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To determine the age-related changes in cardiac rehabilitation (CR) outcomes, which includes hemodynamic and metabolic factors, in patients with myocardial infarction (MI).
CR was administered for 8 weeks to 32 men (mean age, 54.0±8.8 years) who underwent percutaneous coronary intervention for acute MI between July 2012 and January 2016. The exercise tolerance tests were performed before and after the CR. The results were stratified based on a cut-off age of 55 years.
In the whole patient group, the hemodynamic variables such as the resting heart rate (HRrest), systolic blood pressure (SBPrest), submaximal HR (HRsubmax), SBP (SBPsubmax), and rate pressure product (RPPsubmax) significantly decreased and the maximal HR (HRmax) and RPP (RPPmax) significantly increased. All metabolic variables displayed significant improvement, to include maximal oxygen consumption (VO2max) and ventilation (VEmax), anaerobic threshold (AT), and the maximal oxygen pulse (O2pulsemax). However, upon stratification by age, those who were younger than 55 years of age exhibited significant changes only in the HRrest and RPPsubmax and those aged 55 years old or greater displayed significant changes in all hemodynamic variables except diastolic BP. Both groups displayed significant increases in the VO2max, VEmax, and AT; the older group also exhibited a significant increase in O2pulsemax. The magnitude of the changes in the hemodynamic and metabolic variables before and after CR, based on age, did not differ between the groups; although, it tended to be greater among the older participants of this study's sample.
Because the older participants tended to show greater hemodynamic and metabolic changes due to CR, a more aggressive CR program must be administered to elderly patients with MI.
Citations
To analyze the factors related to urinary tract infection (UTI) occurrence after an urodynamic study (UDS) in patients with spinal cord injury (SCI).
We retrospectively investigated the medical records of 387 patients with SCI who underwent UDS with prophylactic antibiotic therapy between January 2012 and December 2012. Among them, 140 patients met the inclusion criteria and were divided into two groups, UTI and non-UTI. We statistically analyzed the following factors between the two groups: age, sex, level of injury, SCI duration, spinal cord independence measure, non-steroidal anti-inflammatory drug use, diabetes mellitus, the American Spinal Injury Association impairment scale (AIS), lower extremity spasticity, a history of UTI within the past 4 weeks prior to the UDS, symptoms and signs of neurogenic bladder, urination methods, symptoms during the UDS and UDS results.
Among the 140 study participants, the UTI group comprised 12 patients and the non-UTI group comprised 128 patients. On univariate analysis, a history of UTI within the past 4 weeks prior to the UDS was significant and previous autonomic dysreflexia before the UDS showed a greater tendency to influence the UTI group. Multivariable logistic regression analysis using these two variables showed that the former variable was significantly associated with UTI and the latter variable was not significantly associated with UTI.
In patients with SCI, a history of UTI within the past 4 weeks prior to the UDS was a risk factor for UTI after the UDS accompanied by prophylactic antibiotic therapy. Therefore, more careful pre-treatment should be considered when these patients undergo a UDS.
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To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion.
Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive.
In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function.
The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.
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To analyze association between urodynamic study (UDS) parameters and renal function in spinal cord injured (SCI) patients with neurogenic detrusor overactivity.
Patients with a suprasacral SCI, who underwent UDS and radioisotope renogram at least twice between January 1, 2006 and January 31, 2013, were included. UDS (cystometric capacity, reflex volume, compliance, and maximal detrusor pressure) and radioisotope renogram (total effective renal plasma flow [ERPF] of both kidneys) data were collected. The following were conducted to reanalyze any association between reflex volume and ERPF: initial and follow-up results of consecutive evaluations were compared; a mixed-model regression analysis to account for clustered data was conducted to evaluate the association between UDS parameters and ERPF; and finally, a mixed-model analysis type 3 test with data pairs, of which the first evaluation showed involuntary detrusor contraction.
A total of 150 patients underwent 390 evaluations which were arranged into 240 pairs of consecutive evaluations, of which 171 had first evaluations with observed involuntary detrusor contraction. The following results were obtained: cystometric capacity was significantly larger and maximal detrusor pressure was significantly lower on follow-up; on univariate analysis, reflex volume and maximal detrusor pressure were significant, and multivariate analysis using these two parameters showed that maximal detrusor pressure is significantly associated with total ERPF; and no significant differences were observed.
Maximal detrusor pressure should be closely monitored in the urologic management of neurogenic detrusor overactivity in SCI patients. The results also may serve as a reference for regular UDS follow-up.
Citations
To compare the urodynamic study variables at the onset of vesicoureteral reflux (VUR) between the overactive and underactive bladders in patients with spinal cord injury who presented with VUR.
A total of 28 (13 cases of detrusor overactivity and 15 detrusor underactivity) men were enrolled. We compared the urodynamic variables between the two groups; detrusor pressure and bladder compliance, the infused volume at the onset of VUR measured on a voiding cystourethrography and cystometric capacity, maximum detrusor pressure, and bladder compliance during filling cystometry were recorded.
At the onset of VUR, the bladder volume and compliance, except for the detrusor pressure, showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance relative to the cystometric capacity showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance at the onset of VUR relative to the cystometric bladder capacity did not show any significant difference between the two groups.
There were differences in some variables at the onset of VUR depending on the type of neurogenic bladder. The VUR occurred at a lower capacity in neurogenic bladder with detrusor overactivity than in neurogenic bladder with detrusor underactivity at the same pressure. VUR occurred at a lower intravesical pressure compared to that known as the critical detrusor pressure (≥40 cm H2O) required for the development of VUR. The results of our study demonstrate that the detrusor pressure should be maintained lower than the well known effective critical detrusor pressure for the prevention and treatment of VUR.
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To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility.
Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling.
Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry.
Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.
Citations
The aim of this study is to exam the effects of exercise modes on the systolic blood pressure and rate-pressure product during a gradually increasing exercise load from low to high intensity.
Fifteen apparently healthy men aged 19 to 23 performed the graded exercise tests on cycle ergometer (CE) and treadmill (TM). During the low-to-maximal exercises, oxygen uptake (VO2), heart rate (HR), systolic blood pressure (SBP) and rate-pressure product were measured.
CE had a significantly lower maximum VO2 than TM (CE vs. TM: 48.51±1.30 vs. 55.4±1.19 mL/kg/min; p<0.001). However, CE showed a higher maximum SBP (SBPmax) at the all-out exercise load than TM (CE vs. TM: 170±2.4 vs. 154±1.7 mmHg; p<0.001). During the low-to-maximal intensity increment, the slope of the HR with VO2 was the same as VO2 increased in times of the graded exercise test of CE and TM (CE vs. TM: 2.542±0.100 vs. 2.506±0.087; p=0.26). The slope of increase on SBP accompanied by VO2 increase was significantly higher in CE than in TM (CE vs. TM: 1.669±0.117 vs. 1.179±0.063; p<0.001).
The SBP response is stronger in CE than in TM during the graded exercise test. Therefore, there is a possibility that CE could induce a greater burden on workloads to cardiovascular system in humans than TM.
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A recent study claimed that botulinum toxin A (BTX-A) injection into the calf muscle of cerebral palsy (CP) children did not change the intrinsic stiffness. Contrary to this recent report, in our case, decreased muscle spasticity, which was measured using a modified Ashworth scale, and increased Gross Motor Function Measure score were demonstrated at 4 weeks after intensive rehabilitation treatment (IRT) with BTX-A injection to the medial gastrocnemius muscle in a child with spastic CP. Additionally, we indentified decreased muscle stiffness which was demonstrated by a decrease in the color-coded scale and shear velocity, and an increase in the strain ratio using dynamic sonoelastography.
Citations
Method: 34 spinal cord injured male patients were participated in this study. We measured the maximal detrusor pressure, compliance of detrusor, involuntary detrusor reflex and urethral pressure by urodynamic study. And we induced ejaculatory stimulation by vibratory (FerticareⰒ) and electrical stimulation (SeagerⰒ) and analyzed the sperm volume, the concentration, the total sperm count, the motile sperm count and motility. Analysis of variance (ANOVA) and paired t-test were used to compare sperm quality among groups of urodynamic parameters.
Results: Semen quality such as sperm concentration, sperm volume, motile sperm count was significantly (p＜0.05) better in patients with low maximal detrusor pressure, high detrusor compliance, normtonic urethral pressure than with high maximal detrusor pressure, low detrusor compliance, hypertonic urethral pressure, regardless of involuntary detrusor reflex.
Conclusion: The proper management of neurogenic bladder for improving semen quality in spinal cord injured male patients may be needed for better pregnant outcomes. (J Korean Acad Rehab Med 2003; 27: 875-879)
Method: Thirteen adults with CP were participated in this study. Nine of these thirteen subjects had urological symptoms. The urological history taking, urine analysis, urine culture, voiding cystourethrography (VCUG) and urodynamic study were done.
Results: The urinary incontinence was the most common presenting symptom. All subjects without urological symptoms showed normal urodynamic findings. Eight of the subjects who had urological symptoms had abnormal findings on urodynamic study. All subjects showed normal findings on voiding cystourethrography. Based on urodynamic findings, six subjects were treated with anticholinergic drug and five (83.3%) of these subjects showed improvement of their urological symptoms.
Conclusion: Many adults with CP might have the problems in urination. Our study showed that many symptomatic subjects had abnormal urodynamic findings and much of these urological symptoms was improved with proper treatment. These adults with CP would, therefore, benefit from proper assessment and treatment, expecially in the subjects who have urological symptoms. (J Korean Acad Rehab Med 2003; 27: 198-203)
Objective: To evaluate the clinical utility of the dynamic gastrocnemius length, calculated with gait analysis after phenol or botulinum toxin block in spastic cerebral palsy.
Method: Gastrocnemius muscles were injected with phenol or botulinum toxin. Kinematic gait parameters including dynamic gastrocnemius length were surveyed with 3-dimensional gait analysis system before and after the procedure.
Results: The dynamic gastrocnemius lengths improved significantly after block of calf muscles, except 3 cases which showed severe genu recurvatum. The vertical displacement of the center of gravities and the maximal ankle dorsiflexion angles after the block were not significantly different from those before the block.
Conclusion: Dynamic gastrocnemius length calculated with gait analysis can be used as a tool to determine the efficacy of spastic calf muscle block, in the absence of severe genu recurvatum. In case of associated severe genu recurvatum, other parameters may be substituted.
Objective: To examine the correlation between Berg balance scale (BBS) which is tool for assessing the clinical balance function and sensory organization test (SOT) of computerized dynamic posturography (CDP) in brain injured patients.
Method: Thirty patients with brain injury were assessed on the BBS and SOT of CDP. BBS consists of 14 items and each item is graded on a five point ordinal scale (0∼4), yielding a total of 56 points. According to its characteristics, each item was divided 3 groups, which were sitting, standing and position change. Six equilibrium scores (EQ) were determined by SOT of CDP (EquiTest SystemⰒ, Version 5.08) under 6 conditions, and somatosensory, visual, vestibular ratios were analyzed by 6 EQ scores.
Results: EQ 5 was correlated with reaching forward item (r=0.513), turning 360 degrees item (r=0.537), stool stepping item (r=0.529) of BBS (p＜0.01). EQ 6 was correlated with turning 360 degrees item (r=0.498) of BBS (p＜0.01). Sum of standing item group scores was correlated with EQ 5 (r=0.478), EQ 6 (r=0.464), and sum of position change item scores was correlated with EQ 5 (r=0.622), EQ 6 (r=0.514)(p＜0.01). Vestibular ratio was correlated with BBS total score (r=0.552, p＜0.01).
Conclusion: We concluded that vestibular ratio of SOT was correlated with BBS, especially position change item group. Therefore BBS is a good tool for evaluating vestibular function in brain injured patients.
Objective: The purpose of this study is to evaluate the effectiveness and safety of aerobic exercise program in cardiac patients.
Method: Twenty patients participated in 6 weeks of aerobic exercise with telemetry monitoring as an outpatient rehabilitation program. For the comparison of physiologic changes, we used graded exercise test (GXT) by means of modified Bruce protocol before and in 6 weeks after aerobic exercise training. Exercise prescription for cardiac rehabilitation was composed of intensity, mode, frequency and duration. By use of EKG telemetry and monitoring of blood pressure and Borg RPE (ratings of perceived exertion) scale, we were monitored patients status during exercise.
Results: In six weeks after aerobic exercise training, the hemodynamic and metabolic responses were improved and statistically significant parameters were as follows: exercise time, maximal METs, resting heart rate, maximal heart rate, submaximal rate pressure product, maximal expired volume, maximal oxygen consumption rate and anaerobic threshold.
Conclusion: We concluded that six week cardiac rehabilitation program is useful and safe to improve the aerobic capacity for cardiac patients.
Objective: The purpose of this study was to determine the clinical usefulness of KCl provocative urodynamic study in spinal cord injured patients with neurogenic bladder.
Method: Urodynamic studies using normal saline and 0.2 M KCl solution were performed on 46 spinal cord injured patients. The reflex volume was measured on urodynamic study using normal saline and 0.2 M KCl solution. If the reflex volume using KCl solution was smaller than 85% of reflex volume using normal saline, it was considered as positive response. Urine culture and urinalysis were also performed before urodynamic study.
Results: KCl provocative tests showed positive response in patients showing current infection on urine culture and urinalysis (p＜0.05). Comparing with the positive response group and negative response group, mean maximal bladder capacity was smaller and mean bladder compliance was lower in the positive response group (p＜0.05). No significant differences were found between positive and negative response groups according to age, duration since injury, completeness of injury, voiding methods, and anticholinergic medication. The mean reflex volume provoked by KCl solution was smaller and mean bladder compliance provoked by KCl solution was lower than those provoked by normal saline in the positive response group (p＜0.01).
Conclusion: The response of KCl provocative test suggested increased bladder-blood-urine barrier permeability by current urinary tract infection. We conclude that the KCl provocative urodynamic study is a useful method for detection of impaired bladder-blood-urine barrier in spinal cord injuries with neurogenic bladder.
Objective: To investigate the deficit of static and dynamic postural control in patients with chronic ankle sprain using dynamic posturography.
Method: Twenty patients with unilateral recurrent ankle sprain and functional instability were assessed by Samsung medical center ankle injury score and by computerized dynamic posturography (EquiTestⰒ system, NeurocomⰒ, international, INC; USA).
The posturography test was performed 3 times at 6 different simulated conditions such as fixed of force platform/open eyes/fixed of screen (condition 1), fixed/closed/fixed (condition 2), fixed/open/movement (condition 3), sway/open/fixed (condition 4), sway/closed/fixed (condition 5), sway/open/movement (condition 6). We evaluated anteroposterior sway of center of gravity of the patients and calculated equilibrium scores. We compared the equilibrium scores of patient group and normal data reported previously. We also compared the equilibrium scores of two subgroups of the patients according to severity of ankle injury.
Results: Patients showed significantly low equilibrium scores than normal one at the condition 4, 5 and 6 (p＜0.05). The group B with severe ankle injury revealed low equilibrium scores at the condition 4, 5 and 6. Especially the group B showed statistically significance at condition 5 (p＜0.05).
Conclusion: Patients with chronic ankle sprain showed the deficit of dynamic postural control due to the proprioceptive dysfunction of injured ankle than normal person.
Objective: To evaluate the usefulness of a newly devised portable cystometer to measure the pressure of bladder in a low cost and easier accessability.
Method: This study was performed in 47 patients with a conventional instrumental cystometer (Jupiter 8000, Wiest) and the newly devised portable cystometer. In the supine position, we measured the maximal intravesical pressure, abdominal pressure and bladder volume with the portable cystometer just after the measurement of the maximal detrusor pressure and bladder volume with the conventional instrumental cystometer. Paired t-test was utilized to analyze and compare the result.
Results: 1) There was no significant difference in the average maximal detrusor pressures measured by maximal intravesical pressures minus abdominal pressures, which were 38.32⁑20.97 cmH2O by the conventional instrumental cystometer and 40.02⁑20.70 cmH2O by the portable cystometer (p＞0.05). 2) There was no significant difference in the average bladder volumes at maximal detrusor pressure, which were 302.13⁑83.92 cc by the conventional instrumental cystometer and 314.04⁑94.17 cc by the portable cystometer (p＞0.05).
Conclusion: We conclude that there is no significant difference between the conventional instrumental cystometer and the portable cystometer in the measurement of detrusor pressure and bladder volume. We believe this portable cystometer would be a useful tool to evaluate the function of bladder in a low cost and easier accessability.
Objective: To determine the clinical utility of ice water test for the urodynamic study in neurogenic bladder of spinal cord injured patients.
Method: Warm water (20∼30oC) urodynamic studies were performed on 66 spinal cord injured patients. Subsequently, ice water (4∼8oC) urodynamic studies were performed. We determined the ice water test to be positive if the reflex volume of ice water urodynamic study is lower than the volume of the warm water urodynamic study.
Results: Ice water test was positive in 24 (55.8%) and negative in 19 (44.2%) of the 43 patients showing hyperreflexic detrusor activity in warm water urodynamic study. Ice water test was negative in all 23 cases showing areflexic detrusor activity. No significant difference was found between positive and negative ice water test groups for the level of injury, sex, age, extent of injury and duration since injury. If water was cool enough, positivity of ice water test was not affected by infusion rate. There was no difference between the two urodynamic studies of maximal bladder pressure and compliance.
Conclusion: This study suggests that ice water urodynamic study is a useful method for the evaluation of hyperreflexic neurogenic bladder activated by cold specific receptors via C afferent fibers in spinal cord injured patients.
Objective: To determine the posturographic characteristics of the stroke patients due to various brain lesions.
Method: Stroke patients capable of standing without assistive devices were included. Patients were divided into three groups according to the lesion distribution: cerebral; brain stem; cerebellar. Quantitative computerized posturographic studies were performed to determine the subject's response to sensory (sensory organization test, SOT) and motor translations (motor control test, MCT).
Results: Equilibrium scores of 4th (EQ4), 5th (EQ5) and 6th (EQ6) conditions and visual (VIS) and vestibular (VEST) ratio of SOT were significantly lower in brainstem and cerebellar lesion groups in comparison with normal population. In addition, prolonged latencies for medium and large backward and forward translations were noticed in the brainstem lesion group. However, there was no significant difference between cerebral lesion group and normal population. According to the lesion distribution, cerebellar group showed increased incidence of abnormalities of EQ4 score. Brainstem group showed increased incidence of abnormalities in EQ5, EQ6 score, VEST ratio and prolonged latency for large forward translation.
Conclusion: We found that posturography revealed characteristic appearances according to the various brain lesions, especially in cerebellum and brainstem stroke patients.
Objective: The aim of this study was to develop objective evaluation method which reflect the velocity dependent increase of stretch reflex in spasticity using the pendulum test and dynamic electromyography.
Method: Kinematic analysis for knee angle and angular velocity measurement, and dynamic electromyography were performed simultaneously during pendulum movement of spastic lower extremity in supine position for nineteen spastic hemiplegia patients and ten normal control subjects. Angular relaxation index (ARI), Maximum angular velocity (MAV), Angular threshold (AT) and Angular velocity threshold (AVT) were used for the evaluation of spsticity.
Results: 1) ARI was 1.64⁑0.04 in normal, 1.28⁑0.14 in modified Ashworth scale (MAS) I, 1.18⁑0.16 in MAS II, 1.02⁑0.13 in MAS III, 2) MAV was 325.0⁑29.4 in normal, 301.7⁑37.8 in MAS I, 269.2⁑29.7 in MAS II, 232.4⁑28.2 in MAS III, 3) In normal subjects EMG activity did not occur, whereas in spastic hemiplegic patient a stretch reflex appears in thigh muscle. AT and AVT were 57.39⁑4.45, 256.24⁑14.07 in MAS I, 38.59⁑4.26, 184.45⁑12.7 in MAS II, 19.13⁑7.13, 136.06⁑12.88 in MAS III, respectively, 4) Correlation coefficients of the ARI (r=0.786), AT (r=0.960), AVT (r=0.949) showed significantly negative correlations with the MAS.
Conclusion: 1) AT and AVT are more sensitive parameters than ARI for documenting spasticity in hemiplegic patients. 2) An evaluation of spasticity using pendulum test and dynamic electromyography would provide consistent results with little error and would not be influenced by the change of examiner or environment. Thus we can get very reliable results using this method.
Objective: The purpose of this study is to evaluate the effects of intramuscular botulinum toxin A injection for the improvement of hand function in spastic hemiplegia.
Method: We have studied 8 patients with spastic hemiplegia. Botulinum toxin A was injected into target muscles with electromyographic guidance. Before injection, muscle activity patterns were evaluated by dynamic electromyography. Follow-up assessments were performed at three months after injection.
Results: There were continuous activity patterns in all dynamic electromyography of target muscles. Dynamic electromyography of antagonist muscles in five patients showed normal phasic activity pattern but it showed absent pattern in other three patients. Mean modified Ashworth scale decreased significantly after injection. There were an improvement in functional classification and a significant increase of mean scores of unilateral hand skills after injection in patients with normal phasic pattern of antagonist muscles.
Conclusion: Botulinum toxin A can improve the impaired hand movement and function in spastic hemiplegia by reducing spasticity and contracture of the target muscles in cases of normal phasic activity in antagonist muscles and continuous activity in target muscles.
Objective: To evaluate peripheral hemodynamics using the doppler ultrasound in the diabetic patients.
Method: We measured mean blood flow velocity (MBFV), resistance index (RI), pulsatility index(PI) in the dorsalis pedis artery (DPA), posterior tibial artery (PTA), and radial artery (RA) from 18 normal controls (n=36), 17 diabetes patients without neuropathy (n=34), and 21 diabetes patients with neuropathy (n=42) by use of Angiodine 2 Doppler system operating at 8 MHz frequency.
Results: MBFV of all the examined arteries increased significantly in the diabetes with neuropathy in comparison to controls and the diabetes without neuropathy (p＜0.05). RI and PI of DPA and PTA decreased significantly in the diabetes with neuropathy in comparison to controls and diabetes without neuropathy (p＜0.05). The blood flow velocity profile was changed from triphasic to monophasic pattern in the diabetes with neuropathy in DPA and PTA.
Conclusion: The Doppler ultrasound is considered as a useful tool for screening change of peripheral blood flow in the diabetic patients with neuropathy.
Objective: To investigate the correlations of neurological level, BCR and urodynamic study (UDS) in the spinal cord injury(SCI) patients, we analyzed the results of BCR and UDS fundings.
Method: The sujects were twenty-four patients with SCI who were beyond 3 months following the SCI. According to the level of injury, the patients were divided into 3 groups: above T10 level, 7; T10 to L2 level, 8; below L2 level, 9. Electrophysiological BCR test and UDS were performed in all patients.
Results: The results showed a significant correlation between the BCR test and level of injury, however there was no correlation between the UDS and level of injury, nor between the detrusor function and BCR test. The results might be from a differential recovery of the somatic and autonomic nervous system.
Conclusion: As a part of comprehensive evaluation for the bladder function in the SCI patients, we recommend both the bulbocavernosus reflex test and urodynamic study. Further neurophysiological research would be needed to understand the urodynamic findings which did not correlate with the level of SCI.
The purpose of this study was to detect where the center of pressure in foot would be located at the end point of loading response and the terminal stance by the dynamic plantar pressure measurement.
Seventeen adults who had the usual feet without a pathologic gait were evaulated simultaneously by the motion analysis using VICON 370, and the plantar pressure measurement using EMED-SF. Two devices were set in the 60 Hz frame. The foot was divided into 3 different zones; hindfoot, midfoot, and forefoot.
The end point of loading response was located at the 1.92⁑1.46 frame distal to the hindfoot- midfoot borderline. The end point of terminal response was located at the 2.27⁑1.96 frame distal to the maximal pressure points of metatarsal head.
Authors could differentiate each period of stance phase; the initial contact, loading response, mid-stance, terminal stance, and preswing, using the analysis of center of pressure by the dynamic plantar pressure measurement.
Flatfoot is a common foot disorder. Some modifications by orthotic shoes for the flatfoot have been prescribed, however their effectivenesses are not fully proven yet. We have tried to validate the effectivenesses of conventional orthotic shoes for the flatfoot patients. We assessed the static and dynamic pressure, dynamic pressure-time integral, and relative impulse with and without wearing orthotic shoes. Thirteen subjects with the flatfoot were included in this study. The results showed the positive effects of orthotic shoes for the subjects. Especially the dynamic pressure-time integral values revealed the significantly reduced values at the medial side of midfoot, which meant the functional improvement of flatfoot status. We have concluded that the use of conventional orthotic shoes for the flat foot patients would be effective for properly selected patients, if there is no other associated abnormality.
The purpose of this study was to measure the foot pressure distribution of normal children. Static and dynamic pressure, dynamic pressure-time integral, relative impulse, static pressure distribution between forefoot and heel, and the percentage of contact time in each phase of the gait cycle were measured from 68 normal children by the in-sole pressure measurement system. The measurements were perfomed while standing and walking with their comfortable speed using the in-sole pressure measurement system.
The sites of the greatest static pressure, dynamic pressure-time integral and relative impulse were obtained from the 2nd and the 3rd metatarsal head areas. And the dynamic pressure was obtained from in the lateral heel area. The forefoot to heel load ratio was about 6 to 4 in the static state. The contact time was greatest during the push-off phase., In-sole pressure measurement system, Static pressure, Dynamic pressure,
Isotonic exercise occurs when the tension or torque generated by a muscle is constant throughout the movement. In practice it is very difficult to maintain the tension constant. Evaluation of isotonic exercise should include the works of concentric and eccentric contraction and the changes in tension and torque during joint motion. However, optimal evaluation tools for isotonic exercise has yet to be developed.
We authors, used virtual reality motion analysis system(VRMAS) which was codeveloped by us and EMG system(Cardwell Excel). Healthy male adult subjects(n=10) were recruited from hospital personnel. After dominant upper arm and trunk of each subject was fixed with velcro, he was instructed to repeat flexion and extension of his dominant elbow grasping dumbell (9 kg) in hand with maximal velocity as possible as can until the point of exhaustion. We measured the elbow angle, the angular velocity, torque, power, total work and the work of concentric and eccentric contraction during exercise.
The results were as follows: there were four distinct elbow flexor muscle contractions during flexion and extension of the elbow with the first and the second contractions during concentric contraction and the third and the fourth contractions during eccentric contraction. Between the peaks of contraction, motion was maintained due to the momentum that was generated. Of the ten subjects, seven had higher concentric work than eccentric work with the eccentric work being higher in the remaining three. But there was no statistic significance between the works of concentric contraction and eccentric contraction(p>0.05). The biggest work was observed in the fourth contraction, while the third contraction showed the least work(p<0.05).
In conclusion, there were four distinct muscle contractions during elbow isotonic exercise and the works of each muscle contraction were different. This result is contrary to the definition of isotonic exercise. This study also shows that the VRMAS could be a very useful evaluation tool for several types of isotonic exercise.
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