Comparison of Functional Electrical Stimulation with Multi-joints Coordinate Movement and Electric Muscle Stimulation on Mono-joint for Arm Recovery in Hemiplegia

BACKGROUND: To assess the efficacy of functional electrical stimulation(FES) with multi-joints coordinate movement compared to electric muscular stimulation for mono-joint movement in enhancing the upper extremity motor and functional recovery of hemiplegic survivors. METHODS: Forty patients with hemiplegia were divided into two groups. The FES group received FES to produce hand grip, elbow flexion, elbow extension and hand release in sequence with voluntary movement. Control group received electrical stimulation to produce wrist extension without voluntary movement. All groups received for 20 minutes per session, twice a day, 5 days a week during 4 weeks and under the same occupational and physical therapies during 4 weeks. Outcomes were assessed in a blinded manner with the upper extremity component of the Fugl-Meyer Motor Assessment, the self-care component of the Modified Barthel Index(MBI), Upper extremity muscle strength, Wolf Motor Function Test(WMFT), spasticity, and Range of motion(ROM) of shoulder before and after treatment. RESULTS: There were significant improvements of the power at shoulder & elbow flexion, WMFT, Fugl-Meyer, hand grip, and MBI in both group(p<0.05). ROM of shoulder, the power of wrist extension, and pinch improved only at the FES group(p<0.05). The FES group had better effects at WMFT, Fugl-Meyer, hand grip, pinch, MBI, shoulder ROM, and spasticity after treatment(p<0.05). CONCLUSION: This study showed that FES and multi-joints coordinate movements are better than electric muscular stimulation for mono-joint movement to enhance the upper extremity functional recovery in hemiplegia.

The Effect of Functional Electrical Stimulation on Swallowing Function in Stroke Patients with Dysphagia

OBJECTIVE: This study was designed to evaluate the effect of functional electrical stimulation on swallowing function in stroke patients with dysphagia. METHOD: The subjects were 22 stroke patients with dysphagia. Functional electrical stimulation was applied to skin over anterior neck for thirty minutes and then, the patients were trained to swallow at the time of maximal stimulation. Swallowing function was evaluated by functional dysphagia scale using videofluoroscopic swallowing study with semisolid material before and 2 weeks after electrical stimulation. RESULTS: There were no significant differences in oral phase scores, the scores of triggering of pharyngeal swallow, residue in piriform sinuses, and coating of pharyngeal wall after swallow of pharyngeal phase. However, the scores of laryngeal elevation and epiglottic closure, residue in valleculae and pharyngeal transit time were significantly decreased (p<0.05). The score of pharyngeal phase was negatively correlated with the pulse intensity. The score of oral phase was negatively correlated with the cognitive function. CONCLUSION: The results of this study showed that the functional electrical stimulation can be used as an additional treatment method for stroke patients with dysphagia.

Successful Immunosuppression with Cyclosporine after Renal Transplantation in a Patient with Chronic Renal Failure Due to Postpartum Hemolytic Uremic Syndrome / 대한이식학회지

Hemolytic uremic syndrome is characterized by the symptoms of microangiopathic hemolytic anemia, thrombocytopenia and renal failure. The incidence of hemolytic uremic syndrome associated with pregnancy is 10 to 25 percent. Hemolytic uremic syndrome is treated with adjunctive therapies, such as anti-platelet agents, glucocorticoid and plasma exchange. However, many patients experience a residual impairment in renal function and some of them progress to end-stage renal disease requiring dialysis or renal transplantation. Immunosuppression with cyclosporine has been implicated as a significant risk factor for post- transplant hemolytic uremic syndrome. A number of reports on transplant recipients have recognized cyclosporine-induced hemolytic uremic syndrome as a distinct entity and a potentially serious complication of cyclosporine administration.We report a case of a patient with successful renal transplantation using cyclosporine who had a severe case of post-partum hemolytic uremic syndrome that progressed to end-stage renal disease. After cadaver-donor renal transplantation using cyclosporine, mycophenolate mofetil and prednisolone her graft function at two years is normal with serum creatinine 1.0 mg/dl.