One hundred and three consecutive admitted patients to Adult Brain Injury Service were screened but twelve patients excluded from the study because they had a post-injury duration of greater than 6 months, penetrating brain injury, or anoxic brain injury.
There were 70 males and 21 females for the study and the age ranged from 16~63 years(meas, 31 years). A cranial nerve injury occurred in 59.3% of the patients (54/91); the facial nerve(30.77%), oculomotor nerve (25.27%) and the olfactoy nerve (14.29%) were the most frequently observed injuries, There was significant correlation with cranial nerve injury and the presence of skull fracture at the level of p-value 0.1.
The aim of this investigation was to establish the normal data of parameters(relaxation index, angular velocity, and angular acceleration) through the pendulum test in the upper extremity, and to assess the difference of parameters berween normal persons and stroke patients.
We have tested pendulum test in elbow joint at prone position using computerized electrogoniometer with subjects of forty normal persons and eleven stroke patients.
The results were as follows:
1) The parameters of pendulum test in normal persons were not different statistically according to age and sex.
2) Normal data of amplitude ratio was 1.41±0.14. Therefore the formula of relaxation index was 1.41×(Ø2/Ø1). Normal data of the first and second maximal angular velocities and angular accelerations were 6.19±1.34 and 5.17±1.03 rad/sec. 28.38±7.91 and 61.72±16.39 rad/sec/sec respectively.
3) Relaxation index and angular velocity were different statistically between thoes of normal persons and stroke patients. But the angular acceleration was not different statistically.
4) Second angular velocity in stroke patients markedly decreased comparing to first angular velocity. This suggested that flexor spasticity was more severe than extensor spasticity.
5) Relaxation index well correlated to degree of spasticity.
According to the above results, relaxation index and angular velocity were more effective parameter for quantitative measurement of the spasticity in the upper extremity.
To evaluate the effect of treatment for th shoulder-hand syndrome, the medical record of the 215 patients seen from March 1989 to June 1992 was reviewed. There were 36 patients with the shoulder-hand syndrome among them. The 22 patients(Group 1) had been treated with sort term oral systemic corticosteroids and conventional physical therapy, while the 11 patients(Group2) had been treated with only conventional physical therapy. The 3 patients were excluded due to missing of medical record and long term steroid therapy.
The major results were as follows,
1) The incidence of the shoulder-hand syndrome in the hemiplegia was 17%.
2) The short term oral systemic corticosteroid treated group was clinically improved more rapidly than non-steroid treated group.
3) The short term oral systemic corticosteroid therapy decrease the pain of the hand the shoulder rapidly rater than the hand swelling and the shoulder LOM.
So, the oral systemic steroid must be started as soon as possible to relieve the pain rapidly and conventional physical therapy may be continued to relive the hand swelling and the shoulder LOM.
Although rarely recognized, the piriformis syndrome appears to be a common cause of buttock pain with radiating to the leg. This seems fully justified by the great potential for confusing this entity with discogenic disease and consequently having unnecessary surgical procedures carried out. This paper is a prospective study of 20 patients, from some 150 patients admitted due to low back and leg pain, with sustained buttock pain with radiating to the leg due to piriformis syndrome after conservative treatment. The ratio females to males is 7 to 3. Trauma history is elicited in 65% of the cases.
Various investigations, including pelvic MRI study, bone scan, electromyography, H-reflex study and sacroiliac joint roentgenography, are of limited diagnostic value. The diagnosis can be made from reproduction of referred pain upon palpation by rectal route and confirmed from dramatic and immediate relief of pain by injection into the piriformis muscle with local anesthetics. 75% of the cases markedly improved immediately after local injection, 80% of the above mentioned remained improved for 2 months. In conclusion, because of the similarity of symptoms to those of discogenic pain syndrome, patients with the piriformis syndrome can be easily misdiagnosed. We feel that digital palpation of the piriformis muscle during rectal examination should be a part of routine examination for low back pain with radiating to the leg.
The purpose of this study is to investigate the S-ray evaluation method with physical examination for the hemiplegic shoulder subluxation with seven radiologic parameters: Vertical Distance 1(Supine) 〔VDI(S)〕, Vertical Distance 1(Erect)〔VDI(E)〕, Vertical Distance 2(VD2), V-Shape Angle 1(VS!), V-Shape Angle 2(VS2), Scapular Rotation Angle(SR), Joint Distance(JD) and with for physical examination index: Finger breadth, Motor power, Pain grade, Modified Ashworth scale in 20 hemiplegic subjects and 20 normal persons. The radiologic parameters were obtained through two X-ray view, one taken at A-P view and the other at 45° oblique view.
The results obtained with the statistical analysis were as follows:
1) The mean values of the radiologic parameters in the control group were 10.4 mm, 9.5mm, 42.8mm as VD1(S), VD1(E), VD2 and -2.8°, 26.2° as VSI, VS2 and 90.1°, 5.3mm as SRs, JD. These values revealed no significant differences compared with those of the hemiplegic shoulders in VS2 and SR, but showed significant differences in the other parameters.
2) The mean values of parameters in the hemiplegic shoulders were 13.4mm, 15.3mm, 35.3mm as VD1(S), VD1(E), VD2 and 6.8°, 10.7mm as VS1, JD. And VS1 reached 243% of the values of control group as the highest increasement and JD get to 202% as the second highest, VD1(E) to 161%, but VD2 decreased to 83%.
3) The sensitivity which was calculated as the percentage of the count of the subjects with abnormal values based on that of control group in each parameters was proved 88.2% in JD ass the highest values, 82.4% in VS1, 76.5% in VD2and 41.2% in VD1(S) as the lowerest.
4) The high correlationship was found between the VD1(E) and JD(r=0.78), between VS1 and JD(r=0.65). And the correlation coefficient was 0.59 between the finger breadth and VD1(E), -0.38 between the motor power and JD, 0.48 between the pain grade and VD1(E).
The results support that JD, VD1(E), VW1 and VD2 may be considered as the more sensitive and exact radiologic parameters for the measurement of subluxation and misalignment tin hemiplegic shoulder, and these values may be useful in diagnosing the shoulder subluxation and estimation the effect of any rehabilitational management.
Electrical stimulation is extensively used as the therapeutic and diagnostic tools at present. The effects of interferential current therapy(ICT) and transcutaneous electrical nerve stimulation(TENS) that are most commonly used in electrotherapy, have been evaluated by the subjective methods such as visual analog scale in human and by the electrophysiological methods such as nerve conduction studies in the experimental animal study, but their mechanism is not clear. And they had not been studied well regarding their electrophysiologic influences in human.
The objectives of this study are to find out whether the electrcial stimulation brings about the actual electrophysiologic change in human nervous system and to observe the differences in the effects between the two different types of electrical stimulation. According to the modes and sites of the applied electrical stimulation (conditioning stimulation), 42 healthy adult volunteers were divided into 4 groups and then the conditioning stimulation was applied for 15 minutes in each group. Four kinds of electrodiagnostic studies were performed before and after conditioning stimulation, and they were sensory and motor nerve conduction studies, H reflex, F response and smatosensory evoked potential(SEP) of tibial nerves.
The results were as follows;
1) After all kinds of conditioning stimulation, the latencies in H reflex and SEP(P1) were significantly delayed(P<0.05).
2) Except the 4th group which was stimulated by TENS at the popliteal area, the latencies of F waves were increased in all other groups(P<0.05).
3) There were no significant changes in all parameters of the peripheral nerve conduction study and the P1N1 amplitude of SEP.
4) Tibial nerve stimulation had more influenced to the change of H reflex latency than the paraspinal stimulation(P<0.05).
5) ICT had more influenced to the change of F wave latency than TENS(P<0.05).
6) ICT had more influenced the change of P1 latency in SEP than TENS significantly(P<0.05).
According to the above results, the conditioning electrical stimulation brought about the electrophysiologic changes in the spinal cord and/or the proximal roots near spinal cord but not in the peripheral nerve.
By American Spinal injury Association(ASIA) definition, the criteria for complete spinal cord injury depends on the neurological level of injury(or neurological level) and the sensory and motor function in the lowest sacral segment. This study was designed to investigate average neurological level, zone of partial preservation(SPP), and total motor score by using the ASIA's 1992 revised "Standards for Neurological and Functional Classification of Spinal Cord Injury" in complete paraplegics. We evaluated thirty-two complete paraplegics, We converted classification of the patients from October, 1991 to April, 1992 by using the 1989 revision of the ASIA standards to the 1992 revised standards. In designing the method, we gave a serial score corresponding to the spinal cord segment from C1(1) to S4(29).
The average neurological level of sensory for the complete paraplegics was 17.06(proximal part in Y9 segment)±3.26(segments) and motor level at 17.77(distal part in T9 segment)±3.01(segments). The average difference between the sensory and motor level was -0.63±1.68(segments). Sensory level of the neurological level was significantly higher about 1 segment than motor level(p<0.05). The average extent of ZPP sensory and ZPP motor was 2.31±1.84(segments) and 2.31±1.96(segments), respectively. However, he difference between ZPP sensory and ZPP motor was not significant. The mean total motor score for the complete paraplegics was 52.44±6.11.
For study of the prevalence and characteristics of anemia in chronic spinal cord injury, 254 patients were investigated in a retrospective way. Also, to evaluate the relationship of erythropoietin synthesis and hemodynamic changes to anemia, we randomly selected 32 cases of 254, and analyzed the erythropoietin level and the ferrokinetics. The patients were devided into four groups:80 cases in group 1(cervical spinal cord injury), 42 cases in group 2(1st-6th thoracic spinal cord injury), 88 cases in group 3(7th-12th thoracic spinal cord injury), and 44 cases in group 4(lumbar spinal cord injury).
The results were as follows:
1) The prevalence rates of anemia and hypoprotinemia in chronic spinal cord injured patients were high(56.3% and 42%) retrospectively. And its related complications as bed sore, lower urinary tract infection, and renal disease were frequent.
2) As the factors that were related to the prevalence of anemia, hypoalbuminemia was strongly associated with anemia, but other factors(age, duration after injury, and level of injury) showed no correlation.
3) Among the complications, bed sore and renal disease were highly correlated with the prevalence of anemia, but lower urinary tract infection was not.
4) The level of serum erythropoietin in spinal cord injured patients was decreased to lower normal range, and these results were proportioned to the level of injury, i.e. when the level is higher, serum erythropoietin is lower.
5) The anemia in chronic spinal cord injury is thought to be a consequence of chronic disease as its significant decrement in serum transferrin and lower normal range of serum ferritin.
From the above results, it is concluded that the treatment of anemia in chronic spinal cord injured patients should include correction of hypoalbuminemia, nutritional support and management of its secondary complication.
Low back pain is a major cause of industrial disability and has a significant socioeconomic impact. Therefore, we did this study to determine the factors affecting treatment duration and recurrence of industrial low back pain in shipyard workers.
The subjects of this study were eight hundred and fourteen male patients with low back pain, shipyard employees, who visited Okpo Daewoo hospital between January, 1987 and June, 1991, and who were followed up prospectively over a one-year period after return to work.
The mean age of the patients was 31.7 years. The occurrence rate of back sprains or strains was 70.6% and lumbar radiculopathies or herniations of the lumbar disc, 29.4%. The most common cause of low back pain was heavy load lifting(33.3%); and 68,9% complained of having to perform difficult tasks in abnormal postures and of overexertion.
The mean treatment duration from initial onset was about 89 days; 13.0% of this group were chronic cases. In the cases who were diagnosed as lumbar radiculopathies or herniations of the lumbar disc and treated at one or more hospitals, the treatment duration form intial onset was significantly longer(p<0.01).
The recurrence rate of low back pain was 24.1% and the mean period between return to work and recurrence was about 218 days. Of the 196 recurred cases, 25 complained of acute low back pain due to industrial accidents. Duration of employment and diagnosis were significantly associated with the recurrence of industrial low back pain(p<0.01).
The mean treatment duration of the recurrent low back pain group was about 120 days, and revealed a significant positive correlation with the treatment duration from initial onset(p<0.01).
According to the above results, early comprehensive rehabilitative treatment of the patients diagnosed as lumbar radiculopathies or herniations of the lumbar disc, is helpful for reducing chronicity and recurrence of industrial low back pain.
Posterior interosseous nerve is a deep muscular branch of radial nerve, and non-traumatic paralysis of this nerve is relatively rare cases. Posterior interosseous nerve may be compressed by fibrous bands in front of the radial head, radial recurrent fan of vessels, arcade of Frohse, and sharp tendinous margin of the extensor carpi radialis brevis muscle.
We report two cases of non-traumatic paralysis of the posterior interosseous nerve which developed spontaneously.
Over 90 percents of the patients with lumbar radiculopathy secondary to the herniated nucleus pulposus improve to a pain-free or functional level with conservative treatment.
The mechanism of improvement, that is what happens to the herniated disc material is still unclear.
We present three cases of lumbar disc herniation with radiculopathy confirmed by the physical examination, electrediagnostic test and MRI.
The direction and location of disc herniation in the MRI findings were compactible with the side and level of radiculopathy in all three cases.
Follow up MRI was performed after the clinical improvement and complete resolution of the neurological deficit.
From these three cases, the mechanism of the healing process of the herniated disc disease can be guessed as follows.
1) The absorption of the herniated disc material relieves the spinal nerve root compression resulting in improvement in clinical symptoms & signs.
2) The resolution of the inflammatory reaction results in improvement in clinial symptoms & signs.
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