Erratum: Effect of Posture on Muscle Activity and Oxygen Uptake in Cycle Ergometer / 대한스포츠의학회지

No abstract available.

Effect of Posture on Muscle Activity and Oxygen Uptake in Cycle Ergometer / 대한스포츠의학회지

This study evaluated the effects of saddle height on the muscle activity and oxygen uptake during bicycling. The subjects were 20 young adult volunteers. Muscle activity and oxygen uptake were measured with the two saddle heights (maximum knee extension of 180degrees and 120degrees) and at two power outputs (70 and 100 watts, respectively.) The pedaling rate was 40 rpm. The exercise time was 1 minute and the resting time between each condition was 3 minutes. The raw electromyogram activity was measured for 1 minute and was converted to a root mean square value. Oxygen uptake was measured during exercise using the mixing chamber mode. The activities of two flexors (the medial hamstring and medial head of gastrocnemius) increased at the high saddle height and the activities of four extensors (rectus femoris, vastus medialis, vastus lateralis, and tibialis anterior) increased at the low saddle height. The oxygen uptake at the low saddle height was significantly higher than that at the high saddle height. The oxygen uptake positively correlated with the muscle activities of the knee extensors. The muscle activity and oxygen uptake were significantly affected by the postures (saddle heights) in cycle ergometer. The postures should be considered in the exercise test and prescription.

Cardiopulmonary Exercise Capacity in Coronary Artery Disease Patients Receiving Percutaneous Coronary Intervention Compared with Coronary Artery Bypass Grafting

OBJECTIVE: To compare the exercise capacity after cardiac rehabilitation (CR) in patients with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. METHOD: 27 patients who underwent PCI and 18 patients who underwent CABG surgery were included. All the subjects performed supervised exercise training for 6~8 weeks at hospital and self-exercise at community for additional 16~18 weeks. Exercise capacity was measured by symptom limited graded exercise tests at study entry and 6 months later. RESULTS: After 6 months of CR, maximal oxygen consumption (VO2max) was significantly increased, resting heart rate (HR) and submaximal rate pressure product (RPP) were significantly decreased in both groups (p<0.05). There were no significant change of maximal HR in both groups (p<0.05). Maximal RPP in CABG increased significantly (p<0.05) but did not change significantly in PCI group. Resting HR was significantly higher, VO2max was significantly lower in CABG group than PCI group at study entry (p<0.05). Resting HR was not significantly different in both groups but, VO2max was still lower in CABG group than PCI group even after 6 months of CR (p<0.05). CONCLUSION: The cardiac rehabilitation program was effective in both PCI and CABG group. Although VO2max in PCI group was higher than CABG group after 6 month CR, the range of improvement was greater in CABG group than PCI group.

The Causes for the Premature Termination of Graded Exercise Test in a Cardiac Rehabilitation Setting

OBJECTIVE: To observe the termination point of graded exercise test (GXT) in cardiac patients and the reasons for the premature termination. METHOD: Cardiac patients taking GXT within 4 weeks after medical intervention or surgery were reviewed. If the GXT was stopped below the respiratory exchange ratio of 1.0, the subjects were chosen as the final study subjects and reviewed for the reason of premature termination. RESULTS: 115 out of a total of 715 subjects terminated GXT prematurely. There were 36 cardiovascular, and 79 non- cardiovascular reasons. The cardiovascular reasons were abnormal blood pressure response (19.1%), dysrhythmia (6.1%), ST abnormality (3.5%), vascular claudication (2.6%). The non-cardio-vascular reasons were subjective dyspnea (45.2%), lower limb fatigue (7.8%), hemiplegic gait (5.2%), arthralgia (3.5%), anxiety (3.5%), neurogenic claudication (2.6%), and abdominal pain (0.9%). The causes of dyspnea were low physical fitness (71.1%), concurrent chronic obstructive pulmonary disease (15.4%), poor motivation (5.8%), and secondary gain (7.7%). CONCLUSION: 16.1% of GXT were terminated prematurely and 68.7% of those for non-cardiovascular reasons. The main causes of the non-cardiovascular premature GXT were subjective dyspnea due to low physical fitness.

Tendon Diameter of Rotator Cuff and Strength of the Shoulder External/Internal Rotator Muscles in Elite Thrower

OBJECTIVE: To know the characteristics of muscle strength and tendon diameter of rotator cuff in the elite thrower and correlation between both parameters. METHOD: Twenty-four elite throwers (male 16, female 8) without pain and injury were included. Dominant hand was right side in all subjects. Thickness and width of rotator cuff except teres minor were measured with ultrasonography. Concentric strengths of shoulder internal (IR) and external rotators (ER) were measured with isokinetic device. RESULTS: There was no difference between dominant and nondominant shoulder in tendon diameter except that thickness and width of dominant infraspinatus were greater than nondominant. ER/IR peak torque ratio was about 1.0 in both sides. There were significant correlations between subscapularis thickness and IR strength, infraspinatus width and ER strength, supraspinatus thickness and ER strength, supraspinatus width and ER strength, infraspinatus thickness and IR strength, infraspinatus width and IR strength in nondominant side, and subscapularis thickness and ER strength in dominant side. CONCLUSION: It is possible that external rotation peak torque is increased in elite thrower. Muscle strength could not be expected by tendon diameter except nondomiant subscapular thickness and infraspinatus width. This study will be the basis of the next study about elite thrower.

Sonographically Guided Musculocutaneous Nerve Phenol Block for Elbow Flexor Spasticity: Case report

Seven hemiplegic stroke patients suffering elbow flexor spasticity were selected for musculocutaneous nerve (MN) blocks. The MN was identified at the proximal 1/3 area on anteromedial surface of upper arm at supine position. An injectable monopolar EMG needle electrode was inserted into MN under real time ultrasonography. The 7% phenol solution was injected 0.2 ml at a time into MN until biceps brachii and brachialis muscle contractions were completely blocked at a maximum of 5 mA electrical stimulation. The total dose of injected phenol solution was 1.2~2.2 ml. We examined modified Ashworth scale (MAS) of elbow flexor and elbow angle at the standing position. In all the subjects, MAS was decreased and elbow angle was increased after nerve block. Ultrasonography guidance makes it exact to identify MN and to inject neurolytic solution to target. It can lead minimal complications by using the least dosage of neurolytic drug.

Effectiveness of the Cardiac Rehabilitation on Exercise Capacity and Risk Factor in Coronary Artery Obstructive Disease

OBJECTIVE: To evaluate the effectiveness of cardiac rehabilitation (CR) program on the exercise capacity and secondary prevention in coronary artery obstructive disease (CAOD). METHOD: CR group of 48 CAOD patients had underwent regularly supervised exercise training for 6~8 weeks as well as home exercise continued for 1 year. CR group was advised to control their risk factors by nutrition counsel, abstaining from smoking and reducing their weight. Control group of 16 CAOD patients did not participate in the CR program. Two groups were evaluated for their exercise capacity and risk factors at baseline and after 1 year. RESULTS: CR group showed significantly higher maximal oxygen consumption, maximal rate pressure product and ratings of perceived exertion at stage 3 compared with control group (p<0.05). The number of risk factors per person after 1 year in both groups was significantly lower than baseline (p<0.05), but there was no significant difference between the two groups. CONCLUSION: CR program can improve the exercise capacity and level of risk factor in CAOD patients. Therefore, CR program is recommended for helping CAOD patients improve their functional capacity and reduce the possibility of recurrence.

Biomechanical Assessment with Electromyography of Post-Stroke Ankle Plantar Flexor Spasticity

Spasticity has been defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflex (muscle tone). Muscle tone consists of mechanical-elastic characteristics, reflex muscle contraction and other elements. The aims of this study were to determine whether to assess spasticity quantitatively, and to characterize biomechanical and electromyographic spasticity assessment parameters. These assessment parameters were described by investigating the correlation between clinical measures and the response to passive sinusoidal movement with consecutive velocity increments. Twenty post-stroke hemiplegic patients and twenty normal healthy volunteers were included in the study. Five consecutive sinusoidal passive movements of the ankle were performed at specific velocities (60, 120, 180, and 240 degrees/ sec). We recorded the peak torque, work, and threshold angle using a computerized isokinetic dynamometer, and simultaneously measured the rectified integrated electromyographic activity. We compared these parameters both between groups and between different velocities. The peak torque, threshold angle, work, and rectified integrated electromyographic activity were significantly higher in the post-stroke spastic group at all angular velocities than in the normal control group. The threshold angle and integrated electromyographic activity increased significantly and linearly as angular velocity increased, but the peak torque and work were not increased in the post-stroke spastic group. Peak torque, work, and threshold angle were significantly correlated to the Modified Ashworth scale, but the integrated electromyographic activity was not. The biomechanical and electromyographic approach may be useful to quantitatively assess spasticity. However, it may also be very important to consider the different characteristics of each biomechanical parameter.

Immediate and Long-term Effect of Exercise on Heart Rate Variability in Coronary Artery Disease

OBJECTIVE: To evaluate the dynamics of autonomic nervous activity at rest and immediately after maximum exercise using heart rate variability (HRV) in coronary artery disease (CAD) and to assess the long-term effect of exercise. METHOD: Time and frequency domain of HRV was measured in 18 normal subjects, 37 CAD patients with percutaneous transluminal angioplasty and 10 CAD patients with coronary artery bypass graft at rest and 1 hour after peak graded treadmill exercise. Nineteen CAD patients were exercised with moderate intensity during 4 month and HRV was measured. RESULTS: At rest, the standard deviation of the NN interval (SDNN) and low frequency was significantly lower in both CAD groups than in normal subjects. At recovery stage after maximum exercise, low frequency and low frequency/high frequency ratio was significantly lower in both CAD groups than in normal subjects. SDNN at recovery stage in normal subjects remained significantly below the baseline. There was no significant change in HRV after long-term exercise even though maximum oxygen uptake had improved. CONCLUSION: This study demonstrated the reduced control of autonomic nervous activity in CAD patients at rest and immediately after peak exercise. There was no change in HRV after long-term exercise.

Effect and Safety of Cardiac Rehabilitation Program in Heart Failure

OBJECTIVE: This study was performed to investigate the effect and safety of cardiac rehabilitation program in heart failure. METHOD: 36 patients who suffered from heart failure with decreased left ventricular ejection fraction less than 50% by echocardiogram were recruited for study subject. They took graded exercise test before and after cardiac rehabilitation program. Cardiac rehabilitation program was consisted of 6~8 weeks monitoring exercise according to the result of exercise test. We reviewed the all courses of the program to see the safety and compared the several results to know the effect of the program. RESULTS: During totally 696 exercise-hours with ECG monitoring, 12 abnormal hemodynamic responses were happened, but those were minor in severity. All of them were managed successfully and could complete their exercise program as their schedules. Even in heart failure patients, cardiac rehabilitation program could improve exercise capacity in terms of increased maximal oxygen consumption, maximal exercise time, and maximal myocardial oxygen demand. Submaximal myocardial oxygen demand and rate of perceived exertion were significantly decreased after cardiac rehabilitation program. CONCLUSION: In case of prudent monitoring and proper management, cardiac rehabilitation program is safe and effective to improve exercise capacity in heart failure patient.

Influence of Beta Blocker on Cardiac Rehabilitation Program

OBJECTIVE: The purpose of this study was to evaluate the beta blocker effect on excercise ability and hemodynamics after cardiac rehabilitation program (CRP). METHOD: Thirty-two patients with coronary artery disease were divided into two groups: 16 patients in the beta blocker group and 16 patients in the control group. CRP with aerobic exercise was done for 6 weeks. Before and after CRP, a symptom limited graded exercise test was done. RESULTS: The maximal exercise time and the maximal oxygen uptake were significantly higher, and the percentage of maximal oxygen uptake and the rating of perceived exertion were significantly lower after CRP as compared to those parameters before CRP in both groups (p 0.05). The submaximal heart rate and submaximal rate pressure product (RPP) were significantly lower after CRP as compared to those before CRP in both groups (p<0.05). After CRP, the maximal heart rate and the submaximal RPP were significantly lower in the beta blocker group than in control (p<0.05). CONCLUSION: A beta blocker can be widely used in CRP without having a negative effect on exercise capacity in the patients with coronary artery disease.

The Reasons That Cardiac Patients Did Not Participate in and Drop out from the Cardiac Rehabilitation Program

OBJECTIVE: To survey the cause of the cardiacs' low participation rate and poor compliance in cardiac rehabilitation. METHOD: Among those who admitted in the department of cardiology and chest surgery for acute care and then discharged, group 1 included 104 patients who never participated in cardiac rehabilitation, and group 2 included 47 patients who once joined in but discontinued before 7 sessions, and group 3 included 25 patients who continued it more than 18 sessions with good compliance. Questions related to the low participation rate and discontinuity and personality, psychological status, education level were asked. By SPSS, basic discriptive data were calculated. To compare the data among groups, independent t-test and Chi-square test were done. RESULTS: In group 1, the main causes of low participation rate was lack of recognition about it (78 patients, 75%), doubt on effect (48 patients, 46.2%), poor physical condition (38 patients, 36.5%). In group 2, the main cause of discontinuity was lack of time (12 patients, 25.5%), thought of being able to perform at home (11 patients, 23.4%), poor physical condition (7 patients, 14.9%). CONCLUSION: To raise the participation rate and compliance in cardiac rehabilitation, it is very important to make a pitch for cardiac rehabilitation and improve program service for patient's convinience.

Cardiovascular Complications during Cardiac Exercise Program

OBJECTIVE: To investigate the safety of exercise program under medical supervision for cardiac patients in their early phase from cardiac events, and the types and the frequency of possible cardiovascular complications during or after exercise. METHOD: 197 cardiac patients who participated in phase 2 cardiac rehabilitation were selected and they performed aerobic exercise program by individualized exercise prescription under ECG monitoring 3 times a week for 6 weeks. Throughout total 2,429 sessions of exercise, abnormal symptoms, hemodynamic responses and ECG abnormalities were analyzed. RESULTS: Cardiovascular complications ocurred in 25 patients (12.7%). ECG abnormalities in 14 sessions (0.58%) of 13 patients, chest pain during exercise in 17 sessions (0.67%) of 13 patients, abnormal hemodynamic responses in 8 sessions (0.33%) of 8 patients were observed. Cardiac arrest and myocardial infarct didn't happened. 18 patients (72%) experienced these complications during warming-up period, 6 patients (24%) during cool-down period and one patient (4%) during resting period. CONCLUSION: During exercise, there was some possibility of abnormal ECG changes, chest pain, hemodynamic responses but these potentially dangerous situations could be prevented from advancing on real emergency by intense attention and monitoring. Even cardiac patients of acute stage can tolerate adequate amount of exercise load safely under careful clinical supervision.

Atypical Sturge-Weber Syndrome: A case report

Sturge-Weber syndrome is a congenital neurocutaneous disorder of the vessels of the face, the leptomeninges and the brain. Clinically SWS consists of symptoms and signs including a facial nevus (port-wine stain), seizure, hemiparesis, mental retardation. But only a few reports related to atypical Sturge-Weber syndrome without facial nevus have been published. We report a patient with atypical Sturge-Weber syndrome without any clinical feature except hemiparesis. In neuroimaging studies using brain CT scan and MRI, leptomeningeal angiomatosis was demonstated that is the characteristic feature of Sturge- Weber syndrome. In atypical Sturge-Weber syndrome, there may be late- developed complications such as hemiparesis. In conclusion, neuroimaging study is recommended to confirm diagnosis in suspicious atypical SWS patient.

Kinematic Gait Analysis in Children with Hemiplegic Spastic Cerebral Palsy

OBJECTIVE: The purpose of this study is to evaluate gait characteristics using kinematic analysis in children with hemiplegic spastic cerebral palsy. METHOD: Fifty-seven non-operated spastic hemiplegic children who were able to walk independently without any walking aid were recruited as subjects. Three-dimensional kinematic gait analysis using a motion analyzer (Vicon 370 M. A. with 6 infrared cameras) were performed in all patients. Changes in joint angle of hip, knee and ankle in sagittal plane were evaluated to classify gait pattern and also the temporospatial values were measured to determine any differences between groups. RESULTS: Gait patterns were able to be classified into 6 groups. Group I had a minimal gait disturbance, a drop foot pattern. Group II showed hip and knee flexed, with normal ankle range. Group III showed hip, knee, and ankle flexed. Group IV showed genu recurvatum with tibia progression, Group V showed genu recurvatum with tibia arrest. Group VI showed stiff crouch gait. However, the temporospatial values between groups were not significantly different. CONCLUSION: This classification system would be useful for converting the vast quantitative information of gait analysis into descriptive and clinically relevant patterns. Therefore, it would be helpful for the clinician to understand underlying pathology and plan appropriate treatment.

Rehabilitation of the Bilateral Upper Extremity Amputees

Rehabilitation in patients with bilateral upper extremity amputation presents a considerable problem for prosthetic training. This is a report of a bilateral transhumeral amputee and a bilateral transradial amputee admitted for intensive prosthetic rehabilitation. They underwent bilateral upper extremity amputation due to electric burn. They were successfully fitted with conventional body-powered prostheses. The problems in rehabilitation of adult bilateral upper extremity amputees were discussed and the patients' compliance was assessed. In our two cases, good acceptance and functional benefit were noted. Thus, we suggest that multidisciplinary approach including prosthetists with full discussion should be a very important factor for specialized comprehensive prosthetic training of multiple complexed amputee.

Clinical Effectiveness of Intravesical Oxybutynin Instillation in Spinal Cord Injured Patients with Hyperreflexic or Hypertonic Neurogenic Bladder

OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness of intravesical oxybutynin chloride instillation in the management of neurogenic bladder dysfunction in spinal cord injured patients. METHOD: Fifty-two spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder were treated with intravesical oxybutynin instillation therapy. The purified oxybutynin chloride was dissolved in sterile water and mixed with normal saline. This oxybutynin solution was instilled twice a day for 7 days. The urodynamic studies were compared before and after the instillation. Total volume of daily incontinence was also monitored. RESULTS: After the intravesical oxybutynin instillations, mean maximal bladder capacity increased from 212.13 to 323.81 ml (p<0.01), mean bladder compliance increased from 11.73 to 18.56 ml/cmH2O (p<0.01), mean maximal detrusor pressure decreased from 67.19 to 50.90 cmH2O (p<0.01) and mean daily amount of incontinence decreased from 735.58 to 201.73 ml (p<0.01). No significant differences were found between the groups according to the level of injury, completeness of injury, duration since onset of injury and the presence of asymptomatic bacteriuria. CONCLUSION: This study proved that intravesical instillation of oxybutynin solution is an effective method in spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder dysfunction regardless the level and completeness of injury, as well as duration since the onset of injury or the presence of asymptomatic bacteriuria.

Ice Water Urodynamic Study in Neurogenic Bladder of Spinal Cord Injured Patients

OBJECTIVE: To determine the clinical utility of ice water test for the urodynamic study in neurogenic bladder of spinal cord injured patients. METHOD: Warm water (20~30oC) urodynamic studies were performed on 66 spinal cord injured patients. Subsequently, ice water (4~8oC) urodynamic studies were performed. We determined the ice water test to be positive if the reflex volume of ice water urodynamic study is lower than the volume of the warm water urodynamic study. RESULTS: Ice water test was positive in 24 (55.8%) and negative in 19 (44.2%) of the 43 patients showing hyperreflexic detrusor activity in warm water urodynamic study. Ice water test was negative in all 23 cases showing areflexic detrusor activity. No significant difference was found between positive and negative ice water test groups for the level of injury, sex, age, extent of injury and duration since injury. If water was cool enough, positivity of ice water test was not affected by infusion rate. There was no difference between the two urodynamic studies of maximal bladder pressure and compliance. CONCLUSION: This study suggests that ice water urodynamic study is a useful method for the evaluation of hyperreflexic neurogenic bladder activated by cold specific receptors via C afferent fibers in spinal cord injured patients.

The Clinical Effectiveness of Serial Radioisotope Renography in Evaluation of Renal Function Changes in Spinal Cord Injured Patients

OBJECTIVE: The purposes of our study were to determine the effect of serial radioisotope renography on the diagnostic evaluation and therapeutic intervention of spinal cord injured patients and to determine the characteristics of renographic findings in spinal cord injured patients. METHOD: Three hundred and two spinal cord injured patients were examined with radioisotope renography using Technetium-99m mercaptoacetyltriglycine. Forty-two of 302 patients were examined in serial studies. Intravenous pyelogram, urodynamic study, 24-hour creatinine clearance, and voiding cystourethrogram were also performed. Radioisotope renography was correlated with diagnostic procedures and therapeutic interventions. Therapeutic interventions included changes in medication and bladder management. RESULTS: The renal functions in the left kidney were better than the functions in the right kidney after spinal cord injury (p<0.01). If neurogenic bladders were managed properly, renal functions improved after the shock stage of injury (p<0.05). Patients with significant improvement in their renal function underwent changes in proper medication and methods of bladder management (p<0.05). Renal function changes were correlated with the type of neurogenic bladder and maximal detrusor pressure (p<0.05). No significant renal function changes were found between the groups according to the completeness of injury and gender. CONCLUSION: Radioisotope renography is a good initial indicator to show problems that required management changes. Serial radioisotope renographic findings give valuable informations about the urinary tract in spinal cord injured patients.

Effect of Seizure Disorders on Developmental Disability in Patients with Cerebral Palsy or Delayed Development

OBJECTIVE: To investigate the effect of epilepsy and neonatal seizure on development in children with cerebral palsy (CP) or delayed development (DD). METHOD: The subjects were 135 patients with CP or DD. Development was evaluated by Bayley Scale of Infant Development II (BSID II). Epilepsy was diagnosed on the base of clinical features, past history and electroencephalography. RESULTS: The incidence of epilepsy was 18.4% in CP, and 37.8% in DD. Spastic quadriplegia of CP has the highest incidence of epilepsy (38.4%). First seizure attack was occurred before 6 months old of age in 66.7% of CP with epilepsy and in 64.3% of DD with epilepsy. The prevailing type of epilepsy was generalized seizure in DD (57.1%), partial seizure in CP (50.0%). The group with epilepsy had lower psychomotor and mental development quotient on BSID II than the group without epilesy (p<0.05). Polytherapy was more used to control epilepsy than monotherapy. Valproate (50.0%), phenobarbital (37.5%), carbamazepine (31.3%) were commonly used drugs for controlling epilepsy. CONCLUSION: The epilpesy has a negative effect on psychomotor and mental development in the children with CP or DD.