Case Reports of Peduncular Hallucinosis in Patients with Pontine Hemorrhage : Two cases report

Peduncular hallucinosis that rarely reported in patients with brain stem lesion has several characteristics. The hallucination tends to be vivid, nonstereotypical images of person or animal. All the patients are aware that the hallucination is not part of reality. One of the suggested mechanisms of peduncular hallucinosis is imbalance among the cholinergic, serotonergic and other transmitting systems in the brain stem. We report two cases with typical features of peduncular hallucinosis which appeared about 30 and 12 months after pontine hemorrhage, respectively. We chose antipsychotics and selective serotonergic reuptake inhibitors for their medications, and their hallucinations disappeared about 2 months and 3 weeks after the medication, respectively. We suggest that peduncular hallucinosis should be considered in the patients with pontine hemorrhage if they complain of typical visual hallucinations.

Electrodiagnostic Methods for Carpal Tunnel Syndrome Combined with Diabetic Polyneuropathy

OBJECTIVE: To find out the most useful method among three electrodiagnostic tests for carpal tunnel syndrome (CTS) in patients with diabetic peripheral polyneuropathy (PPN). METHOD: Eighty-three hands out of seventy-four patients who had diabetic PPN and tingling sensation in their hands were included in this study. They were divided into two groups: Group A, PPN with CTS; Group B, PPN only. Fifty-four hands with CTS in patients without diabetes were included as a control group (Group C). Another forty normal hands were also included as a healthy control group (Group D). Clinical and electrophysiologic information was gathered from those subjects. Sensitivity, specificity and receiver operating characteristic (ROC) curves of the three electrodiagnostic tests, namely, the difference between the median nerve latency to the second lumbrical muscle and the ulnar nerve latency to the second interosseous muscle (L-I difference), ratio of distoproximal latency in median sensory nerve (MW ratio), and difference of distoproximal latency in median sensory nerve (MW difference) to diagnose clinical CTS were obtained. RESULTS: The specificity of L-I difference as a diagnostic test for CTS was highest (87.0%). The area of ROC curve of L-I difference was also highest (0.949) among three different electrodiagnostic tests of CTS with diabetic PPN. CONCLUSION: We suggest that L-I difference as the most useful test with highest specificity for the diagnosis of CTS in the patients with diabetic PPN.

Effects of the Balance Control of the Affected Lower Extremityon Balance and Gait in Hemiparetic Patients

OBJECTIVE: To investigate the effects of balance control of affected lower extremity on berg balance scale and gait in hemiparetic patients, using the newly developed balance control trainer of lower extremity. METHOD: Thirty five hemiparetic patients who could stand and ambulate more than 10 meters without assist on even surface were included in this study. The balance control trainer of lower extremity was designed to measure weight shift and knee flexion angle of hemiparetic side and to play a game named "Board cleaner" which use these data, so considering the vertical movement of the center of gravity. We measured above three parameters, and also evaluated with clinical tests including berg balance scale (BBS). We evaluated correlations between parameters on the balance control trainer of lower extremity and clinical parameters. RESULTS: Weight shifting to affected side statistically significantly correlated only with BBS. Affected knee flexion had statistically significant correlations with all clinical tests examined, especially 10 meters walking time (10mWT), timed up and go test (TUG), and BBS. Scores earned from board cleaner game also had statistically significant correlations with all clinical tests examined, especially 10mWT, TUG, and BBS. CONCLUSION: Correlation exists between the ability to control the affected knee measured by balance control trainer of lower extremity and clinical parameters including 10mWT, TUG, and BBS, so we think the balance control trainer can be a useful tool for the evaluation in hemiparetic patients.

Evaluation of Driving Ability of Stroke Patients Using Cognitive Behavioral Driver's Inventory

OBJECTIVE: We tried to evaluate the driving ability of stroke patients using Cognitive Behavioral Driver's Inventory (CBDI), Psychological Software Service, U.S.A. to find out whether it is helpful in predicting the outcome of driving rehabilitation. METHOD: Subjects were 18 stroke patients who had driven a car before the stroke. Each patient was evaluated with CBDI and got a driving test. We compared driving test results with CBDI scores. RESULTS: Average CBDI score was 63.0 +/- 19.3. There was no significant difference according to lesion sides or types of stroke. Average score of driving test was 85.3 +/- 10.9. Twelve of 18 subjects passed the driving test and six subjects failed. Average score among right hemiplegics was significantly higher than that of left hemiplegics (p<0.05). Average CBDI score of the subjects who passed the driving test was 52.3 +/- 4.7, while that of the failed subjects was 84.7 +/- 19.6. There was significant difference in CBDI score between 2 groups (p<0.05). Among the 28 items of CBDI, 11 items including brake reaction time, Wechsler Adult Intelligence Scale-Revised Picture Completion showed significant correlation with the total score of the driving test (p<0.05). CONCLUSION: CBDI can be used as a useful tool for predicting driving ability of stroke patients.

Measurement of the Hand Control Operating Force in Cervical Cord Injured Drivers

OBJECTIVES: To provide proper standards of handicapped driver's ability test in Korea and evolve new driving aids. METHOD: Thirty-six cervical cord injured persons (C5-C7) were evaluated with Baltimore Therapeutic Equipment work simulator to which a straight handle was attached. The isotonic torque on a straight handle was measured during forward and backward movement and isometric torque was measured at neutral position. Analysis of variance (ANOVA) was used to compare torque among three groups (C5-C7). RESULTS: The forward and backward torque of C7 tetraplegics was significantly higher than that of C6 tetraplegics (p<0.05). All of 12 persons with C5 tetraplegia could not pass the test. Only 1 out of 12 persons with C6 tetraplegia and all of 12 persons with C7 tetraplegia could pass the test. But 9 out of 12 persons with C5 tetraplegia and all of 12 persons with C6 tetraplegia could operate brake and accelerator with servo-hand control. CONCLUSION: All of the C5 tetraplegics and 92% of the C6 tetraplegics could not pass the handicapped driver's ability test of Korea. Therefore it is necessary to evolve driving aids for the C5 and C6 tetrapleigics and to modify this test.

Evaluating Driving Ability of Brain Damaged Subjects with MMSE and MVPT

OBJECTIVE: The purpose of this study was to determine the ability of Mini Mental Status Examination (MMSE) and Motor Free Visual Perception Test (MVPT) to predict driving outcome in subject with brain damage. METHOD: Fifteen brain damaged subjects were administered for this study. Fourteen subjects had brain damage due to stroke and only one subject had traumatic brain injury. All subjects were evaluated with MMSE and MVPT. We used total score for each tests. Subjects were also evaluated in driving simulator that measured their operational responses to filmed driving situation. Correlation between neuropsy chological tests score and driving simulator score were analyzed. RESULTS: 1) By average score, MMSE score was 26.6 and MVPT score was 23.7. Driving simulator score was average 30.1. 2) There was good correlation between MVPT score and driving simulator score (r=0.675, p<0.01). 3) There were no correlation between MMSE and driving simulator score nor between MMSE and MVPT score. CONCLUSION: MVPT can be used as screening test for identifying person who are not ready to drive after getting brain damage

Measurement of the Steering Torque in Cervical Cord Injured Persons Using BTE Work Simulator

OBJECTIVE: To evaluate the standards of handicapped driver's ability test in Korea and available driving aids in cervical cord injured persons. METHOD: Forty-two cervical cord injured persons (C5~C8) were evaluated with BTE (Baltimore Therapeutic Equipment) work simulator. The isotonic turning torque was measured during clockwise and counter-clockwise turning. And isometric turning torque was measured at 12 directions. RESULTS: By the isotonic measurement, the turning torque increased in the lower level of injury. In the C6 tetraplegics, the counter-clockwise turning torque was significantly higher than clockwise. Among 25 persons with C5 or C6 tetraplegia, only 2 with C6 tetraplegia could operate the power steering with the lowest wheel turning torque (3.0 Nm). Only three persons (1 person with C7 tetraplegia, 2 persons with C8 tetraplegia) could pass the handicapped driver's ability test of Korea (9.4 Nm). By the isometric measurement, turning torque was lowest at left upper quadrant (10 to 12 o'clock direction) in clockwise rotation. CONCLUSION: Among the 42 cervical cord injured persons, only 3 persons with C7 and C8 tetraplegia could pass the handicapped driver's ability test of Korea. And among 25 C5 and C6 tetraplegia, only 2 persons with C6 tetraplegia could operate the power steering. It seems to be essential to modify the standards of handicapped drivers ability test and to evolve the driving aids for the C5 and C6 tetraplegics in Korea.

A Study on Driver Training Program for the Handicapped at the National Rehabilitation Center

OBJECTIVE: To evaluate the results of driver training program for the handicapped. METHOD: Retrospective study on the 699 disabled who participated in the two-months driver training program at the NRC (National Rehabilitation Center) from January 1995 to May 1998. RESULTS: 1) Of these subjects, 70.4% were men and 29.6% were women. 2) According to the disability grading system by the Ministry of Health and Social Welfare of Korea, 19.2% of the subjects had the first grade disability, 28.2% the second grade, 26.3% the third grade, 18.3% the fourth grade, 6.3% the fifth grade, and 1.4% the sixth grade. 3) The licensing rate was 74.6% for the first grade, 64.7% for the second grade, 70.9% for the third grade, 73.6% for the fourth grade, 55.8% for the fifth grade, and 70% for the sixth grade. 4) The licensing rate was the highest in the subjects with spinal cord injury (79.2%) and the lowest in the subjects with stroke (45.0%). 5) Overall, 78.2% of subjects licensed with automatic transmission and 21.8% with hand- control. On the other hand, in the subjects with spinal cord injury, 42.5% licensed with automatic transmission and 57.5% with hand-control. CONCLUSION: The mean licensing rate of this program was 69.2%. Further study is required for the effect of cognitive function on driving test and various driving aids to promote the licensing rate for the handicapped.

The Effect of Functional Electrical Stimulation on Hemiplegic Shoulder Subluxation

OBJECTIVE: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients. METHOD: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment. RESULTS: 1) The severity of subluxation was significantly increased after 6 weeks (p0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. CONCLUSION: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.