Method: We retrospectively studied 81 patients with postinfarction seizures to determine the clinical features (onset, type of seizure, etc.) with their clinical recordings, electroencephalographic (EEG), and computed tomographic (CT) or magnetic resonance imaging (MRI) findings.
Results: Patients comprised 49 men and 32 women with their ages ranged from 31 to 87 (mean 64.7) years. After cerebral infarction, 31 patients experienced seizures within 2 weeks and 50 patients more than 2 weeks. Generalized tonic-clonic and simple partial seizures were the most common type of seizure. 40 patients showed focal slowing on EEG. The most common location of the cerebral infarction was cortical area and frequently involved lobes were frontal and temporal lobes. The recurrent seizure was not associated with seizure onset duration, seizure type, EEG finding, or location of infarction. The size of cerebral infarction was significantly associated with recurrent seizure but not associated with first-attack seizure.
Conclusion: This results would be helpful for prevention and treatment of postinfarction seizures. (J Korean Acad Rehab Med 2003; 27: 1-6)
Method: Subjects were 18 stroke patients who had driven a car before the stroke. Each patient was evaluated with CBDI and got a driving test. We compared driving test results with CBDI scores.
Results: Average CBDI score was 63.0⁑19.3. There was no significant difference according to lesion sides or types of stroke. Average score of driving test was 85.3⁑10.9. Twelve of 18 subjects passed the driving test and six subjects failed. Average score among right hemiplegics was significantly higher than that of left hemiplegics (p＜0.05). Average CBDI score of the subjects who passed the driving test was 52.3⁑4.7, while that of the failed subjects was 84.7⁑19.6. There was significant difference in CBDI score between 2 groups (p＜0.05). Among the 28 items of CBDI, 11 items including brake reaction time, Wechsler Adult Intelligence Scale-Revised Picture Completion showed significant correlation with the total score of the driving test (p＜0.05). Conclusion: CBDI can be used as a useful tool for predicting driving ability of stroke patients. (J Korean Acad Rehab Med 2003; 27: 7-12)
Method: The subjects were 21 hemiplegic stroke patients, 11 men, 10 women, age 60.3⁑8.4 years and 21 age and sex matched controls. We measured BMDs in patients, and compared BMDs of the affected and unaffected sides, and compared BMDs of each affected and unaffected sides with controls, and evaluate the relationship between BMDs with functional parameters.
Results: Stroke patients have high prevalence of osteoporosis and osteopenia, and affected side BMDs of patients were lower in upper and lower limbs compared with the controls. BMDs of the affected side were lower for the upper and lower limbs compared with the unaffected side.
Conclusion: Stroke patients have high prevalence of osteoporosis. Therefore early rehabilitative care, including weight- bearing and outdoor ambulation, is essential for hemiplegic stroke patients in order to prevent possible complications, especially osteoporotic fractures. (J Korean Acad Rehab Med 2003; 27: 13-20)
Method: Sixty-four stroke patients (40 male; 24 female, mean age: 59.2⁑10.4) were included in the study. All subjects underwent a clinical examination that included spasticity and Brunnstrom stage; and a radiologic examination. The diagnosis of CRPS was based on clinical criteria and three-phase scintigraphies. The degree of shoulder subluxation was assessed by the distance between inferomedial point of acromion and the center of humeral head and glenoid fossa.
Results: CRPS after stroke occurred in 34 patients (53%). There were significant differences in Brunnstrom stage and shoulder subluxation between the CRPS groups and the non CRPS groups. Among radiographic measurements, vertical distance ratio (involved/uninvolved) and oblique distance ratio indicated a strong correlation with CRPS (p＜0.01). Among clinical variables and radiographic measurements, oblique ratio was the most valuable determinant of the risk for CRPS.
Conclusion: Shoulder subluxation shows a significant correlation with CRPS after stroke. We suggest oblique ratio as a useful measurement of shoulder subluxation to estimate the risk of CRPS. (J Korean Acad Rehab Med 2003; 27: 21-26)
Method: Sixteen stroke and traumatic brain injured subjects participated in this study. Electrical stimulation on the dermatome of spastic muscles was applied for 30 minutes a day for 4 weeks. Spasticity was quantified through the use of a relaxation index obtained from pendulum test and a amplitude and latency from knee tendon reflex test. The measurements were performed 6 times in treatment period. The data were analyzed by repeated measures one way ANOVA.
Results: Relaxation index was significantly increased in treatment period (p＜0.05). In each therapeutic stimulation session, relaxation index of post-stimulation was increased in comparison with that of pre-stimulation (p＜0.01). The amplitude of post-stimulation was significantly decreased in comparison with pre-stimulation status in each measurement session (p＜0.01). The latency of tendon reflex was not changed after stimulation.
Conclusion: These results showed that the electrical stimulation was useful method to decrease spasticity in patients with brain lesions. Further studies are needed to explore the effects of functional improvement and the long-lasting carryover effects on spasticity in electrical stimulation. (J Korean Acad Rehab Med 2003; 27: 27-32)
Method: Twenty children with mild spastic diplegic cerebral palsy and fourteen normal children over 7 years old participated in this study. The foot was divided into 7 portions and then foot contact area, pressure of each foot portion and pathway of center of pressure (COP) were measured and analyzed by F-scan system (Tekscan Inc., USA)
Results: In children with cerebral palsy, first metatarsal area (MET1) showed the highest relative impulse followed by MET2/3, hindfoot and hallux. Relative impulse of hallux, MET1 and medial midfoot were significantly higher in cerebral palsied than in normal children, while that of hindfoot was significantly lower in cerebral palsied than in normal children. Anteroposterior ratio of COP and gait velocity were significantly lower in cerebral palsied than in normal children.
Conclusion: The characteristics of foot pressure distribution and the pathway of COP in children with mild spastic diplegic cerebral palsy were identified by quantitative analysis by F-scan system. Foot scan could be used for evaluating the foot pathology in children with cerebral palsy during gait. (J Korean Acad Rehab Med 2003; 27: 33-37)
Method: The medical records of thirty one patients, who were diagnosed as SMA by electromyography or muscle biopsy from January 1987 to December 1999, were reviewed retrospectively. Classification of SMA was mainly based on age at onset and achieved milestones.
Results: Patients with SMA type I, II and III were 17 (54.8%), 7 (22.6%) and 3 (9.7%) respectively. Four patients were unclassifiable due to functional improvements. Two patients who were classified as SMA type I, had achieved ability to sit unaided at last follow up (at 20 months and 24 months old). Two patients who were classified as SMA type II, could walk independently at last follow up (at 34 month and 26 years old). In three of SMA type I patients, functional improvements of rolling over and head control were achieved.
Conclusion: Classification of SMA based on age at onset and achieved milestones was helpful in prediction of prognosis. But 12.9% of SMA patients were not classifiable due to unexpeceted functional improvement. (J Korean Acad Rehab Med 2003; 27: 38-42)
Method: Thirty-one patients with DMD were investigated. The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory (MIP), and expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and assisted PCF at three different conditions were evaluated.
Results: The mean value of MICs (1,873⁑644 cc) was higher than that of VCs (1,509⁑640 cc). MIP and MEP were 48.8⁑21.4% and 29.5⁑19.5% of predicted normal value respectively. MIP was correlated with UPCFs as well as MEP. All of three assisted cough methods showed significantly higher value than unassisted method (p＜0.01). The manual assisted PCFs at MIC significantly exceeded those produced by manual assisted or PCFs at MIC. The positive correlation between the MIC-VC difference and PCF at MIC-UPCF difference was seen (p＜0.01).
Conclusion: Inspiratory muscle strength and the preservation of pulmonary compliance is important for the development of effective cough as well as expiratory muscle power. Thus, the clinical implication of the inspiratory phase in assisting a cough should be emphasized. (J Korean Acad Rehab Med 2003; 27: 43-48)
Method: The BTE work simulator was used on 17 cervical cord injuries to test the force and endurance during wheelchair propulsion. The 141 large wheel of BTE work simulator and standard wheelchair which was removed handrims was used for simulating wheelchair propulsion. Wilcoxon rank sum test was used to compare force and endurance among the groups.
Results: The wheelchair propulsion force and endurance showed significant differences between neurological levels and types of the life style. The lower the level, the higher the strength and endurance (p＜0.001). The wheelchair propulsion force of cervical cord injuries showed statistically significant differences between those with and without jobs (p＜0.05). The outdoor wheelchair users and wheelchair propulsion exercise group showed significantly high maximum isometric strengths compared to the indoor users and the only ROM exercise group, respectively (p＜0.05).
Conclusion: During the rehabilitation period cervical cord injured persons need the wheelchair propulsion exercise using BTE work simulator to improve the quality of life. (J Korean Acad Rehab Med 2003; 27: 49-57)
Methods: Thirty nine patients who underwent cervical decompression and fusion for cervical myelopathy were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated with Nurick classification, Functional Independence measure (FIM) score and gait analysis using three dimensional motion analyzer before surgery, 1 week and 3 months after surgery.
Results: In the Nurick classification there was statistically significant change but no significant change in FIM score after surgery. In the gait analysis there were statistically significant improvements in all the linear parameters, kinetic (ankle plantarflexion moment) and kinematic (knee range of motion in swing phase) parameters (p＜0.05).
Conclusion: This study suggests that gait analysis can be used as a quantitative tools of postoperative gait improvement in patient with cervical myelopathy. (J Korean Acad Rehab Med 2003; 27: 58-62)
Method: Electrodiagnostic data of 152 patients who had been diagnosed as lumbosacral radiculopathy with the findings of operative record were obtained retrospectively. The findings of needle electromyography were reviewed and the frequency of abnormal spontaneous activities in L5 and S1 myotomes was investigated. We selected 8 individual muscles which had high sampling rate. These muscles were combined into different muscle screens and the detection rates were calculated that the frequency with which one or more muscles in the screen displayed abnormal spontaneous activity was divided by the total number of radiculopathies.
Results: The detection rates of lumbosacral radiculopathy were compared according to the number of muscle screens. Including paraspinal muscle, the detection rate of 6 muscle screens was higher than 5 muscle screens (p＜0.05), but there was no significant difference of detection rate between 6 muscle screens and 7 muscle screens. The detection rates of each muscle screens without paraspinal muscle were lower than those including paraspinal muscle for all screens (p＜0.05).
Conclusion: Although there is controversy about selection of muscles, six muscle screen including paraspinal muscles may be optimal number for detecting lumbosacral radiculopathy. (J Korean Acad Rehab Med 2003; 27: 63-69)
Method: The subjects were 65 patients with neurogenic bladder. The causes of neurogenic bladder were consist of seven brain lesions; 39 spinal cord injuries; 15 cauda equina syndromes; and four peripheral polyneuropathies. PSEP and EBCR were done.
Results: Of the patients with hyperreflexic bladder (43.1%), PSEP latency was normal in 21.4%, delayed in 21.4%, and not obtainable in 57.2%. Of the patients with areflexic bladder (56.9%), PSEP latency was normal in 24.3%, delayed in 21.6%, and not obtainable in 54.1%. Of the patients with hyperreflexic bladder, EBCR latency was normal in 82.1%, delayed in 14.3%, and not obtainable in 3.6%. Of the patients with areflexic bladder, EBCR latency was normal in 16.2%, delayed in 37.8%, and not obtainable in 46.0% (p＜0.01).
Conclusion: There was significant correlation between EBCR and type of neurogenic bladder, but not with PSEP. These results seem to be reflected from the neuro-anatomical lesion of the neurogenic bladder. (J Korean Acad Rehab Med 2003; 27: 70-74)
Method: The subjects were 26 patients with asymptomatic diabetic neuropathy and 40 healthy adults as control group. All subjects underwent electrodiagnostic evaluation of the following motor nerves: median, ulnar, tibial, and peroneal. Sensory nerves included: median, ulnar, radial, superficial peroneal, sural, lateral dorsal cutaneous branch of the sural nerve (LDSN) and medial plantar. And other studies were the sural/radial amplitude ratio, LDSN/sural amplitude ratio, peroneal and tibial F-responses, and H-reflex recorded from the soleus muscle. The frequency of abnormal parameters in the patients with asymptomatic diabetic neuropathy was obtained by comparison with the normative limits obtained from the control group.
Results: The most frequent abnormal electrodiagnostic parameters were the LDSN onset latency and the amplitude ratio of LDSN/sural (84.6%, respectively) followed by the LDSN peak latency, LDSN amplitude, and medial plantar onset and peak latency (80.8%, respectively).
Conclusion: We concluded that the LDSN and medial plantar nerve conduction studies are useful for early detection of neuropathy in diabetes mellitus. (J Korean Acad Rehab Med 2003; 27: 75-79)
Method: Prospectively, total 40 patients with non-insulin dependent diabetes mellitus were included in the study. NCS was performed on median, ulnar, posterior tibial, deep peroneal, superficial peroneal, and sural nerves. Distal latency and conduction velocity (CV) of compound muscle action potential (CMAP), distal latency and amplitude of sensory nerve action potential (SNAP) were used as parameters of NCS. Multiple linear regression analysis were used to analyze the relations of HbA1c and parameters of NCS, after adjustment for age, height, weight, and disease duration of diabetes mellitus.
Results: HbA1c level had an inverse relation to CV of median motor nerve (β=1.272, p＜0.01), ulnar motor nerve (β=1.287, p＜0.01), posterior tibial nerve (β=0.982, p＜0.05), and deep peroneal nerve (β=1.449, p＜0.05).
Conclusion: This study indicates that HbA1c level was inversely related to motor nerve CV, and that sustained hyperglycemia may be involved in demyelination of motor nerves. Analysis of motor nerve CV related to HbA1c is expected to be useful in the follow-up or efficacy study of diabetes mellitus neuropathy as baseline data. (J Korean Acad Rehab Med 2003; 27: 80-84)
Method: Nerve conduction studies were performed in 23 patients with chronic renal failure. We not only measured distal latencies, amplitudes, and conduction velocities of median and ulnar motor nerves but also measured same parameters of radial sensory nerves at both upper limbs. In case of pateints with suspected peripheral polyneuropathy, we checked peripheral nerves at one lower limb. The results of nerve conduction studies and the frequency of cubital tunnel syndrome or carpal tunnel syndrome were compared between arteiovenous fistula side and non-arteiovenous fistula side.
Results: The amplitudes of median motor, ulnar motor nerves and radial sensory nerve in arteiovenous fisula side are statistically lower than those in non-arteiovenous fisula side (p＜0.05). In the 14 patients with peripheral polyneuropathy, the difference is also statistically significant between two sides (p＜0.05). Compared arteiovenous fisula side with non-arteiovenous fisula side, the frequency of cubital tunnel syndrome or carpal tunnel syndrome was not different between two sides.
Conclusion: Arteiovenous fisula may damage to the peripheral nerve in patients with chronic renal failure. (J Korean Acad Rehab Med 2003; 27: 85-89)
Method: Fifty female rats (Sprague-Dawley strain; BW 210∼260 g, 12∼15 week old) were used: control group; cisplatin group; cisplatin-nimodipine 2 week group, 10; ciplatin-nimodipine 4 week group; base group. Peripheral neuropathy was induced by intraperitoneal injection of the cisplatin (0.04 mg/ml, 1 ml/kg/ip/ for 2 weeks). Nimodipine was injected intraperitoneally for 2 weeks and 4 weeks in cisplatin-nimodipine 2 week group and cisplatin-nimodipine 4 week group, respectively. Motor and sensory nerve conduction studies were done using in rat tail nerve from the beginning and biweekly till to 10th week.
Results: Weight reduction was significant in cisplatin group at 2nd week (p＜0.05). The latencies of motor and sensory nerves were delayed in 2nd, 4th week in all groups with cisplatin (p＜0.05) and the recovered after 6th week in all groups. The amplitudes of motor and sensory nerves in these groups haven't made any difference compared with control group (p＞0.05).
Conclusion: The neurotoxicity of cisplatin revealed in motor and sensory neurons. The neuropathy has recovered to control value in 6th week and the preventive effect of nimodipine was transient. (J Korean Acad Rehab Med 2003; 27: 90-95)
Method: During 4-year periods (1997∼2001), 37 patients with anterior chest wall pain was analyzed with regard to the causes of pain and the frequencies of the diseases.
Results: 17 patients (45.9%) had systemic diseases and 20 patients (54.1%) had focal joint problems. Systemic disease included the undifferentiated spondyloarthropathy (18.9%), ankylosing spondylitis (13.5%), psoriatic arthritis (2.7%), SAPHO (Synovitis, Acne, Psoriasis, Hyperostosis, Osteitis) syndrome (8.1%), and rheumatoid arthritis (2.7%). Focal joint diseases included costochondritis (10.8%), sternoclavicular inflammatory arthropahty (5.4%), sternoclavicular hyperostosis (2.7%) and infective arthritis (2.7%). Other focal joint problems were pain in sternoclavicular joint with the tenderness and swelling (2.7%), pain in costochondral joint (13.6%), sternoclavicular joint (5.4%), xyphoid process (2.7%) with only focal tenderness. 3 (8.1%) patients had pain in chest wall which had no focal tenderness and swellings on the joint.
Conclusion: Diverse systemic diseases were identified as causes of the anterior chest wall pain. So physiatrist keep in mind this result and make use of them in diagnostic approaching of the anterior chest pain due to chest wall skeletal involvement. (J Korean Acad Rehab Med 2003; 27: 96-101)
Method: 33 cases with elective operation for hallux valgus were prospectively investigated. All blocks were performed with the aid of a peripheral nerve stimulator, and 0.5% pucaine was injected in a dose of 1.5 mg/kg when minimal stimulator output still elicited a slight motor response of the foot. In evaluating the analgesics effects of the nerve block, the intensity of pain was assessed by using VAS before, immediately after, and at given time intervals during 36 hours. In the control group, the pain scores were assessed after immediate post-operation and at the given time intervals during 36 hours. The nerve block group rated their level of satisfaction at the first visit of out-patient clinic after discharge.
Results: There was significant pain-control effect at least during 24 hours after the nerve block. The patient's satisfaction was high and they had no severe complications.
Conclusion: Block of sciatic nerve in the popliteal fossa provides high satisfaction as the safe effective pain-control method after hallux valgus surgery, so it may be available method for postoperative analgesia after another foot surgery. (J Korean Acad Rehab Med 2003; 27: 102-105)
Method: Each of the two methods of cryotherapy, cold-jet stream (CS) and cold-jet stream combined with infrared therapy (CSCI), was applied to the medial aspect of 32 volunteers' knees. The first phase was the required time that skin was dropped to 10oC with CS/CSCI. The second phase was the time for rewarming to 20oC without CS/CSCI. The third phase was the required time that skin dropped to 10oC again with CS/CSCI. The fourth phase was the time for re-warming to 20oC again without CS/CSCI.
Results: The required time which cold pain appeared after CS/CSCI were 51.3 sec and 62.3 sec, respectively, with significance (p＜0.01). In CS and CSCI, first phase was 71.6 sec and 90.7 sec, respectively, and third phase was 33.2 sec and 39.9 sec, respectively (p＜0.01). At second and fourth phases, it took 46.9 sec and 56.6 sec in CS (p＜0.01), and took 46.9 sec and 54.6 sec in CSCI (p＜0.01).
Conclusion: As compared with CS, CSCI delayed sensation time of cold pain and prolonged application time of CS at the knee. (J Korean Acad Rehab Med 2003; 27: 106-109)
Method: Twenty eight healthy volunteers were examined. Cold-jet stream (CS) was applied on buttock (5 cm below of iliac crest, surface of gluteus medius muscle). We measured the time that skin temperature fall from room temperature to 10oC (first period), the time rewarmed from 10oC to 20oC (second period), the time fall again to 10oC (third period) and the time rewarmed again to 20oC (fourth period). Cold-jet stream with infrared combination (CSIC) therapy was performed with the same method.
Results: At the first and third cooling periods, It took longer in CSIC group than CS group to decrease skin temperature. At fourth period, It took longer in CSIC group than CS group to rewarm skin. In CS and CSIC groups, fourth period is longer than second period.
Conclusion: It took longer in CSIC method than CS only to decrease skin temperature to 10oC. Rewarming speed of skin temperature was slower twice cold-jet stream applies than once. Rewarming speed of skin temperature was slower at cold-jet stream and infrared combination therapy than cold-jet only. (J Korean Acad Rehab Med 2003; 27: 110-114)
Method: Experimental muscle pain was induced by the injections of 5% hypertonic saline in the upper trapezius and extensor carpi radialis longus in 20 healthy volunteers respectively. Coordinative work of upper extremity was performed through the computer simulation games which were controlled by the motion of forearm pronation and supination using the steering handle. The performance scores were measured during the tasks requiring the relatively high level (driving mode) and low level (tracking mode) of coordination. Electromyographic activities were measured from the pronator teres and biceps brachii simultaneously.
Results: The performance scores were decreased after induction of muscle pain in the high coordinative task and their decreasing rate was higher in the distal muscle pain. There were no statistical differences of electromyographic activities according to the intensity and pain site and level of coordination.
Conclusion: The upper limb coordination which required high speed and complex activities was decreased in the presence of the muscle pain. (J Korean Acad Rehab Med 2003; 27: 115-120)
Method: The experimented rats were total 50 Sprague- Dawley female rats. They were divided randomly 5 groups. The treatment was initiated on the first day after surgery and continued for a period of 4 weeks. Bone measurements were performed in the distal femoral metaphysis and 5th lumbar vertebrae with dual energy x-ray absorptiometry at the time of 2nd week and 4th week after drug injection in all groups.
Results: The cancellous bone density in the ovariectomized rats treated with high dose of the salmon calcitonin microspheres was significantly higher than that of the free salmon calcitonin-treated ovariectomized rats, but less than that of the sham-operated control rats.
Conclusion: This study shows that the salmon calcitonin microspheres were evaluated for protection against the cancellous bone loss in the ovariectomized rats. The bone protective effect of the salmon calcitonin microspheres was greater than that of the free salmon calcitonin. (J Korean Acad Rehab Med 2003; 27: 121-125)
Method: 15 healthy persons who were pain-free and didn't have the history of neuromuscular disease were participated in this study. Measurements were taken in three different sitting positions (relaxed, erect and forward head posture) with staring forward and arms hanging at the side. Paraspinal myoelectrical activities were measured by surface electrodes in paracervical, paralumbar, sternocleidomastoid (SCM) and levator scapular (LS) muscles. Simultaneously whole spine lateral X-ray including skull was taken. We measured cranio-cervical spinal alignment indicies (craniovertical, craniocervical, cervicohorizontal and upper cervical angles) introduced by Huggare and Gonzalez, lower cervical angle, lumbar lordosis angle and myoelectrical activity of each muscle in three different sitting positions.
Results: The analysis of relationship between lumbar lordosis and cranio-cervical spinal alignment index showed significant results. The more the lumbar lordosis increased, the head forward displacement decreased. But, the myoelectrical activities of paraspinal muscles were not influenced by the posture.
Conclusion: Maintaining lumbar lordosis is very important to correct forward head posture and research for the distraction force loaded to soft tissue of the neck in forward head posture is needed. (J Korean Acad Rehab Med 2003; 27: 126-130)
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