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.

The Importance of Motivation and Dropping Out from Treatment in Constraint-induced Movement Therapy for Stroke Patients

OBJECTIVE: To assess the effect of motivation for treatment and to find out causes of dropping out from treatment in performing the constraint-induced movement therapy (CIMT). METHOD: Forty six stroke patients were treated with CIMT for 2 weeks. Prior to and after treatment, Fugl-Meyer motor assessment (FMA), Wolf motor function test (WMFT), box and block test (BBT), and 9 hole peg test, motor activity log (MAL) were performed, and for the evaluation of treatment motivation, motivation score (MS) was assessed in 24 patients. RESULTS: After 2 weeks of CIMT treatment, the mean value of FMA increased by 15.1%, WMFT by 19.5%, BBT by 35.8%, the time of 9 hole peg test decreased by 20.2%, and the "How well" sub-score of the increased MAL was 59.6% (p<0.05). Larger improvement of FMA score was observed in patients with high MS (p<0.05). Twelve out of 46 patients were dropped, 5 patients (18.5%) among 27 right side hemiplegic patients and 7 patients (38.9%) of 19 left side hemiplegic patients gave up the treatment in the middle, and the MS score of the quitted patients (35.3 point) was lower than that of patients who did not quit (40.5 point) (p<0.05). CONCLUSION: After 2 weeks of CIMT treatment, larger improvement of movement capacity was observed in patients with high motivation. Among patients with low treatment motivation and old age, many patients were dropped out during CIMT.

The Effect of Modified Constraint-induced Movement Therapy for the Stroke Patients in Inpatient Setting

OBJECTIVE: To evaluate the effectiveness of the modified constraint-induced movement therapy (CIMT) for inpatient rehabilitation of the stroke patients. METHOD: Twenty-four patients admitted by subacute or chronic stroke were enrolled and divided into two groups, experimental and control groups. The experimental group (n=13) received the CIMT five days a week for 2 weeks. Less affected arm was restrained for 14 hours a day, practicing purposeful activities with more affected arm for 6 hours a day in group setting. The control group (n=11) received conventional occupational therapy for the same period. The outcome was measured by Fugl-Meyer MotorAssessment (FMA), Brunnstrom stage, Jebsen hand function test, grip strength, Box and Block test, nine hole peg test, Functional Independence Measure (FIM), and Motor Activity Log (MAL). RESULTS: The experimental group showed significantly higher improvements (p<0.05) in FMA, Brunnstorm stage, Jebsen hand function test, grip strength, Box and Block test, FIM, and MAL. CONCLUSION: Modified CIMT delivered in group setting is considered to be an effective treatment to improve functional use of the hemiparetic arm of stroke patients in inpatient setting.

The Interrater and Intrarater Reliability of Korean Wolf Motor Function Test

OBJECTIVE: To verify the interrater and intrarater reliability of Korean Wolf Motor Function Test (K-WMFT) for assessing upper extremity function after stroke. METHOD: Twenty patients with chronic hemiparesis after stroke participated in the study. The Wolf Motor Function Test consists of 15 functional tasks. Performances were timed and rated by functional ability scale. The K-WMFT were administered to the subjects by an occupational therapist. All test sessions were videotaped and scored by 2 physiatrists and another occupational therapist to examine interrater reliability. They were reevaluated at a later time by the same occupational therapist to examine intrarater reliability. RESULTS: Intraclass correlation coefficient of the performance time of K-WMFT was 0.94 and that of the functional ability scale of K-WMFT was 0.99. Intrarater correlation coefficient of the performance time of K-WMFT was 1.00 and that of the functional ability scale of K-WMFT was 0.97. CONCLUSION: The interrater and intrarater reliability of K- WMFT were verified. K-WMFT can be used as a reliable tool to measure upper extremity function of the stroke patients in Korea.

The Discharge Destination of Rehabilitation Inpatients in a Tertiary Hospital

OBJECTIVE: To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. METHOD: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIM(TM) instrument were studied by a medical record review. RESULT: Patients who were transferred to other hospitals or discharged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. CONCLUSION: Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals.

Quality of Life and Life Satisfaction of the Registered Disabled Persons in Uiwang City

OBJECTIVE: The purposes of this study were to investigate the factors influencing life satisfaction and quality of life (QOL) of the disabled persons and to help the planning and evaluation of Community Based Rehabilitation (CBR). METHOD: Data were collected through personal interviews of 503 registrated disabled persons in Uiwang City. Demographic variables and scores of modified Barthel index (MBI), modified Lambeth disability screening questionnaire (MLDSQ), Craig handicap assessment and reporting technique (CHART) and life domain satisfaction measure (LDSM) were obtained. RESULTS: The score of LDSM was 4.0+/-1.0. Life satisfaction was related to the age, sex, employment status, severity of disability, educational level, housing and residence, level of instrumental activities of daily living and social integration. MLDSQ score was the most strong predictor of life satisfaction (p=0.00) followed by social integration (p=0.001) and total CHART scores (p=0.017). And the factors influencing the handicap were monthly income, severity of disability, employment, level of education and age. CONCLUSION: Based on our study, we suggest that the CBR program of Uiwang City need to focus on improving functional ability and social skill of disabled individual and housing, and also promoting their vocational and educational status.

Effects of Psyllium Husk for the Management of Neurogenic Bowel in Chronic Spinal Cord Injured Persons

OBJECTIVE: The purposes were to determine the baseline colon transit time (CTT) and to assess the effect of dietary fiber (psyllium husk) on neurogenic bowel function in chronic spinal cord injured (SCI) persons. METHOD: Eleven chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were participated. Personal interview were carried out for all studied subjects at pre and post treatment period. The baseline colon transit time (CTT) were measured for the right (rCTT), left (lCTT), rectosigmoid (rsCTT) colons as well as for the entire colon using radio-opaque markers. After 4 weeks treatment of psyllium husk, the subjects were reevaluated for their CTTs and the results were compared to the pretreatment values. RESULTS: The mean age of the subjects was 33.9+/-11.0 years and the level of injury ranged from C3 to T10. The mean duration after SCI was 22.6 months (6~47 months). The rCTT, lCTT, rsCTT and tCTT were not affected after the treatment of psyllium husk. Also their bowel care patterns and satisfaction were unaffected by the treatment. CONCLUSION: The results of this study suggest that the use of psyllium husk in chronic spinal cord injured persons do not show the same effect on bowel function as has been previously reported in general population with idiopathic constipation.

The Effect of Body Mass Index on Nerve Conduction Studies

OBJECTIVE: To determine whether there is a difference in nerve conduction studies depend on the body mass index (BMI) of subjects METHOD: Twenty normal healthy volunteers were enrolled for the study. A routine usual sensory and motor nerve conduction study and a sensory nerve conduction study using the near nerve needle technique were performed. BMI was calculated as weight (kg) divided by height (m) squared. In order to evaluate the effect of BMI on the various measure ments of the nerve conduction study, one-way analysis of variance (ANOVA) was used. RESULTS: The sensory nerve amplitudes of median, ulnar and sural nerves correlated significantly (p<0.05) with BMI. However, no correlation was noted between BMI and sensory nerve amplitude by near nerve needle technique. There was no statistical differences noted in the measurements of latency of examined motor and sensory nerves neither the velocity of examined motor nerves. CONCLUSION: In clinical practice, the effect of BMI should be taken into account when the interpretation of abnormal sensory nerve study has to be soli.