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To investigate the immediate therapeutic effects of mental singing while walking intervention on gait disturbances in hemiplegic stroke patients.
Eligible, post-stroke, hemiplegic patients were prospectively enrolled in this study. The inclusion criteria were a diagnosis of hemiplegia due to stroke, and ability to walk more than 10 m with or without gait aids. Each patient underwent structured music therapy sessions comprising 7 consecutive tasks, and were trained to sing in their mind (mental singing) while walking. Before, and after training sessions, gait ability was assessed using the 10-Meter Walk Test (10MWT), the Timed Up and Go test (TUG), gait velocity, cadence and stride length.
Twenty patients were enrolled in the interventions. Following the mental singing while walking intervention, significant improvement was observed in the 10MWT (13.16±7.61 to 12.27±7.58; p=0.002) and the TUG test (19.36±15.37 to 18.42±16.43; p=0.006). Significant improvement was also seen in gait cadence (90.36±29.11 to 95.36±30.2; p<0.001), stride length (90.99±33.4 to 98.17±35.33; p<0.001) and velocity (0.66±0.45 to 0.71±0.47; p<0.002).
These results indicate the possible effects of mental singing while walking on gait in patients diagnosed with hemiplegic stroke.
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To identify the clinical characteristics of proper robot-assisted gait training group using exoskeletal locomotor devices in non-ambulatory subacute stroke patients.
A total of 38 stroke patients were enrolled in a 4-week robotic training protocol (2 sessions/day, 5 times/week). All subjects were evaluated for their general characteristics, Functional Ambulatory Classification (FAC), Fugl-Meyer Scale (FMS), Berg Balance Scale (BBS), Modified Rankin Scale (MRS), Modified Barthel Index (MBI), and Mini-Mental Status Examination (MMSE) at 0, 2, and 4 weeks. Statistical analysis were performed to determine significant clinical characteristics for improvement of gait function after robot-assisted gait training.
Paired t-test showed that all functional parameters except MMSE were improved significantly (p<0.05). The duration of disease and baseline BBS score were significantly (p<0.05) correlated with FAC score in multiple regression models. Receiver operating characteristic (ROC) curve showed that a baseline BBS score of '9' was a cutoff value (AUC, 0.966; sensitivity, 91%–100%; specificity, 85%). By repeated-measures ANOVA, the differences in improved walking ability according to time were significant between group of patients who had baseline BBS score of '9' and those who did not have baseline BBS score of '9'
Our results showed that a baseline BBS score above '9' and a short duration of disease were highly correlated with improved walking ability after robot-assisted gait training. Therefore, baseline BBS and duration of disease should be considered clinically for gaining walking ability in robot-assisted training group.
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To determine the 9 month period effect of botulinum toxin A (BoNT-A) injection into the salivary gland in children with neurologic disorders and sialorrhea by qualified parent/caregiver-administered questionnaires.
A total of 17 patients (age 7.6±4.24 years) were enrolled in this study. The degree of sialorrhea was assessed at the baseline, 2 weeks, 1, 2, 4, 6 and 9 months after injection. The Drooling Count (DC) was assessed as an objective measurement. The Drooling Frequency and Severity Scale (DFS) and the Teacher Drooling Scale (TDS) were evaluated as a subjective measurement. BoNT-A (0.5 unit/kg) was injected into each submandibular and parotid gland under ultrasonography-guidance.
DC, DFS and TDS showed significant improvement at 2 weeks, 1, 2, 4, 6, and 9 months follow-up (p<0.05). Twelve of 17 cases (70.5%) showed more than 50% reduction in DC from the baseline value.
Ultrasonography-guided BoNT-A injection into the submandibular and parotid gland was a safe and effective method to treat sialorrhea in children with neurologic disorders.
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Possible mechanisms of neurologic recovery in spinal cord injury were postulated by Ditunno Jr. JF in 1987. The first window encompasses recovery from neurapraxia within 6 to 8 weeks. The second window covers the period from 2 to 8 months after the injury. Recovery during this period might be due to peripheral sprouting of intact nerves to denervated muscle and hypertrophy of functioning muscles. The third window of recovery happens usually beyond 8 to 12 months when axonal regeneration may play a role in further increases in strength.
On the basis of these possible mechanisms, we measured the neurological and functional recovery rate according to the periods of these possible mechanisms of motor recovery through 12 months following injury in 21 traumatic spinal cord injury patients.
The results were as follows:
1) Neurologically, the most rapid recovery was shown within 6 to 8 weeks after injury, during the phase of recovery from neurapraxia.
2) Most of functional recovery occured in the period between 2 month and 8 month of the compensatory phase.
3) Statistically significant correlation between motor and functional recovery was shown among the incomplete spinal cord injury group.
These data would be helpful in planning a timely appropriate rehabilitation program by understanding the time-course of neurologic recovery and prognostication of neurologic and functional recovery in the spinal-cord injured.
Objective: To investigate cortical reorganization of the brain during voluntary activities of the hand in patients with subcortical cerebral infarction.
Method: Twelve patients with first-ever subcortical brain lesion causing hemiparesis had been evaluated with functional MRI. Bilateral hand clenching was done to test voluntary hand activities. Recovery period ranged from 2 to 36 months.
Results: During the unaffected hand movement, activation of contralateral primary sensorimotor cortex (SMC) were recorded in all cases and supplmentary motor area (SMA) in 1 case. The affected hand movement showed activation of the cotralateral SMC in all cases, ipsilateral SMC in 4 cases, SMA in 4 cases and contralateral prefrontal area in 2 cases. As for the contralateral SMC, affected hand movement showed more increased activation than the unaffected. For the bilateral SMC activation during movement of the affected hand, contralateral SMC activation was greater than the ipsilateral.
Conclusion: Ipsilateral activation of the SMC, SMA, prefrontal area and increased activation of the contralateral SMC during affected hand movement suggest that these may play an important role in the reorganization of sensory and motor system in stroke patients with subcortical lesion. Functional MRI studies of patients who recovered from subcortical stroke provide evidence for several process that may be related to restoration of neurologic function.
Recent advances in the technology of neonatal intensive care have greatly improved the survival rate of high-risk infants who would otherwise have died. However, the surviving infants still have higher risks of long-term neuro-developmental disabilities such as cerebral palsy.
As a result, early intervention programs are advocated for the detection and remediation of neuromotor abnormalities in risk infants. A number of assessment scales and screening tools have been developed for the evaluation of infant neuromotor functions in western countries. Infant Neurological International Battery(INFANIB) was established by Ellison and Browning in 1985. INFANIB consists of assessment of posture, extremity and axial tone, primitive reflexes and postural reactions. This is relatively simple and easier for examiner and less burdensome to examinee. So we have used INFANIB as assessment tool for the detection of neurodevelopmental abnormal infants since 1993 and studied correlation between INFANIB results and neuromotor outcome for 2 years in 70 risk infants.
All the infants of the abnormal results group (29 cases) on the initial INFANIB examination grew into either cerebral palsy (26 cases) or minor neural dysfunction group (3 cases) on the follow-up examinations. All the infants of the normal results group (12 cases) appeared to be in normal developmental outcomes on the follow up. However, the transient results group (29 cases) showed variable outcomes, which were 9 cases of cerebral palsy, 6 cases of minor neural dysfunctions, and 11 cases of normal development.
INFANIB test results of the infants were highly sensitive and specific with the follow up examinations. Normal INFANIB results can be used to reassure parents of risk infants and an early intervention programs can be started to abnormal INFANIB infants. It can be used as a reliable screening tool for suspicious neurologically deviant neonates and infants. However the transient groups showed diverse neuromotor outcomes, they should be carefully monitored during infancy and childhood.
Tuberculous spondylitis occurs commonly by the hematogenous spread of infectious organism, Mycobacterium tuberculosis, from the primary foci of the pulmonary and genitourinary systems. Spinal involvement is the most common among tuberculosis of the musculoskeletal system. Tuberculous spondylitis is not easily diagnosed in its early stages and furthermore it is hard to know whether or not the vertebrae are involved by simple X-ray study. The incidence of neurologic deficits varies from 4 to 50%. If the disease is not diagnosed and treated promptly, paraplegia may occur from vertebral collapse. A retrospective study was performed to evaluate the clinical features of tuberculous spondylitis in 51 patients (male 25, female 26), age range of 4-79 years (mean, 36.2⁑18.7). Clinical symptoms, signs, radiological findings and laboratory findings were reviewed. The latest follow ups were done with telephone interviews to evaluate their general improvement and neurological recoveries.
Back pain was the most frequent symptom, followed by sensory disturbance and gait difficulty. Twenty one patients had kyphotic deformity, 7 had lower extremity paralysis, and 29 patients were accompanied by pulmonary tuberculosis. The involved spinal segments were C2 through S1 with the most common site of thoracolumbar spines. The average erythrocyte sedimentation rate (ESR) was 42.1⁑23.5 mm/hour before medical or surgical treatment and 19.6⁑12.6 mm/hour after treatment. The acid-fast bacillus test was positive in only 6 patients. Electrodiagnostic studies and bone scans showed positive findings in 75% and 86%, respectively. Back pain was relieved in 90% of the patients with medical or surgical treatment. In patients with paralysis, initial kyphotic angle and degree of vertebral body loss were significantly greater than in patient without paralysis. When treated surgically early after the leg paralysis, patients with paralysis improved their neurologic deficits and gait better than when treated after 2 months.
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.
Objective: Traumatic brain injury is related to the acute stress response, and this can be accompanied by an elevated serum glucose level. So we estimated the influence of hyperglycemia on neurologic, functional status and outcome.
Method: We studied the 139 traumatic brain injured patients who had been admitted to the department of neurosurgery from 1996 to 2000, retrospectively. We reviewed initial serum glucose level, postoperative glucose level, and Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS). We compared these values with functional independence measure (FIM) scores. Patients were divided into two groups according to the initial serum glucose level, then we analyzed the correlation between glucose level and GCS, GOS, FIM.
Results: The correlations of early hyperglycemia with GCS, GOS, initial FIM scores were significant (p＜0.01). But serum glucose levels were not correlated with plateau FIM scores (p＞0.05). Patients with unfavorable neurologic outcome after 10 days from head injury had significantly high serum initial and postoperative glucose levels than those with favorable neurologic outcome (p＜0.01).
Conclusion: In patients who had received rehabilitation therapy with moderate or severe head injury, early hyperglycemia were significantly correlated with initial FIM scores, GCS, GOS, but not with the plateau FIM scores.
Kyphotic deformity arising from the failure in formation of a vertebral body is an uncommon condition showing late complications of gross spinal angulation, paraplegia, impaired bladder function and cardiopulmonary deficiencies. Congenital hemivertebra constitute approximately 6% of anomalies associated with congenital spinal deformities. The natural course of this disease remains unpredictable, especially regarding the development of neurological impairment. Only a few numbers of patients with severe kyphosis due to congenital dorsal hemivertebra have been reported.
We present a 40-year-old man with severe thoracic kyphosis. Gait difficulty due to paraplegia occurred at the age of fifteen with progressive development of the right lower limb pain and later impairment of bladder function. He had no cardiopulmonary deficiencies. Radiological findings showed a wedge shaped dorsal hemivertebra and cord compression at the eleventh level of thoracic vertebra. In view of the poor prognosis of surgical intervention he was fitted with an Jewett brace so that further neurological impairment was avoided. We report a rare case of congenital kyphosis due to dorsal hemivertebra in adult with progressive neurological impairment.
Objective: We observed the nature of ipsilateral weakness, not hemiplegic side after stroke. And we studied correlation between ipsilateral weakness and neurologic recovery of hemiplegia.
Method: This study was prospective, follow-up clinical trial. Ipsilateral motor power was checked serially in 20 subjects using Nicholas Manual Muscle Tester (NMMT) (shoulder abduction, wrist extension, hip flexion, ankle dorsiflexion). The subjects are first attacked hemiplegic stroke patients. Other outcome measures are Mini-mental Status Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS). We studied correlations between motor power recovery in ipsilateral limbs and recovery of neurologic impairment in hemiplegic limbs of stroke patients through SPSS 7.0 program.
Results: Ipsilateral motor power in early stage stroke patients is significantly low compared with that of normal subject except ankle dorsiflexion (p＜0.05). Comparing ipsilateral proximal with distal limbs power in pre and post multidisciplinary rehabilitation program, upper proximal part recovered faster than the distal part, but which was not statistically significant. Recovery of ipsilateral upper proximal and distal limb weakness is associated with neurologic recovery in hemiplegic side.
Conclusion: After the stroke, ipsilateral upper limb motor weakness does occur and which follows similar neurologic recovery pattern to the hemiplegic side. Ipsilateral cortical and subcortical tracts take effect on the neurologic recovery of contalateral side.
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