Comparison of Outcome between Patients the Traumatic and Non-traumatic Spinal Cord Injured

OBJECTIVE: To investigate the difference of outcome variables and demographic features between traumatic and non-traumatic spinal cord injury (SCI) patients. METHOD: Medical records of 87 spinal cord injured patients were retrospectively reviewed. The patients were divided into traumatic and non-traumatic groups. The etiology, level and completeness of SCI were investigated. The functional evaluation was performed by Frankel's classification, American spinal cord injury association (ASIA) motor and sensory scores, and modified Barthel scores at the time of admission and discharge. Bladder function and emptying method were also investigated. RESULTS: Spinal cord injury of non-traumatic etiology was more likely to result in a incomplete injury and more prevalent in females. At admission, the ASIA motor and sensory scores and modified Barthel index of non-traumatic spinal cord injury patient were higher than those of traumatic patients. At discharge, same results were observed for ASIA motor and sensory scores, but the modified Barthel scores showed no difference between the two groups. The changes of the scores between time of admission and discharge showed no significant difference in the two groups. There was no significant difference of bladder type and bladder emptying method. CONCLUSION: This study suggest that favorable outcome in non-traumatic spinal cord injury patients might be due to better functional status at the time of admission and not due to the degree of recovery.

Quality of Life after Stroke

OBJECTIVE: The purposes of this study were to examine overall quality of life (QOL) in long term stroke survivals and to identify variables that predict QOL after stroke. METHOD: Subjects were 51 stroke patients (male; 28, female; 23) with stroke onset at least 6 months previously. Interview, measurement of depression and QOL were performed at outpatient clinic after discharge. Review of medical records included characteristics of stroke and communication disorders. Interview questionnare included caregiver, religion, education level, occupation and income. Depression and functional status was measured by the Beck depression inventory (BDI) and modified Barthel index (MBI), respectively. QOL was measured with the use of 5-item (activity, daily living, health, support, outlook) version of the Quality of Life Index (QLI) and its range of scores is 0~10. We compared QLI scores according to various factors obtained from medical records and questionnaire. RESULTS: Mean duration after onset of stroke was 33.6 months (range, 6~216 months). The mean score of QLI were 7.0+/-2.1. Low MBI score, communication disorder and depression had a negative effect on QOL (p0.05). CONCLUSION: Low MBI score, depression and communication disorders would be negative predictors of QOL and identification of these factor may assist stroke patients in coping their personal and social life.

Median and Ulnar Sensory Nerve Conduction Study in Five Digits

OBJECTIVE: To establish the reference values of the sensory conduction for all the digits in the hand, conduction studies were performed using the standard technique. METHOD: One hundred hands of fifty neurologically healthy adults with mean age of 45 years (range, 23~69) were tested. Depending on ages, the 50 adults were devided into three groups: group 1, 20~45 years old; group 2, 46~60 years old; group 3, 61~ years old. Antidromic sensory nerve conduction techniques using a fixed distance were performed. The onset latency and baseline to peak amplitude of the sensory nerve action potentials (SNAPs) were measured. During the test, the skin temperature of the hand was maintained at 34 degrees C or above. These variables from SNAPs were compared according to age, gender, side, and recording digits. RESULTS: Comparison of the median and ulnar SNAPs between age groups revealed longer onset latency and smaller amplitude in the elderly group. The amplitude of SNAPs was larger in females than in males and the left side than the right side. Comparison of the latencies and amplitudes between the second and third digits showed no significant difference statistically. Also, the latencies and amplitudes of the median and ulnar nerves recorded from the fourth digits showed no significant difference statistically. CONCLUSION: Based on these results, the reference values for sensory conductions from all the digits were obtained. These values would be helpful in evaluation of CTS or unspecified finger pain or upper extremity neuropathy.

A Correlation of Bulbocavernosus Reflex Test and Urodynamic Investigation in the Spinal Cord Injury Patients

OBJECTIVE: To investigate the correlations of neurological level, BCR and urodynamic study (UDS) in the spinal cord injury(SCI) patients, we analyzed the results of BCR and UDS fundings. METHOD: The sujects were twenty-four patients with SCI who were beyond 3 months following the SCI. According to the level of injury, the patients were divided into 3 groups: above T10 level, 7; T10 to L2 level, 8; below L2 level, 9. Electrophysiological BCR test and UDS were performed in all patients. RESULTS: The results showed a significant correlation between the BCR test and level of injury, however there was no correlation between the UDS and level of injury, nor between the detrusor function and BCR test. The results might be from a differential recovery of the somatic and autonomic nervous system. CONCLUSION: As a part of comprehensive evaluation for the bladder function in the SCI patients, we recommend both the bulbocavernosus reflex test and urodynamic study. Further neurophysiological research would be needed to understand the urodynamic findings which did not correlate with the level of SCI.

The Prognosis of Preganglionic Brachial Plexus Injuries by Electrodiagnosis

OBJECTIVE: To document the neurological recovery of the preganglionic lesion of brachial plexus, both clinically and electrodiagnostically. METHOD: Sixteen male and three female patients were evaluated. Ages of the patients ranged from 1 to 45 years with the mean age of 25.2+/-14.3 years. We studied retrospectively the improvements of 43 injured nerves and its innervated muscles of 19 patients retrospectively according to the complete or incomplete nature of the injuries by the electromyographic findings. We compred the results of initial and final examinations by the electromyographic and clinical findings including a muscle strength test. RESULTS: In the complete injuries, 84.0% of the cases showed a minimal or no improvement in muscle strength whereas in the incomplete injuries, 88.2% of the cases showed a greater than moderate improvement in muscle strength. The cases in which no compound muscle action potential could be evoked on the initial study, showed the improvements of greater than 3/5 muscle strength only in 20.0%. However 71.5% of cases with the initial amplitude between 0.1 & 0.5 mV and 100.0% of cases with the initial amplitude greater than 0.5 mV showed the muscle strength greater than 3/5. CONCLUSION: The prognosis for the neurological recovery was significantly poor in the complete preganglionic lesions of brachial plexus injuries but in the incomplete lesions, the prognosis was extremely good. It would be crucial for the initial CMAP being greater than 0.5 mV to expect the recovery of muscle strength to the functional level. Rehabilitative or operative management should be instituted based on the electrodiagnostic findings.

Skin Temperature Mapping in Upper and Lower Extremities

The role of skin temperature is very important in clinical neurophysiology but has often been neglected. In nerve conduction studies, lower normal temperature affects slower conduction velocities and increased nerve (sensory or mixed) action potential amplitudes. To determine the normal skin temperature in various parts of upper and lower extremities within close approximation of the nerve passages, the temperature was measured using Physitemp Model BAT-12 (Accuracy 0.1oC, Clifton, New Jersey, U.S.A.). Fifty-three neurophysiologically healthy adults (Age range, 22-77 years old) were tested : upper extremity, 20 (male, 7 ; female, 13) ; lower extremity, 33 (male, 11 ; female, 22). The total points of skin temperature measurement were 21 : upper extremity, 10 ; lower extremity, 11. The skin temperature for the upper and lower extremities was 34.6+/-0.9 degrees C (range, 32.6-36.7degrees C) and 33.4+/-1.1degrees C (range, 28.1-35.7degrees C), respectively. Although it is frequently time consuming, monitoring normal skin temperature will result in greater electrodiagnostic accuracy.