Effects of Electrical Stimulation for Dysphagia Caused by Stroke

OBJECTIVE: To investigate the benefit of electrical stimulation for dysphagia caused by stroke. METHOD: Ten consecutive stroke patients with dysphagia for 3 months or more were enrolled in this study and assigned to one of the two group (electrical stimulation group or sham group) according to randomization table. Five patients were allocated to electrical stimulation group and 5 patients to sham group. One patient in the sham group dropped out because of transfer to other hospital. Electrical stimulation with a maximal tolerable intensity was applied on both digastric muscles and both thyrohyoid muscles for 1 hour, 5 days a week for 4weeks in electrical stimulation group. Sham group received electrical stimulation in same condition except stimulation intensity of 1 mA. Clinical dysphagia scale, functional dysphagia scale and kinematic analysis of hyoid bone movement were assessed at baseline (before treatment), 2 weeks later (during treatment), 4 weeks later (after treatment). RESULTS: The clinical dysphagia scale decreased in both group, of which the difference was not statistically significant. The functional dysphagia scale decreased significantly in the electrical stimulation group. The electrical stimulation group revealed greater improvement in clinical dysphagia scale and functional dysphagia scale compared to sham group. CONCLUSION: Electrical stimulation therapy with a maximally tolerable intensity to digastric and thyroid muscles might be effective in chronic stroke patients with dysphagia.

Effects of Electrical Stimulation on Muscle Apoptosis in Spinal Cord Injury Rabbit Model: A preliminary study

OBJECTIVE: To determine the effect of functional electrical stimulation (FES) in the paralyzed muscles of rabbits with spinal cord injury (SCI). METHOD: Fifteen male New Zealand white rabbits were injured by spinal cord transection at the T6 level. We classified animals into a normal control group (n=3), and SCI without FES (n=3), SCI with 10 Hz FES (n=6) and SCI with 40 Hz FES (n=6) groups. FES was applied on both tibialis anterior (TA) muscles at two frequencies (10 Hz, 40 Hz) for 1 hour daily for 2 weeks. After treatment TA muscles were separated and apoptotic features were measured by in situ DNA nick-end labeling (TUNEL), DNA fragmentation assays and western blotting for Bcl-2and Bax protein. RESULTS: In TUNEL and DNA fragmentation assay results, the FES groups showed more fragmented myonuclei and DNA, and western blotting showed more Bax protein expression in FES groups than no FES group and control (higher in 40Hz group), whereas Bcl-2 protein expressions were similar in all groups. CONCLUSION: Apoptosis of paralyzed muscle was increased in FES group with higher Bax/Bcl-2 in 40 Hz than in 10 Hz. To evaluate the clinical significance of muscle apoptosis with FES in SCI, further study would be needed.

Quantitative Measurement of Three Phase Bone Scintigraphy in Stroke Patients with Complex Regional Pain Syndrome

OBJECTIVE: To evaluate usefulness of quantitative measurement of three phase bone scintigraphy in assessing the complex regional pain syndrome (CRPS) after stroke using reference value in healthy adults. METHOD: Twenty nine stroke patients with CRPS and 15 stroke patients without CRPS underwent three phase bone scintigraphy (TPBS). Uptake ratio was calculated by isotope count of affected side divided in isotope count of unaffected side in each phase. Reference value was obtained in 13 healthy adults. The sensitivity and specificity of quantitative measurement of TPBS was assessed. RESULTS: In the all phases of hand, uptake ratios of the CRPS group were significantly higher than non-CRPS group (p<0.05). There was no significant difference in the delayed phase of shoulder between the CRPS group and the non- CRPS group. In the delayed phase of hand, sensitivity and specificity of quantitative measurement of TPBS were 82.8% and 86.7%, whereas those of qualitative interpretation by nuclear physician were 65.5% and 66.7%, respectively. CONCLUSION: Quantitative measurement of TPBS was more sensitive and more specific than qualitative interpretation by nuclear physician in assessing the CRPS after stroke. Quantitative measurement of TPBS may be helpful in detecting CRPS after stroke.

Functional Status and Blood Level of IGF-1 and IGFBP-3 in Post-acute Stage Brain Diseases

OBJECTIVE: To evaluate the blood level of IGF-1 (insulin-like growth factor-1) and IGFBP-3 (insulin-like growth factor binding protein-3) in patients with post-acute stage brain diseases, and to investigate the relationship between IGF-1/ IGFBP-3 blood level and functional status in patients with post-acute stage brain diseases. METHOD: Initial IGF-1/IGFBP-3 blood levels of 32 patients with post-acute stage brain disease were obtained and various functional indices, including modified Barthel index (MBI), functional ambulatory category (FAC), and Jebsen hand function test (JHFT), were assessed initially and at discharge. RESULTS: The IGF-1 blood level was normal in 23 patients and decreased in 9. The IGFBP-3 blood level was normal in 20 patients and increased in 13. The initial IGF-1/IGFBP- 3 levels were associated with the change of MBI score during admission (p<0.05, r2=0.214/p<0.05, r2=0.213). There was a correlation between IGF-1/IGFBP-3 levels and JHFT score only on the unaffected side at discharge (p<0.05, r2=0.278). There was no relation between IGF-1/IGFBP-3 levels and the change of JHFT score on either side during admission. CONCLUSION: Initial IGF-1/IGFBP-3 blood level check can be a useful method to anticipate functional improvement of patients with post-acute stage brain disease.

The Investigation of the Pain after the Orthotic Treatment in Adolescent Idiopathic Scoliosis

OBJECTIVE: To provide a perspective on the recent trends in the etiologies and levels of lower limb amputations in Korea. METHOD: Medical records of 284 patients discharged from Seoul National University Hospital between 1990 and 1999 who had amputation related procedure codes were reviewed. Data were used to calculate ratios of congenital anomaly, trauma related, tumor related, diabetes related, and vascular insufficiency related amputations, and ratios of each level of amputations. Trends over time were examined by comparing data from 1990 to 1994 with those from 1995 to 1999 using chi square tests. RESULTS: Dysvascular amputations accounts for 53.5% of lower limb loss in recent 10 years, and tumor (18.9%), congenital anomaly (14.5%), and trauma (6.1%) ranked the next common etiologies. The proportion of dysvascular amputations since 1995 was found to be significantly greater than the ratio before 1995 (p<0.05), and the ratio of amputations secondary to congenital anomaly was lower (p<0.05). There was no significant change in the level of amputations. CONCLUSION: Over recent 10 years, the risk of amputation secondary to dysvascular conditions has been increased, which warrants further investigations and efforts to improve our management of amputees.

A Newly Designed Sling for Hemiplegic Shoulder Subluxation: A Pilot Study

OBJECTIVE: To introduce a newly designed arm sling and to compare the effects on a shoulder subluxation. METHOD: Sixteen hemiplegic patients with shoulder subluxation were evaluated by a simple X-ray with and without the slings and the vertical and horizontal distances on the plain AP views were measured. The newly designed arm sling was compared in terms of the effects of correction with a pouch sling and a Bobath sling. The arm sling designed for this study was developed for the purpose of maintaining patients' hands in a functional position and performing ROM exercise of the shoulder easily. The mean values of the vertical and horizontal distance were compared to determine if there was significant difference of function between the new sling and the conventional slings. Variables such as comfort, choice, and easiness for donning and doffing of the arm slings were evaluated by questions. RESULTS: The new sling provided the patients with good vertical correction of the subluxation (p<0.05) but did not increase the horizontal distance significantly. According to the responses to the questions, the new sling was more comfortable than the conventional slings. CONCLUSION: These results support the effectiveness and the comfort of a new sling to decrease subluxation in hemiplegia. Further study on the long term effects or complication of the new sling is recommended.

Relationship between Clinical Outcome and Electrophysiological Study in Spinal Bifida

OBJECTIVE: To investigate the relationship the electrodiagnostic findings with the functional outcomes in spina bifida patients and to assess usefulness of follow up electrodiagnostic study. METHOD: Initial and follow up electrodiagnostic data of 100 patients who had been diagnosed as spina bifida were obtained retrospectively. Electrophysiological diagnosis and neurological level were investigated by the findings of needle electromyography. Each patients were divided into no change, improvement and deterioration group according to follow up study. The change of urodynamic study findings and clinical findings were also investigated. The recent functional outcomes and the presence of complications were evaluated by recent outpatient record. RESULTS: 56 patients had no change, 15 patients had improvement and 29 patients had deterioration electrophysiologically. The initial electrodiagnostic findings were associated with the functional outcomes in patients with spina bifida (p<0.05). However, neurological level by electrodiagnostic findings cannot predict functional outcomes except ambulation activities. The change of electrodiagnostic findings of follow up study were related with the change of clinical findings statistically (p<0.05). CONCLUSION: Follow up electrodiagnostic study as well as initial study is necessary for the evaluation of the change of neurological states in the patients with spina bifida.

Effects of Exercise and Steroid on Apoptosis in Skeletal Muscle of Mdx Mouse

OBJECTIVE: To investigate the effect of exercise and steroid to the muscle of animal model of Duchenne muscular dystrophy. METHOD: We used 15 mdx and 15 control mice. To grade exercise loading, control and mdx mice were divided into free-living, exercise and immobilization groups. Free-living and exercise groups were further divided into steroid-treated and sham-treated groups to evaluate the effect of steroid administration. We measured the apoptotic changes using in situ DNA nick-end labling (TUNEL), DNA fragmentation assay and western blots for Bcl-2 and BAX. RESULT: With TUNEL method, the largest number of myonuclei became positive in sham-treated exercise group while apoptosis was significantly reduced in steroid-treated exercise group in mdx mice. Steroid-treated free-living group showed higher rate of apoptotic change than sham-treated free-living group. With western blots for Bcl-2 and BAX, the value of BAX/Bcl-2 ratio was highest in sham-treated exercise group and among free living mdx mice, it was higher in steroid-treated group than sham-treated one. CONCLUSION: Apoptosis can be minimized in free living condition while exercise loading or immobilization can cause apoptotic change in muscular dystrophy animal model. Steroid administration induces apoptosis in free living muscle and it alleviates apoptotic damage caused by exercise loading in mdx mice.

Optimal Sampling of Muscles to Detect Lumbosacral Radiculopathy

OBJECTIVE: To determine the optimal number of muscles to detect lumbosacral radiculopathies. METHOD: Electrodiagnostic data of 152 patients who had been diagnosed as lumbosacral radiculopathy with the findings of operative record were obtained retrospectively. The findings of needle electromyography were reviewed and the frequency of abnormal spontaneous activities in L5 and S1 myotomes was investigated. We selected 8 individual muscles which had high sampling rate. These muscles were combined into different muscle screens and the detection rates were calculated that the frequency with which one or more muscles in the screen displayed abnormal spontaneous activity was divided by the total number of radiculopathies. RESULTS: The detection rates of lumbosacral radiculopathy were compared according to the number of muscle screens. Including paraspinal muscle, the detection rate of 6 muscle screens was higher than 5 muscle screens (p<0.05), but there was no significant difference of detection rate between 6 muscle screens and 7 muscle screens. The detection rates of each muscle screens without paraspinal muscle were lower than those including paraspinal muscle for all screens (p<0.05). CONCLUSION: Although there is controversy about selection of muscles, six muscle screen including paraspinal muscles may be optimal number for detecting lumbosacral radiculopathy.

Stimulation Intensity of Functional Electrical Stimulation on Hemiplegic Upper Extremity

OBJECTIVE: This study aimed to assess optimal stimulation intensity and to investigate other variables on functional electrical stimulation (FES) for hemiplegic upper limb. METHOD: We divided hemiplegic subjects into two groups, acute (n=28) and chronic (n=18), and control subjects into old (n=26) and young (n=27). Electrical stimulation was performed on the forearm of both sides in hemiplegic patients and of the nondominant side in normal controls. The stimulation site that aimed at open hand motion was targeted to the extensor digitorum and extensor pollicis brevis muscles. We measured the peak to peak amount of current and skin impedance while making hand extension. RESULTS: The acute and chronic hemiplegic groups required a greater current than the control groups (p<0.01).The hemiplegic side required a greater current than the non- hemiplegic side (p<0.001). There was no significant difference of current amount between the acute and chronic hemiplegic groups. The current amount was significantly correlated with subject's age (p=0.001). No difference of skin impedance was found among any of the groups. CONCLUSION: Irrespective of disease duration on hemiplegia, a greater current is required in the hemiplegic upper limb than in the normal upper limb. Age was an important factor in determining stimulation intensity.