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To describe a hand-stretching device that was developed for the management of hand spasticity in chronic hemiparetic stroke patients, and the effects of this device on hand spasticity.
Fifteen chronic hemiparetic stroke patients with finger flexor spasticity were recruited and randomly assigned to an intervention group (8 patients) or a control group (7 patients). The stretching device consists of a resting hand splint, a finger and thumb stretcher, and a frame. In use, the stretched state was maintained for 10 minutes per exercise session, and the exercise was performed twice daily for 4 weeks. Spasticity of finger flexor muscles in the two groups was assessed 3 times, 4 weeks apart, using the Modified Ashworth Scale (MAS). Patients in the intervention group were assessed twice (pre-1 and pre-2) before and once (post-1) after starting the stretching program.
Mean MAS (mMAS) scores at initial evaluations were not significantly different at pre-1 in the intervention group and at 1st assessment in the control group (p>0.05). In addition, no significant differences were observed between mMAS scores at pre-1 and pre-2 in the intervention group (p>0.05). However, mMAS scores at post-1 were significantly lower than that at pre-2 in the intervention group (p<0.05). Within the control group, no significant changes in mMAS scores were observed between 1st, 2nd, and 3rd assessments (p>0.05). In addition, mMAS scores at post-1 in the intervention group were significantly decreased compared with those at the 3rd assessment in the control group (p<0.05).
The devised stretching device was found to relieve hand spasticity effectively in chronic hemiparetic stroke patients.
Citations
Objective: This study had three objectives: 1) to investigate the rehabilitation professionals' way of thinking on physical, psychological and social characteristics of older patients: 2) to assess their actual knowledge level about aging; and, 3) to deduce and analyze the influences that cause these different kinds of perceptions and attitudes.
Method: Total 239 rehabilitation professionals (including rehabilitation doctors, nurses, physical therapists, occupational therapists, speech therapists, social workers, psychologists, prosthetists & orthotists) responded to our questionnaire were included in this study. Self-addressed questionnaires were composed of two categories: 1) the perception of older patients compared with younger patients: and 2) the actual knowledge level about aging.
Results: 1) There were significant (p＜0.05) differences by job classification on a speculative disposition with the physical characteristics, motive of treatment, emotional characteristics, and discharge problem of older patients. 2) There were also significant (p＜0.05) differences by job classification in the actual knowledge level about aging by job classification. A higher score on the questionnaire correlated with a more optimistic view of the motive of treatment, emotional characteristic and discharge problem.
Conclusion: Many rehabilitation professionals have a misconceptions about older patients due to insufficient knowledge on aging. Therefore we propose an objective understanding of older patients along with proper education on aging to provide an effective rehabilitation treatment.
Objective: Day hospital program for the brain injured patients has been developed and conducted as a model project in the National Rehabilitation Hospital of Korea since August 1998. This article is to present our 1-year experience and evaluate the efficacy and effectiveness of the program.
Method: All patients treated in day hospital from August 1998 to July 1999 were included. Functional Independence Measure (FIM), ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status), Medical Outcome Study 36-item Short Form Survey (SF-36) were assessed at admission and discharge. Patient satisfaction was surveyed at discharge. Program cost was compared with that of inpatient control group.
Results: 1) Among 51 subjects (32 males, 19 females, mean age 57), 48 suffered stroke and 2 had traumatic brain injury. Average length of stay was 10 weeks and 45 patients (88.2%) were discharged to home. 2) FIM total score, motor subtotal score and cognitive subtotal score were all incresed significantly (p＜0.01). 3) ESCROW score was also improved significantly (p＜0.01). 4) SF-36 showed significant improvement in physical functioning, role limitation-emotional, mental health and general health (p＜0.05). 5) 95.1% answered satisfaction with the program and 73.2% reported health enhancement. 6) Program costs were significantly lower than the inpatient group (p＜0.01).
Conclusion: Day hospital seems to be a useful program for comprehensive rehabilitation for the brain injured, and needs to be pervaded throughout the country with proper payment.
Objective: The purpose of this study is to survey the health and functional status of adult cerebral palsy.
Method: This study included 47 patients who have cerebral palsy between the ages of 20 and 45 years. We evaluated the functional status by the interview and questionnaire, the medical status including a detailed medical history, with emphasis on the musculoskeletal system.
Results: 1) In the functional status, the number of non-functional ambulator increased from ten cases (21.3%) to fourteen cases (29.8%) in proportion to the incidence of fracture. 2) In the medical status, thirty-seven cases (78.8%) had more than one musculoskeletal complaint. Twenty-three cases (48.9%) had gastric discomfort, twenty-five cases (53.2%) had dental caries and thirty cases (63.9%) had speech disturbance. 3) Only eleven cases (23.4%) had undergone the comprehensive rehabilitation.
Conclusion: To prevent and minimize the physical disabilities and musculoskeletal complications of adult cerebral palsy, we need more active medical intervention, active research on the methodology and comprehensive rehabilitation.
Objective: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients.
Method: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment.
Results: 1) The severity of subluxation was significantly increased after 6 weeks (p＜0.05) in the control group. In the study group, it was reduced but the difference was not statistically significant (p＞0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period.
Conclusion: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.
Objective: To investigate the changes of gait patterns in hemiplegic patients with ankle foot orthosis (AFO) and with functional electrical stimulation (FES).
Method: Fifteen hemiplegic patients who can walk independently with cane participated in this study. Kinematic gait analysis was performed for all subjects using three-dimensional gait analysis system in barefoot, wearing AFO, and applying FES. The mean values of each gait trials were taken and statistically analysed by repeated measures of ANOVA.
Results: Genu recurvatum at stance phase and excessive ankle plantar flexion at stance and swing phase were decreased after wearing AFO. Excessive ankle plantar flexion at swing phase were decreased after applying FES.
Conclusion: The results showed that the FES is useful for the correction of hemiplegic gait as mush as of wearing AFO.
Objective: To know the category, incidence, severity and clinical correlation, we evaluate the patient with neuropathy due to electrical burn on the basis of the electrodiagnostic findings and clinical feature.
Method: We reviewed the electrodiagnostic findings of 30 patients who had been referred for the evaluation of the neuromuscular symptoms due to electrical burn. The clinical factors such as the input and output of the electrical current, current pathway, associated injury, neuromuscular symptoms and signs were investigated by the chart review and phone interview.
Results: 1) The 67% of the cases had the peripheral neuropathy and the 40% had the central nervous system lesion. 2) The median nerve was the most frequent injured nerve by electrical burn and then ulnar nerve was the next. 3) The 82% of the mononeuropathies were related to the entrance site of the electricity and the 35% were related to the exit site. 4) The central nervous system lesion was highly correlated with the current pathway through the head.
Conclusion: The mononeuropathy, one of the peripheral neuropathies is closely related to the entrance and exit site of electrical injury. The central nervous system lesion was highly related to the current pathway through the head.
Nine normal subjects and fourteen hemiparetic patients were studied using transcranial magnetic stimulation and somatosensory evoked potential. The stroke location, degree of recovery in terms of muscle power and Modified Barthel Index score, which represent the functional status of a stroke patient, assessed at the tine of evoked potential testing within 2 months after stroke onset and again of follow-up 2 months later were compared with the evoked potentials elicited. Motor response was better(p<0.05) than somatosensory response, at predicting an outcome in terms of functional recovery. The central motor conduction times in the examined muscles facilitated by contraction of the contralateral corresponding muscles were significantly increased on the involved side. While absence of response and normal response were seen after both cortical and subcortical lesions, delayed central motor conduction time only were seen in cases of subcortical lesions, which may be indicative of subcortical lesions following stroke(p<0.05). There were no signigicant relationship between evoked potential response and degree of recovery in muscle power. There were no untoward side effects.
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