Voiding Dysfunction after Stroke and Traumatic Brain Injury: Multi-center Study

OBJECTIVE: Voiding dysfunction after stroke and traumatic brain injury has been known to be a predictive factor of death or severe disability, and an important factor on hospital discharge. Thus we aim to investigate its prevalence, related factors and natural course of brain injury related voiding dysfunction for proper rehabilitation after brain injury. METHOD: Two hundred ten brain injury patients (male 130, female 80) admitted in 5 university hospitals were included. The cognitive function was assessed using the Korean version-Mini mental state examination (K-MMSE), and bladder function was evaluated with the International Prostate Symptom Score (IPSS) and voiding diary. We excluded the patients that had previous urologic and gynecologic problem. RESULTS: Overall, 43.7% of total patients had voiding difficulty and the most common symptom was nocturia (80.6%), which was followed by frequency (72.6%) and urgency (40.3%). Patients with incontinence had lower K-MMSE scores than continent patients. There was no significant difference of rate of incontinence in relation with sex, cause of brain injury, and lesion site. Prevalence of urinary symptoms decreased as the duration after brain injury was longer. The quality of life score showed a high correlation with the total IPSS score (p<0.05). CONCLUSION: The overall results demonstrate that voiding dysfunction after brain injury is influenced by onset time and cognitive function after brain injury.

The Effect of Height and Tilt Adjustable Keyboard Tray on Work-related Musculoskeletal Pain

OBJECTIVE: To evaluate the effect of height and tilt adjustable keyboard tray on work-related musculoskeletal pain in visual display terminal (VDT) workers. METHOD: Twenty-one VDT workers, who had myofascial pain in upper trapezius (UTZ) and extensor carpi radialis longus (ECRL) or brevis (ECRB) during VDT work, were randomly assigned to a control (n=10) that used conventional keyboard or experimental group (n=11) that used height and tilt adjustable keyboard tray. A pretest assessed the visual analog scale (VAS), pain threshold of UTZ and ECRL or ECRB, and grip and tip pinch strength as well as upper extremity function index (UEFI). Post-test was conducted 1 month later. Additionally, differences in working posture between the two groups were evaluated. RESULTS: For the UTZ, the decrease of VAS (p<0.05) and increase of pain threshold (p<0.01) in experimental group were significantly greater than control group after 1 month. Increase of right grip strength (p<0.01) and UEFI (p<0.05) in the experimental group were significantly larger than control group. Experimental group showed lower keyboard height (p<0.01) and smaller elbow angle (p<0.01) as well as more anterior tilted keyboard angle (p<0.01) than the control group. CONCLUSION: Application of height and tilt adjustable keyboard tray seems to affect the working posture, thus reduce the work-related musculoskeletal pain of UTZ as well as enhance the strength of right grip strength and upper extremity function in VDT workers. Additionally, anterior keyboard tilting may help to reduce wrist extension in low keyboard height which contributes to decreasing UTZ muscle tension.

Sensitive Balance Parameters in Detecting Age-related Changes of Balance Control in Elderly

OBJECTIVE: To determine stability parameters in clinical balance tests and posturography that can assess age-related changes in posture control sensitively METHOD: Thirty nine healthy elderly people over 60 years old and twenty young controls were recruited. Elderly people were subdivided into 3 groups by age (aged 60~69, 70~79, over 80). Subjects were evaluated with clinical balance tests and posturography. In posturography, center of pressure (COP) parameters were obtained as total path distance, sway area, mean frequency of sway in comfortable standing. Visual feedback system (VFS) was added to posturography and then subjects were asked to move their COP into the target circle on monitor with active movement on force plate. In VFS, time to get in the circle, total path of deviation, time in the circle were measured. RESULTS: Time in the circle assessed by posturography with VFS showed significant difference between age groups (p<0.05). Significant correlations between time in the circle and clinical balance tests were also found (p<0.01). CONCLUSION: A posturography with VFS was considered to have clinical usefulness in sensitive evaluation of age-related change of balance control in healthy elderly people.

Effect of Characteristics of Joint Motion of Lower Extremity according to Aging on Balance in Elderly

OBJECTIVE: To investigate the effect and the correlation of characteristics of joint motion of lower extremity according to aging on balance in elderly. METHOD: There were thirty nine healthy elderly subjects aged 60 and older. The subjects were divided into 3 groups by their age. Each group was measured with joint motion of bilateral lower extremities by goniometer. The subjects were evaluated with clinical balance tests [(Berg balance scale (BBS), Functional reach test (FRT), Tinetti's performance oriented mobility assessment (POMA), and one leg standing (OLS)]. RESULTS: The flexibilities of lower extremities were decreased according to the increase in age. The balance ability was also decreased according to the increase in age by tested clinical balance scores. The flexibility of the ankle joints showed the strongest correlation with clinical balance scores (BBS, FRT, POMA and OLS) according to the increase in age, and the flexibility of hip joints also correlated with clinical balance scores (POMA and OLS). CONCLUSION: Among clinically validated balance tests, the decline of balance performance related with aging. Correlation exists between ankle ROM and balance in healthy elderly people. Additional research is needed to add the ankle ROM to reflect the excise for balance tests and balance ability.