Improving upper extremity motor function in stroke patients using a complex task with multi-joint-based mirror therapy: A randomized controlled trial

@#Background & Objective: Mirror therapy has been shown to be effective in restoring upper extremity function in stroke patients through changes in the central nervous system. Therefore, it is important to evaluate the effectiveness of various tasks to induce central nervous system excitation. This study investigated the effect of using a complex task with multi-joint-based mirror therapy on upper extremity function and activities of daily living (ADL) in patients with hemiplegia after a stroke. Methods: In this study, 25 stroke patients were recruited and assigned randomly to the experimental or control group. The experimental group received a complex task using multi-joint-based mirror therapy, and the control group received a simple task using single-joint-based mirror therapy. Both groups received the same standard rehabilitation treatment 5 days per week for 4 weeks. An upper extremity evaluation was performed using the Fugl-Meyer Assessment (FMA) and Motor Activity log (MAL). The FMA includes an upper extremity subsection (FMA-UE) as well as upper arm (FMA-UA) and wrist/hand (FMA-WH) subparts. The MAL includes quality of movement (QOM) and amount of use (AOU) subsections. ADL were evaluated using the Korean version of the Modified Barthel Index (K-MBI). Results: Compared with the control group, the experimental group showed greater improvement on the FMA-UE, -UA, and -WH (p = 0.034, 0.047, and 0.013, respectively); MAL-AOU and -QOM (p = 0.048 and 0.034, respectively); and K-MBI (p = 0.031). The following effect sizes (Cohen’s d) were observed: FMA-UE, -UA, and -WH (1.0); MAL-AOU (0.2); MAL-QOM (1.6); and K-MBI (0.2). Conclusions: This study demonstrates that a complex task using multi-joint-based mirror therapy is more effective in restoring upper limb function and ADL in stroke patients than simple task-based mirror therapy.

Transdermal Nicotine Patch Effects on EEG Power Spectra and Heart Rate Variability During Sleep of Healthy Male Adults

OBJECTIVE: The effect of transdermal nicotine patch on sleep physiology is not well established. The current study aimed to examine the influence of nicotine patch on homeostatic sleep propensity and autonomic nervous system. METHODS: We studied 16 non-smoking young healthy volunteers with nocturnal polysomnography in a double blind crossover design between sleep with and without nicotine patch. We compared the sleep variables, sleep EEG power spectra, and heart rate variability. RESULTS: The night with nicotine patch showed significant increase in sleep latency, wake after sleep onset, and stage 1 sleep; and decrease in total sleep time, sleep efficiency, and percentage of REM sleep. Also, spectral analysis of the sleep EEG in the night with nicotine patch revealed decreased slow wave activity in stage 2 and REM sleep and increased alpha activity in the first NREM-REM sleep cycle. Heart rate variability showed no differences between the 2 nights, but the low to high ratio (a parameter indicative of sympathetic nervous system activity) positively correlated with wake after sleep onset in night with nicotine patch. CONCLUSION: Transdermal nicotine patch significantly disrupts sleep continuity, sleep architecture, and homeostatic sleep propensity. The overactivation of the sympathetic nervous system may be responsible for these changes.

Compliance of Nasal Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome / 수면정신생리

OBJECTIVES: Nasal continuous positive airway pressure (nCPAP) is the treatment of choice and has been shown to reduce the frequency of nocturnal respiratory events, improve sleep architecture, and decrease daytime sleepiness in patients with obstructive sleep apnea syndrome (OSAS). However, little is known about the compliance of nCPAP treatment in Korea. Our objective was to look into the nCPAP compliance and examine the factors influencing it. METHODS: We reviewed the records of one hundred and twenty consecutive patients with OSAS referred for nocturnal polysomnography with nCPAP pressure titration during the period of January 1995 through April 1999 to the Seoul National University Hospital. We performed a telephone interview and obtained data from eighty-three patients. RESULTS: In sixty patients who had accepted nCPAP treatment, twenty-six patients (43.3%) were still using nCPAP device, while thirty-four patients (56.7%) stopped using it. Fifteen patients (25%) were using nCPAP device everyday. In thirty-four patients who discontinued nCPAP use, twenty-five patients (73.5%) did within the first three months, and thirty-one (91.2%) within the first year. Significant predictor of long-term nCPAP use was the presence of subjective daytime sleepiness before nCPAP application. CONCLUSIONS: Long-term compliance with nCPAP treatment appears to be associated with the presence of subjective daytime sleepiness before nCPAP application. Long-term compliance with nCPAP may be mostly predicted from the usage pattern within the first three months of use.

The Temperament and Character Pattern of Korean Narcolepsy Patients / 수면정신생리

OBJECTIVES: To compare the biogenetic temperament and character patterns of subjects with narcolepsy and those of healthy control subjects. METHODS: Twenty-two subjects with narcolepsy, diagnosed with the International Classification of Sleep Disorder (ICSD) criteria, and 22 healthy control subjects were recruited. The Korean version of the Temperament and Character Inventory was administered to all subjects. RESULTS: Compared to healthy control subjects, subjects with narcolepsy showed significantly higher Novelty-Seeking (ANCOVA, F=5.42, p=0.025), lower Persistence (F=8.41, p=0.006) and lower Self-Directedness scores (F=4.70, p=0.036). CONCLUSION: Narcoleptic patients have a distinct pattern of biogenetic temperament and character. Our findings suggest that narcoleptic patients are exploratory in response to novelty but give up easily. In addition, our findings show that narcoleptic patients consider themselves ineffective, purposeless, and fragile.