Contralateral Mirror Image Spreading in Post-Stroke Complex Regional Pain Syndrome

The long-term prognosis of complex regional pain syndrome is difficult to predict because of its unclear pathophysiology. The syndrome can spontaneously spread to other regions in the body. We report a case in which a complex regional pain syndrome that occurred in a 75-year-old male patient after a stroke spread to the opposite side.

Williams Syndrome with Multiple Cervical Vertebral Fusion Presenting Dysphagia: A Case Report / 대한연하장애학회지

Williams syndrome is a multiple-system disorder, caused by deletion of the locus 7q11-23 gene and characterized by an ‘elfin’ facial appearance, developmental delay, cardiovascular disorders, and transient hypercalcemia. Vertebral abnormalities in Williams syndrome have not been reported yet, except for one case report on cervical stenosis at the C1 level. In this case, the authors incidentally found Williams syndrome with the fusion of the fifth and sixth cervical vertebrae and an associated dysphagia showing delayed, forward-deviating esophageal passage during a videofluoroscopic swallowing study. The authors could not confirm whether the multiple cervical vertebrae fusion was related with the Williams syndrome or was just incidental. However, because physiatrists frequently encounter children with Williams syndrome and numerous kinds of developmental delay, if a patient with Williams syndrome suffers from swallowing difficulty, evaluation of dysphagia and cervical abnormalities should be considered. The present authors report the case of multiple cervical vertebral fusion in Williams syndrome.

Mirror Therapy Using Virtual Reality on the Wrsit of Rheumatoid Arthritis; Pilot Trial

OBJECTIVE: Authors conducted the pilot trial to evaluate whether the virtual reality using mirror therapy induces analgesia and functional improvement to the patients of rheumatoid wrist arthritis. METHOD: Three patients with no symptom or sign of active phase at both wrists were recruited. Voluntary range of motion (ROM) of each wrist over as far as possible was recorded and then the same movement was recorded only over 60% of the previous one after break of 5 minutes. For the virtual reality treatment, the second recorded motion was reconstructed into the another one of as same ROM and spent time as the first one, providing confusing visual information to the patients while patients were instructed to reach only the red flags (60% ROM of 1st one). This exercise was repeated for 5 days. Numerous scales such as VAS, ROM, Michigan Hand Outcomes Questionaire (MHQ), Performance and Satisfaction in Activities of Daily Living (PS-ADL), patient-rated wrist evaluation (PRWE) were evaluated before and after repetition. RESULTS: The increased satisfaction with their hands (satisfaction score of MHQ; 5.8 ± 2.3, [6-30]), improved ADL performances (PS-ADL score: 5.0 ± 3.5, [0-117]), and no side effect were noticed. CONCLUSION: The virtual reality using mirror therapy may be safe and has some analgesic effect, which warrants a clinical trial in the future for the patients of rheumatoid wrist arthritis.

A Model of Glial Scarring Analogous to the Environment of a Traumatically Injured Spinal Cord Using Kainate

OBJECTIVE: To develop an in vitro model analogous to the environment of traumatic spinal cord injury (SCI), the authors evaluated change of astrogliosis following treatments with kainate and/or scratch, and degree of neurite outgrowth after treatment with a kainate inhibitor. METHODS: Astrocytes were obtained from the rat spinal cord. Then, 99% of the cells were confirmed to be GFAP-positive astrocytes. For chemical injury, the cells were treated with kainate at different concentrations (10, 50 or 100 µM). For mechanical injury, two kinds of uniform scratches were made using a plastic pipette tip by removing strips of cells. For combined injury (S/K), scratch and kainate were provided. Cord neurons from rat embryos were plated onto culture plates immediately after the three kinds of injuries and some cultures were treated with a kainate inhibitor. RESULTS: Astro-gliosis (glial fibrillary acidic protein [GFAP], vimentin, chondroitin sulfate proteoglycan [CSPG], rho-associated protein kinase [ROCK], and ephrin type-A receptor 4 [EphA4]) was most prominent after treatment with 50 µM kainate and extensive scratch injury in terms of single arm (p<0.001) and in the S/K-induced injury model in view of single or combination (p<0.001). Neurite outgrowth in the seeded spinal cord (β-III tubulin) was the least in the S/K-induced injury model (p<0.001) and this inhibition was reversed by the kainate inhibitor (p<0.001). CONCLUSION: The current in vitro model combining scratch and kainate induced glial scarring and inhibitory molecules and restricted neurite outgrowth very strongly than either the mechanically or chemically-induced injury model; hence, it may be a useful tool for research on SCI.

Intermittent Oroesophageal Tube Feeding via the Airway in Patients With Dysphagia

OBJECTIVE: To investigate the feasibility of the use of the oropharyngeal airway (OPA) during intermittent oroesophageal tube (IOET) feeding. METHODS: Ten patients, who were evaluated using the videofluoroscopic swallowing study (VFSS), were enrolled. One patient withdrew from the study during the study period. Tube insertion time with and without OPA use was recorded in the same patients in a random order during the VFSS. Patients who could safely undergo IOET feeding were then randomly allocated to 2 groups (OPA and non-OPA). Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) scores and pneumonia incidence were assessed on the 3rd and 10th day after the VFSS. Non-parametric analysis was used for statistical analyses. RESULTS: The IOET insertion time was significantly shorter in the OPA group than in the non-OPA group (17.72±5.79 vs. 25.41±10.41 seconds; p=0.017). Complications were not significantly different between the 2 groups (p=0.054). Furthermore, although there were no significant differences in the SAGA-8 scores (25.50±2.38 vs. 21.40±3.13; p=0.066), which reflect the patient/caregiver satisfaction and the ease of tube insertion, patients in the OPA group tended to be more satisfied with the feeding procedure. CONCLUSION: Although the small size of the study cohort is a limitation of our study, the use of the OPA appears to be beneficial during IOET feeding in patients with dysphagia.

Toluene-induced Encephalopathy: A Case Report

Toluene is one of well-known neuro-toxicants. It can readily cross the blood-brain-barrier and mainly affect the central nervous system (CNS). An inhalation is the typical route of its human exposure and show a variety of symptoms involving cerebral and cerebellar dysfunction, bronchial asthma, chemical pneumonitis, toxic hepatitis, renal tubular acidosis, intestinal obstruction, and myelo-dysplastic syndrome. In this case, toluene-inhalated showed numerous CNS and systemic symptoms. Authors performed such gait analysis, gross and fine motor evaluations, computerized neurocognitive test that we noticed the impaired results. After comprehensive rehabilitation for four weeks, patient improved as much as she could carry out the independent life, and finally discharged home. Authors report the case of toluene-induced encephalopathy in Republic of Korea for the first time.

The Effects of Removable Denture on Swallowing

OBJECTIVE: To investigate the relationship between removable dentures and swallowing and describe risks. METHODS: Twenty-four patients with removable dentures who were referred for videofluoroscopic swallowing study (VFSS) were enrolled. We evaluated the change of swallowing function using VFSS before and after the removal of the removable denture. The masticatory performance by Kazunori's method, sensation of oral cavity by Christian's method, underlying disease, and National Institutes of Health Stroke Scale for level of consciousness were collected. Functional dysphagia scales, including the oral transit time (OTT), pharyngeal transit time (PTT), percentage of oral residue, percentage of pharyngeal residue, oropharyngeal swallow efficiency (OPSE), and presence of aspiration were measured. RESULTS: Four patients dropped out and 20 patients were analyzed (stroke, 13 patients; pneumonia, 3 patients; and others, 4 patients). The mean age was 73.3+/-11.4 years. There were significant differences before and after the removal of the denture for the OTT. OTT was significantly less after the removal of the denture (8.87 vs. 4.38 seconds, p=0.01). OPSE increased remarkably after the removal of the denture, but without significance (18.24%/sec vs. 25.26%/sec, p=0.05). The OTT and OPSE, while donning a removable denture, were correlated with the masticatory performance (OTT, p=0.04; OPSE, p=0.003) and sensation of oral cavity (OTT, p=0.006; OPSE, p=0.007). CONCLUSION: A removable denture may have negative effects on swallowing, especially OTT and OPSE. These affects may be caused by impaired sensation of the oral cavity or masticatory performance induced by the removable denture.

Quantitative Evaluation of the Corticospinal Tract Segmented by Using Co-registered Functional MRI and Diffusion Tensor Tractography

PURPOSE: The purpose of this study was to investigate the quantitative evaluation of the corticospinal tract (CST) at the multiple levels by using functional MRI (fMRI) co-registered to diffusion tensor tractography (DTT). MATERIALS AND METHODS: Ten normal subjects without any history of neurological disorder participated in this study. fMRI was performed at 1.5 T MR scanner using hand grasp-release movement paradigm. DTT was performed by using DtiStudio on the basis of fiber assignment continuous tracking algorithm (FACT). The seed region of interest (ROI) was drawn in the area of maximum fMRI activation during the motor task of hand grasp-release movement on a 2-D fractional anisotropy (FA) color map, and the target ROI was drawn in the cortiocospinal portion of anterior lower pons. We have drawn five ROIs for the measurement of FA and apparent diffusion coefficient (ADC) along the corona radiata (CR) down to the medulla. RESULTS: The contralateral primary sensorimotor cortex (SM1) was mainly found to be activated in all subjects. DTT showed that tracts originated from SM1 and ran to the medulla along the known pathway of the CST. In all subjects, FA values of the CST were higher at the level of the midbrain and posterior limb of internal capsule (PLIC) than the level of others. CONCLUSION: Our study showed that co-registered fMRI and DTT has elucidated the state of CST on 3-D and analyzed the quantitative values of FA and ADC at the multiple levels. We conclude that co-registered fMRI and DTT may be applied as a useful tool for clarifying and investigating the state of CST in the patients with brain injury.

Arthroscopic Repair of Type II SLAP Lesion with Bioabsorbable Knotless Suture Anchor: Surgical Technique and Clinical Results

Purpose: The purpose of this study was to evaluate the results of bioabsorbable knotless suture anchoring for isolated type II SLAP. Materials and Methods: Fourteen patients with isolated type II SLAP underwent a surgical repair with bioabsorbable knotless anchor arthroscopically. Instability, rotator cuff tears or simple subacromial decompression were excluded. The UCLA and pain of VAS (Visual Analogue Scale), ADL (Activity of Daily Living, from the American Shoulder and Elbow Society) were evaluated and patients underwent a thorough shoulder examination at a minimum follow-up period of 2 years postoperatively. Results: At a mean of 27.1 months follow-up. The mean UCLA score improved from 14.4 pre-operatively to 31.2 on last follow-up. The mean VAS for pain was 4.9 and on last follow-up 1.0. The mean VAS for instability was 2.6 and on last follow-up 0.5. The mean ADL was 10.4 and on last follow-up 25.0. 12 patients reported their satisfaction as good to excellent and 10 of the 14 patients returned to their pre-injury level of activity (athletics) (P<0.05). Conclusion: Arthroscopic repair with bioabsorbable knotless suture anchors is an effective surgical technique for the treatment of an isolated unstable type II SLAP lesion. Overall satisfaction was only 85.7%. 1 patient had severe stiffness and 1 patient had shoulder pain.

Preemptive Swallowing Stimulation in Long-term Intubated Patients

OBJECTIVE: To evaluate the effect of preemptive swallowing stimulation on the recovery of swallowing function in long-term intubated patients. METHOD: Patients in the intensive care unit intubated for at least 48 hours due to respiratory distress from March to August 2003 were randomly assigned to two groups. Fifteen patients were stimulated (experimental group), and 18 patients were not stimulated (control group). The duration of intubation was 15.5+/-6.7 days in the experimental group and 15.7+/-6.5 days in the control group. Duration of stimulation in the experimental group was 7.3+/-3.6 days. After extubation, we compared the severity of dysphagia via video-fluoroscopic swallowing study. RESULTS: There was no difference in percentage of aspiration and swallowed volume between two groups. Oral transit time of the experimental group (0.37+/-0.07 sec) was significantly shorter than that of the control group (0.83+/-0.10 sec), and the oropharyngeal swallowing efficiency of the experimental group (73.3+/-17.4%/sec) was significantly higher than that of the control group (50.1+/-13.0%/sec). CONCLUSION: Preemptive swallowing stimulation in long term intubated patients may facilitate recovery of dysphagia.

Effects of Intensive Early Rehabilitation Program in Postmastectomy Patients

OBJECTIVE: To investigate whether early postmastectomy rehabilitation program could improve shoulder function and upper limb edema. METHOD: 40 patients who underwent either a breast conserving procedure or a modified radical mastectomy were included. Among 40 patients, 20 patients recieved early postmastectomy rehabilitation program and 20 patients were recieved only instruction for exercise. The patients were assessed on the three days after surgery and one month after surgery. The range of motion (ROM) of shoulder, pain on mobility of shoulder and arm circumference were evaluated. RESULTS: One month after surgery, both groups showed improvements in shoulder motion range, pain and edema. But there were significantly better in early rehabilitation group than control group (p <0.05). CONCLUSION: We concluded that early postmastectomy rehabilitation program was beneficial in regaining the shoulder motion and in reduction of pain and edema.

Functional Outcome of Patients with Posterior Circulation Stroke

OBJECTIVE: To compare functional outcome of posterior circulation (PC) stroke with middle cerebral artery (MCA) stroke. METHOD: We reviewed retrospectively 2, 226 records of stroke patients admitted to our hospital from June 1992 to October 2001, and selected PC stroke patients as a case with exclusion criteria; the presence of other neurological disease, the history of previous stroke, or multiple brain lesions. Also, we considered MCA stroke patients matched to a case as a control. 28 patients were selected as a case and 24 patients as a control. We compared FIM gains and efficiencies. RESULTS: Self care FIM efficiency (0.56+/-0.45) of PC stroke was higher than that (0.43+/-0.24) of MCA stroke and sphincter FIM efficiency (0.04+/-0.10) of the former was lower than that (0.10+/-0.11) of the latter. But, we couldn't detect any difference in cognitive (0.09+/-0.14 vs. 0.14+/-0.14), motor (1.10+/-0.71 vs. 0.87+/-.51), and total FIM efficiency (1.20+/-0.73 vs. 1.02+/-0.60). CONCLUSION: Our study shows the functional outcome of PC stroke previously reported as controversial or rather poor result is favorable like that of MCA stroke, under active rehabilitation intervention. And so we think that comprehensive rehabilitation management is needed for functional regain even in patients with PC stroke.