Citations
To predict ambulatory capacity, 1 month after physical therapy following hip fracture surgery.
A retrospective chart review was carried out. Patients more than 60 years old, who underwent hip fracture surgery and received physical therapies, were selected (n=548). Age, gender, presence of cognitive dysfunction, combined medical diseases, combined fractures, previous history of hip surgery, prefracture ambulatory capacity, days from the fracture to surgery, type of fracture, type of surgery, presence of postoperative complications, days from the surgery to physical therapy, and total admission period, were collected. Prefracture ambulatory capacity and postoperative ambulatory capacity were classified into non-ambulatory status (NA), ambulation with assistive device (AA), and independent-ambulation without any assistive device (IA). Multiple-logistic regression analysis was performed for the prediction of postoperative ambulatory capacity.
Age (odds ratio [OR]=0.94 for IA and 0.96 for IA or AA), gender (OR=1.64 for IA and 0.98 for IA or AA), prefracture ambulatory capacity (OR of IA=19.17 for IA; OR of IA=16.72 for IA or AA; OR of AA=1.26 for IA, OR of AA=9.46 for IA or AA), and combined medical disease (OR=2.02) were found to be the factors related to postoperative ambulatory capacity and the prediction model was set up using these four factors.
Using this model, we can predict the ambulatory capacity following hip fracture surgery. Further prospective studies should be constructed to improve postoperative ambulatory capacity.
Citations
Objective: The aim of this study was to identify factors influencing the degree of neurological injury, show the natural course of recovery, and evaluate the relationship between degree of neurological injury and functional recovery from traumatic central cord syndrome.
Method: We reviewed 15 patients retrospectively and investigated their demographic and treatment data. Initial ASIA motor scales and functional recovery at 4 weeks and 8 weeks after injury were analyzed.
Results: The age of patients showed significant correlation with degree of neurological injury (r=0.55145, p＜0.05) while mechanism of injury, surgical intervention and gender difference showed no correlation. Only 2 patients (13.3%) ambulated independently at initial period but subsequently 13 patients (86.7%) at 8 weeks. The number of patients who independently voided increased from 2 (13.3%) to 11 (73.3%) during the 8 weeks. Early ASIA motor score differed significantly according to the degree of functional recovery of bladder and ambulation in 4 weeks, 8 weeks after injury (p＜0.05).
Conclusion: Only the age of patients related to the initial neurologic severity. Most patients regained their bladder and ambulatory functions considerably within 8 weeks, and the degree of early neurological injury by ASIA motor scale reflected the degree of functional recovery in 4 and 8 weeks after injury. (J Korean Acad Rehab Med 2002; 26: 285-291)
Objective: The purpose of this study was to investigate the influence of hyperactive stretch reflexes and contralateral adductor spread on the prognosis of gait in cerebral palsy with spastic diplegia and to investigate the reflex characteristics of spastic patients according to motor development.
Method: Thirty three children with spastic diplegia were examined. Compound muscle action potentials elicited by electrical hammer were used for quantification of stretch reflexes. Clinical spasticity was evaluated with the modified Ashworth scale and re-evaluation was done at least for 18 months. The patients were classified as 3 groups according to the stage of motor development: Group I consisted of children who were unable to sit; Group II children were able to pull to stand but unable to walk independently; Group III children could walk independently more than ten steps. Reflex irradiation, amplitudes of compound muscle action potentials, amplitude ratios, and Ashworth scores were analyzed and compared between the groups. Twenty four normal infants and 18 children were examined as control.
Results: Contralateral adductor responses were elicited with patellar tendon tap stimulation in all spastic diplegic children. The amplitudes of contralateral adductor were 2.41 mV in group I, 1.75 mV in group II, and 1.21 mV in group III. The amplitude ratio of contralateral adductor to rectus femoris were 0.53 in group I, 0.40 in group II, and 0.26 in group III, respectively, and correlated with the degree of spasticity.
Conclusion: The stretch reflex responses in children with cerebral palsy with spastic diplegia were highly exaggerated, and correlated with motor development. Spread of reflexes to contralateral adductor muscle would be in clinical and electrophysiological value.
Objective: To investigate the ambulatory status and its contributing factors in eighty one patients with spina bifida, and to obtain informations about the actual state and the problems of their orthotic uses for the lower limbs.
Method: Eighty one spina bifida patients above thirty months of age who registered to the Myelomeningocele Clinic of Seoul National University Hospital were investigated through the telephone interviews and the retrospective reviews of the medical records by a physiatrist.
Results: About one half of 81 spina bifida patients had problems in their ambulation. It was significantly influenced by the neurological level, the type of spina bifida, the contractures and deformities of the lower limbs, and presence of hydrocephalus. The deformity of hip and the neurological level were revealed to be the most important factors contributing to their state of ambulation by the multiple linear logistic analysis(p＜0.01). Forty patients had used the lower limb orthoses of which the ankle-foot-orthosis was most frequently used. The satisfaction and compliance of the patients, however, were not high and the most common complaint of the parents was a skin wound from the use of orthoses.
Conclusion: The neurological level and the deformity of hip were the two most important contributing factors to the ambulation of the spina bifida patients. Early detection of the neurological level and an adequate prescription of the lower limb orthoses should be stressed for the management of ambulation in spina bifida patients.
First
Prev
