A Model of Glial Scarring Analogous to the Environment of a Traumatically Injured Spinal Cord Using Kainate

OBJECTIVE: To develop an in vitro model analogous to the environment of traumatic spinal cord injury (SCI), the authors evaluated change of astrogliosis following treatments with kainate and/or scratch, and degree of neurite outgrowth after treatment with a kainate inhibitor. METHODS: Astrocytes were obtained from the rat spinal cord. Then, 99% of the cells were confirmed to be GFAP-positive astrocytes. For chemical injury, the cells were treated with kainate at different concentrations (10, 50 or 100 µM). For mechanical injury, two kinds of uniform scratches were made using a plastic pipette tip by removing strips of cells. For combined injury (S/K), scratch and kainate were provided. Cord neurons from rat embryos were plated onto culture plates immediately after the three kinds of injuries and some cultures were treated with a kainate inhibitor. RESULTS: Astro-gliosis (glial fibrillary acidic protein [GFAP], vimentin, chondroitin sulfate proteoglycan [CSPG], rho-associated protein kinase [ROCK], and ephrin type-A receptor 4 [EphA4]) was most prominent after treatment with 50 µM kainate and extensive scratch injury in terms of single arm (p<0.001) and in the S/K-induced injury model in view of single or combination (p<0.001). Neurite outgrowth in the seeded spinal cord (β-III tubulin) was the least in the S/K-induced injury model (p<0.001) and this inhibition was reversed by the kainate inhibitor (p<0.001). CONCLUSION: The current in vitro model combining scratch and kainate induced glial scarring and inhibitory molecules and restricted neurite outgrowth very strongly than either the mechanically or chemically-induced injury model; hence, it may be a useful tool for research on SCI.

The Effect of Family Member's Attendance on Relief of Patient's Discomfort during Upper Gastrointestinal Endoscopy

BACKGROUND: Upper gastrointestinal endoscopy is a very important and highly sensitive method to detect gastroduodenal lesions. But the investigation and diagnosis of gastrointestinal diseases might be delayed by discomfort, pain and anxiety in patients during endoscopy. This study was performed to evaluate the effect of family member's attendance on relief of discomfort in patients and to identify the predictors for pain and discomfort during upper gastrointestinal endoscopy. METHODS: From July to August 2005, 147 clients who underwent gastrointestinal endoscopy were enrolled in this study. The subjects were randomly grouped into family-attended (n=70) group and non-family-attended group (n=77). The patients recorded their pain and discomfort during endoscopy by Visual-Analogue Scale (VAS) score. And also the client's demographic characteristics and endoscopy related factors (procedure duration, previous endoscopy experience, biopsy, endoscopist etc.) were evaluated. We studied the relationship between the various characteristics and discomfort during endoscopy. RESULTS: There were no significant differences of clients' demographic characteristics and endoscopy related factors between the two groups. There was a significant difference of VAS scores between the family-attended group (3.51+/-1.90) and non-family-attended group (4.35+/-2.10) (P= 0.012). Oxygen saturation and pulse rate during the procedure were lower in the family-attended group than in the non-attended group. Recipients' demographic characteristics and various factors related with the procedure (waiting time, biopsy, and previous experience, etc) were not associated with the degree of discomfort. CONCLUSION: Family member's attendance decreased pain and discomfort during endoscopy. The recipients' demographic characteristics and factors related to the procedure had no influence on the degree of discomfort during endoscopy. In conclusion, attendance of a family member should be considered during endoscopy in order to decrease pain and discomfort during the procedure.

Dynamic Changes of Pelvis and Lower Extremities after Operation in Lumbar Degenerative Kyphosis

OBJECTIVE: Gait pattern in patients with lumbar degenerative kyphosis (LDK) is disturbed because trunk bends forward due to decreased lumbar lordosis. Surgical therapy in LDK is required when conservative management fails. We investigated kinematic and kinetic changes of the pelvis, hip, and knee joints on the sagittal plane in patients with LDK before and after operation. METHOD: Fifteen patients underwent operations between March 1999 and September 2003. Gait analysis was performed for all patients. RESULTS: Total lumbar lordotic angle increased from 10.50 degrees +/-11.22 degrees to 26.71 degrees +/-8.80 degrees postoperation. In gait analysis, anterior pelvic tilting angle increased from maximum 7.86 degrees +/-9.69 degrees, minimum 4.40 degrees +/-9.82 degrees to maximum 12.61 degrees +/-5.36 degrees, minimum 9.68 degrees +/-5.63 degrees (p<0.05). Maximum hip flexion angle changed from 31.39 degrees +/-11.71 degrees to 35.83 degrees +/-5.84 degrees (p<0.05). Maximum knee flexion angle in terminal stance phase decreased from 13.32 degrees +/-7.34 degrees to 8.30 degrees +/-6.38 degrees (p<0.05). CONCLUSION: After corrective operation, an increase of lumbar spine lordosis and anterior pelvic tilt with decrease of knee flexion were observed. However, an increase of maximum hip flexion secondary to increased anterior pelvic tilting influenced ambulation negatively. Therefore, stretching of the hip flexor and strengthening of the hip extensor are required before and after operation.

The Therapeutic Effects of Body Weight-Supported Treadmill Training on Childeren with Cerebral Palsy

OBJECTIVE: To determine the effectiveness of body weight- supported treadmill training on gait pattern in children with cerebral palsy METHOD: Seventeen children with cerebral palsy were given with body weight-supported treadmill training. The gait training was offered on treadmill and they were trained five times a week, 20 minutes a session for three weeks. To evaluate the ambulatory function, we estimated the walking distance for one minute and gait analysis before and after the treatment. Gait analysis was done for 11 children with Vicon 370 computerized gait analyzer and linear parameters, kinematic and kinetic data were obtained. RESULTS: Walking distance for one minute increased from 6.74+/-6.16 m to 11.06+/-7.98 m. In linear parameters by gait analysis, gait speed (0.15+/-0.18 m/sec to 0.23+/-0.24 m/sec, p<0.05), cadence (53.0+/-26.3 steps/min to 65.9+/-35.7 steps/min, p<0.05), and stride length (0.30+/-0.17 meters to 0.35+/-0.18 meters, p<0.05) increased following body weight-supported treadmill training. Also, there was a significant difference in knee flexion during loading response. CONCLUSION: In rehabilitation of cerebral palsy, body weight- supported treadmill training improved gait pattern. So, we recommend this gait training method for children with cerebral palsy.

The Effects of Gait Training with Partial Weight Bearing Harness on Treadmill in Early Stroke Patients

OBJECTIVE: To assess the effects of partial weight bearing (PWB) harness with comparison of traditional exercise program by gait analysis in non-ambulatory acute stroke patients. METHOD: Nine patients participated with PWB harness on the treadmill, and nine patients with traditional exercise. In harness group, the gait training with 30% weight reduction was offered on treadmill, they were treated daily and gait training was done for 20 minutes. In no-harness group, traditional gait training was done by physical therapists. Variables were gait parameters assessed by VICON 370 Gait Analyzer, other function tested by Motricity Index and Functional Ambulatory Category. RESULTS: In linear parameter, the harness group had faster gait speed, longer stride length, and more decreased double support time compared to the no-harness group. In kinematic parameters, the maximal flexion of knee was significantly increased in harness group, but no significant differences was in hip and ankle motion. In kinetic parameters, hip flexion moment of normal side was increased in harness group at heel strike phase, knee flexion moment of normal side was decreased in harness group at heel strike phase. CONCLUSION: The gait training with partial weight bearing harness was more effective in acute stroke patients than traditional therapy, and was influenced in gait pattern, functional ability.

Gait Analysis in Cervical Spondylotic Myelopathy at Pre- and Post-Surgery

OBJECTIVE: To investigate objectively the postoperative change of the gait pattern in patients with cervical myelopathy through gait analysis. METHODS: Thirty nine patients who underwent cervical decompression and fusion for cervical myelopathy were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated with Nurick classification, Functional Independence measure (FIM) score and gait analysis using three dimensional motion analyzer before surgery, 1 week and 3 months after surgery. RESULTS: In the Nurick classification there was statistically significant change but no significant change in FIM score after surgery. In the gait analysis there were statistically significant improvements in all the linear parameters, kinetic (ankle plantarflexion moment) and kinematic (knee range of motion in swing phase) parameters (p<0.05). CONCLUSION: This study suggests that gait analysis can be used as a quantitative tools of postoperative gait improvement in patient with cervical myelopathy.

Gait Analysis in Degenerative Arthritis of the Knee at Pre- and Post-Total Knee Arthroplasty (TKA)

OBJECTIVES: To evaluate changes of the gait pattern and the clinical improvement in patients with degenerative arthritis of the knee after total knee arthroplasty (TKA). METHOD: Gait analysis was performed in 64 patients with degenerative arthritis of the knee at pre- and post-surgery 1 year, also Hospital for Special Surgery (HSS) knee score and Visual analogue scale (VAS) for clinical assessment were investigated. RESULTS: 1) In the HSS knee score and VAS, there were statistically significant improvement after surgery (p<0.05). 2) In the postoperative gait analysis, all the linear parameters except single limb support period were significantly improved (p<0.05). Single limb support period was improved, but statistically insignificant. All the kinematic and kinetic parameters also were significantly improved (p<0.05). CONCLUSION: This study suggests that gait analysis can be used for quantitative evaluation of the effects of total knee arthroplasty in patients with degenerative arthritis of the knee.

Significance of Gait Analysis in Surgical Treatment of Lumbar Degenerative Kyphosis

OBJECTIVE: Sagittal imbalance in lumbar degenerative kyphosis (LDK) is usually more evident when walking, suggesting its dynamic nature. Radiographic examination which only revealed the static status of the spine was considered to be inadequate for assessment of this condition. Gait analysis allows estimation of dynamic spinal imbalance associated with the pelvis and lower extremities in LDK. This study was designed to predict the success of surgery for LDK with gait analysis. METHOD: Twenty-six patients who had corrective surgery after gait analysis and had been followed up for more than two years were included in this study. All patients were female, and in average 57.1 years of age (42-70). Group I consisted of 21 satisfactory patients with marked improvement in stooping, and Group II consisted of five patients with persistent stooping, whose condition remained unsatisfactory despite surgery. In order to find the cause of postoperative persistent stooping, various radiographic and preoperative gait parameters were compared between the two groups. RESULTS: The average angle of anterior pelvic tilt, hip, and knee flexion were more increased in Group II than Group I. The pattern of hip internal moment in stance phase of gait cycle was biphasic in Group I, similar to the normal pattern, whereas it was monophasic and internal hip extensor hip moment was increased throughout the stance phase in Group II. CONCLUSION: An available tool that permitts practical evaluation of dynamic sagittal imbalance of the spine is gait analysis as substantiated by the results of this study.

Dynamic Imbalance of Lumbo-Pelvic Motion in Pregnant Women with Back and Pelvic Pain

OBJECTIVE: To investigate a biomechanism of pelvic pain in pregnancy by use of motion analyzer. METHOD: Ten pregnant women in the early third trimester and 10 healthy women as control were enrolled. A gait analysis by a Vicon 370 motion analyzer system was performed to investigate the dynamic lumbo-pelvic motion of pregnancy in biomechanical aspects. RESULTS: The mean maximal surface lordotic angle of pregnant women was 24.42+/-3.98 degrees, the mean minimal surface lordotic angle 20.64+/-4.27 degrees, and the mean maximal surface lordotic angle of controls was 21.61+/-2.43 degrees, the mean minimal surface lordotic angle 18.38+/-2.29 degrees (p>0.05). The mean maximal anterior pelvic tilt of pregnant women was 21.11+/-5.91 degrees, and the mean maximal anterior pelvic tilt of controls was 15.28+/-4.94 degrees (p<0.05). CONCLUSION: The angle of lumbar lordosis was within normal ranges but the anterior pelvic tilt was increased significantly in pregnancy. This can place mechanical stress on lumbo-pelvic region. This dynamic sagittal imbalance of the spine may be a considerable cause for low back and pelvic pain in pregnancy as indicated by the results of this study.

Gait Analysis of Patients with Unilateral Total Hip Arthroplasty

OBJECTIVE: The purpose of this study is to evaluate objectively and quantitatively gait improvement after total hip arthroplasty (THA) using a 3-dimensional computerized Vicon motion analyzer. METHOD: A preoperative gait evaluation was performed within one month before surgery and two postoperative gait evaluations at 6 months intervals after surgery. Pre- and postoperative gait parameters of 176 patients with unilateral total hip arthroplasty were evaluated and data were compared with those of 56 healthy persons. RESULTS: 1) Single limb support of affected limb increased significantly at postoperative 6 and 12 months compared with preoperative data. 2) The improvements of hip flexion and abduction of affected limb were in almost normal range at postoperative 12 months. 3) Maximal hip flexor moment in terminal stance of affected limb reached to nearly normal level at postoperative 12 months. CONCLUSION: A quantitative gait analyzer is a very useful tool to assess objectively the success of THA as substantiated by the results of this study with a significant improvement in all the parameters of gait.

Effect of Torque Heel on Excessive External Rotation of Hemiplegic Foot: Three Dimensional Gait Analysis

OBJECTIVE: Excessive external rotation of the hemiplegic foot is a common problem of hemiplegic gait. There has been a few report on etiological investigation and corrective measurement of an excessive external rotation of hemiplegic foot. Thus we present a newly designed Torque heel to correct the external rotation of hemiplegic foot. METHOD: Ten hemiparetic patients with an excessive external rotation of affected foot participated in this study. All of the participants were able to walk at least 10 meters with metal a ankle foot orthosis (AFO) using a single cane. Each of these patients was placed on four tries of walk: (1) on a bare foot; (2) with an AFO; (3) with an AFO and a quarter inch of lateral wedge; and (4) with an AFO and the Torque heel . Gait patterns were analysed by the Vicon 370, three dimensional motion analyser. RESULTS: The speed and stride length increased in all tries except for the bare foot walk. Those who walked with the assistive devices showed no difference in the speed and stride length. All the participants showed an increased in external rotation of pelvis and ankle. Those who walked with an AFO and Torque heel presented a decrease in the external rotation of foot and pelvis. The hip and ankle motions of the hemiplegic limbs were not affected with the AFO and Torque heel . A significant degree of correction in pelvic rotation with an AFO and Torque heel was noted. CONCLUSIONS: This study indicates that an AFO with Torque heel is beneficial to the correction of external rotation of a hemiplegic foot. And the excessive external rotation of hemiplegic foot may be due possibly to the external rotation of pelvis.

Gait Analysis of Patients with Unilateral Hip Lesion Treated with Total Hip Arthroplasty / 대한정형외과학회잡지

Total hip replacement arthroplasty ( THA ) is a useful treatment method in the patients with avascular necrosis ( AVN ) or degenerative arthritis ( DA ) to relieve pain and recovery of function. Beside pain relief , patients want improvement in gait pattern , which is related with Jeg length discrepancy, range of motion, and muscle power. It could be difficult to analyse the cause of limp accuratelv by the clini-cal observation. Therefore gait analysis will he a good tool for the identification of the factors related to the recovery of patients after the operation. This study was undertaken in an attempt to evaluate the gait characteristics of 16 patients with unilateral hip disease treated with THA. We compared the outcome of qualitative and quantitative analysis of gait and also compared with those of 14 healthy person. The results were as followed : 1. The patients showed short single support time on their painful limb prior to THA , but postoperatively , it was increased to near normal (p<0.05). 2. Preoperatively, the range of hip flexion of the sound side was increased more than those of the normal control and the painful limh. After the THA, it returned to the near normal (p<0.05~). The hip extension of the painful limh uas increased postoperatively (P<0.05) but still it was lower than normai subject. The hip ahduction and internal roiation of sound side was also increased to near normal after THA. In conclusion, great improvement ot the gait characteristics in patients with hip disease after THA was found and this gait improvement can he analyzed quantitatively hy gait analysis.

Rehabilitation of the complicated bilateral amputee with right below the knee and left above the knee amputation

No abstract available.

Tarsal tunnel syndrome associated with hyperlipidemia

No abstract available.