The Effect of Treadmill Aerobic Exercise in Stroke Patients

OBJECTIVE: To investigate the effect of treadmill aerobic exercise for eight weeks on cardiopulmonary fitness and functional mobility in stroke patients METHOD: Twenty one stroke patients who could walk independently and had MMSE score of 24 or higher were included. We used maximal exercise test by means of modified Harbor protocol before and after eight weeks' treadmill aerobic exercise. We monitored patients' status with EKG, heart rate, blood pressure and Borg rating of perceived exertion, and measured maximal O2 consumption, maximal heart rate, blood pressure, minute ventilation, rate pressure product and respiratory exchange ratio during maximal exercise test. We also assessed functional mobility by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index before and after 8 weeks' training. RESULTS: Twenty one patients completed treadmill aerobic exercise training. After eight weeks' treadmill aerobic exercise, the cardiopulmonary fitness, measured by maximal O2 consumption, maximal heart rate, minute ventilation, systolic blood pressure, functional mobility measured by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index showed statistically significant improvement (p<0.05). CONCLUSION: Eight weeks' treadmill aerobic exercise improved the cardiopulmonary fitness and functional mobility in ambulatory stroke patients.

Transfer Activities in Patients with Spinal Cord Injury after Discharge from Hospital

OBJECTIVE: To investigate the transfer activities in patients with spinal cord injury (SCI) after discharge, and assess the caregivers' pain related to patient transfer in the community residence. METHOD: One hundred seventeen SCI patient and 35 caregivers for the patients dependent on bed-wheelchair transfer activities were included. As for SCI patients, motor index score (MIS), one transfer item from the Korean version of modified Barthel index (K-MBI), and three items related to transfers from the spinal cord independence measure (SCIM) II were evaluated. Regarding caregivers, musculoskeletal pain with patient transfer, ease-of-use and safety of transfer methods including an electric-powered lift were measured. RESULTS: The degree of transfer activity changed in 21 patients (17.9%). During follow-up, all patients with SCI at and above C6 showed dependent transfer activities. Eight from 10 patients with SCI at C7, and all patients with SCI at and below C8 performed independent bed-wheelchair transfer activities. Thirty caregivers complained of chronic musculoskeletal pain. The degree of pain at the time of patient transfer was significantly lower in those who used electric-powered lifts compared to manual transfer methods. Caregivers using electric-powered lifts showed significantly better ease-of-use scale than those using manual transfer methods. However, there was no significant difference in the safety scale. CONCLUSION: The use of electric-powered lifts is essential for patients who cannot perform independent transfers, especially those with SCI at and above C7.

Rehabilitation of Drivers with Brain Injury Using Virtual Reality Based Driving Simulator

OBJECTIVE: To investigate the effect of driving-simulator based training for the persons with brain injury. METHOD: Twenty-seven brain injury patients and 19 healthy volunteers were included in this study. Driving simulator program was composed of an aptitude test (which have 4 items) and simulated road driving. The brain injury patients had 4 sessions of driving simulator training with assessment performed during the first and the last session. Healthy volunteers underwent only one driving simulator session for assessment. To evaluate subjective satisfaction in terms of training effect and the sense for the real, a survey was administered after the training. RESULTS: In brain injury patients, there were significant improvements in both aptitude test and simulated road driving test after training (p <0.01). There were no significant differences between the scores of patients taken at the last session and the scores of healthy volunteers, while the scores of patients taken at the first session were significantly lower than those of healthy volunteers. The patients group reported positively in terms of training effect (81.5%) and the sense for the real (62.9%). CONCLUSION: A driving-simulator based training was effective for brain injury patients to regain driving skill.

Selection of Aerobic Exercise Intensity Using Heart Rate Reserve in Stroke Patients

OBJECTIVE: To determine the intensity of aerobic exercise in stroke patients using heart rate reserve (HRR) by comparing maximal oxygen consumption (VO2max) and VO2 at % HRR in maximal exercise test of treadmill, arm ergometer and bicycle ergometer. METHOD: Twenty nine stroke patients who could walk independently were included. Maximal exercise test using treadmill, arm ergometer and bicycle ergometer was performed. Heart rate, rating of perceived exertion, minute ventilation, oxygen consumption and respiratory exchange ratio were measured through respiratory gas analysis. When the standard criteria for maximal oxygen consumption (VO2max) was achieved, each test was terminated. We compared the measured VO2max with the VO2 at % heart rate reserve (HRR) and figured out the statistically significant % HRR point. RESULTS: Twenty-four (82.7%), twenty-four (82.7%) and twenty-five (86.2%) patients completed maximal exercise test using treadmill, arm ergometer and bicycle ergometer. Most patients who completed maximal exercise test satisfied the VO2max criteria with VO2 plateau at the end of the exercise test (41.3~48.2%) or RER > 1.0 (79.3~82.7%) or peak HR >age-predicted maximal heart rate (APMHR)-10 or peak HR > 70% {208-(0.7 x age)} when they took beta- blockers (6.8~13.7%). The differences between measured VO2max and VO2 above 60% HRR at treadmill test, 65% HRR at arm ergometer test, 65% HRR at bicycle ergometer test were not statistically significant (>0.05). CONCLUSION: Exercise above 60% HRR at treadmill test, 65% HRR at arm and bicycle ergometer test can be useful as aerobic exercise intensity in stroke patients.

Impact of Sitting Time on Seat-Interface Pressure of Spinal Cord Injured Patients

OBJECTIVE: To examine changes in seat-interface pressure in wheelchair seated spinal cord injured patients. METHOD: Twenty-six spinal cord injured patients, who were motor complete tetraplegic and paraplegic patients, were included in this study. After 5 cm air-filled cushion (ROHO(R)) was placed on their own wheelchair seat, patients were seated on wheelchair with neutral position for sixty minutes. The interface pressure and contact area of buttock was measured every 5 minutes. RESULTS: Significant increases of interface pressure were found in maximal and mean interface pressure during 0 to 25 minutes of sitting (p<0.05). An increased tendency of contact area of buttock was observed during sitting time but it was not significant. CONCLUSION: There were no significant changes of interface pressure after 25 minutes of sitting in spinal cord injured patients. Therefore, twenty-five minutes may be a reasonable sitting time before interface pressure is recorded.

Nocturnal Penile Tumescense and Rigidity Testing for Evaluation of Erectile Dysfunction in Men with Spinal Cord Injury

OBJECTIVE: To evaluate erectile dysfunction in patients with spinal cord injury and the relationship between patient's subjective answers and the results of objective tests regarding erectile dysfunction. METHOD: Twenty-one male patients with erectile dysfunction after spinal cord injury were administered with nocturnal penile tumescense and rigidity testing (NPTR) using Rigiscan(R) over 2 consecutive nights. NPTR using Rigiscan(R) at second night was performed after oral administration of sildenafil 50 mg. Answer of the global efficacy question (GEQ) after oral administration of sildenafil 50 mg and the parameters of NPTR were compared. RESULTS: After oral administration of sildenafil 50 mg, number and duration of erectile episodes, and duration of rigidity greater than 60% on NPTR improved significantly (p< 0.05). Sixteen out of seventeen patients (94.1%) who showed improved nocturnal erection after oral administration of sildenafil 50 mg answered that they had an improved erectile function after sildenafil. All four patients (100%) who showed no improvement in nocturnal erection after sildenafil answered that their erectile function was not improved after oral administration of sildenafil 50 mg. CONCLUSION: We expect NPTR using Rigiscan(R) might be useful for the evaluation of erectile dysfunction in men with spinal cord injury.