Simulated Stiff-knee Gait in Healthy Adults

OBJECTIVE: To investigate the effect of simulated stiff knee on the gait parameters. METHOD: Twenty healthy male adults were recruited. The temporospatial, kinematic & kinetic parameters and energy consumption were analyzed under three different conditions which were free gait, fixed knee flexion in neutral position and limited knee flexion to 30 degrees using knee orthosis. RESULTS: When knee flexion was fixed in neutral position, the cadence and walking speed significantly decreased, and the step time, step width, O2 cost significantly increased compared to free gait. When knee flexion was limited or fixed in neutral position, the kinematic and kinetic parameters in pelvis, hip, knee and ankle joints significantly changed compared with free gait. CONCLUSION: Simulated stiff-knee may affect not only knee joint but also pelvis, hip and ankle joints with increased energy consumption. These findings help us to understand the compensatory mechanism and energy conservation of stiff-knee gait.

The Efficacy of Donepezil on Cognitive Dysfunction in Subacute Post-stroke Patients

OBJECTIVE: To evaluate the efficacy of donepezil on cognitive dysfunction in subacute post-stroke patients. METHOD: Sixty subacute stroke subjects were enrolled and randomly assigned into an experimental or control group. There was no significant difference between the two groups in age, sex and post-onset duration. Donepezil 5 mg was administered daily for 6 weeks to patients in the experimental group. Mini-Mental Status Examination (MMSE), Wechsler Memory Test (WMT) and Colored Progressive Matrices (CPM) were performed before and 6 weeks after administration of the study drug in both groups. RESULTS: There was no difference between the two groups in the MMSE, WMT, CPM scores at baseline. Six weeks later, the total score, memory input, recall and judgement as measured by the MMSE and the score on the WMT were significantly more improved in the experimental group when compared to the control group (p<0.05). However, there was no significant difference between the two groups on the CPM score. CONCLUSION: These results suggested that donepezil may be helpful for improving cognitive function, especially memory in post-stroke patients.

The Relationship between Weight-Bearing and Stiff-Knee Gait in Hemiplegic Patients

OBJECTIVE: To determine whether insufficient weight-bearing on the hemiparetic side has a correlation with the degree of stiff-knee gait in hemiplegic patients. METHOD: Fifty hemiplegic patients were included. In all patients, 3-dimensonal gait analysis and static and dynamic foot pressure measurements were taken. The degree of stiff-knee gait was evaluated using the peak knee flexion angle and the knee flexion slope at toe-off in hemiplegic limb. The degree of weight-bearing was evaluated using the percentage of hemiplegic foot pressure and pressure-time integration on the non-hemiplegic side. RESULTS: The static and dynamic mean pressure ratios and pressure-time integration ratio were statistically correlated with peak knee flexion angle and knee flexion slope (p<0.01). CONCLUSION: As a result, insufficient weight-bearing had a correlation with the degree of stiff-knee gait in hemiplegic patients. Insufficient weight-bearing should be further investigated to determine whether it is one of the characteristic findings of stiff-knee gait, or another cause of stiff-knee gait.

Quantitative Assessment of the Effect of Tizanidine on Spasticity in Stroke Patients

OBJECTIVE: The aims of this study were to evaluate quantitatively the effect of tizanidine on spasticity reduction and to evaluate the effective and tolerable dosage of it in stroke patients. METHOD: A prospective, randomized controlled study was carried out. 24 stroke patients were included and randomly assigned to a control and experimental group. In experimental group, tizanidine was medicated from starting dose of 3 mg/day and titrated up by 3 mg/day increments every 3 days to a maximal dose of 15 mg/day. In both group assessment of spasticity was done by clinical and biomechanical-neurophysiological methods one day before medication (baseline), on 9th and 15th days after medication. Biomechenical-neurophysiological assessment was done through isokinetic dynamometer and BIOPAC system. RESULTS: In control group, no significant changes were found in the degree of spasticity between each assessment. In experimental group, most of the parameters that determine the degree of spasticity revealed the significant reduction of spasticity on the post-medication assessment compared with the baseline assessment (p<0.01). The degree of spasticity reduction was increased with the increase of dosage. The incidence of adverse effect was also increased with the increase of dosage, but tolerable within the dosage of 15 mg/day. CONCLUSION: Tizanidine was effective in reducing spasticity in stroke patients. Its efficacy and adverse effects were dosage-related.

Assessment of Colonic Motility and Nutrients Intake in Adult with Cerebral Palsy

OBJECTIVE: To evaluate the colonic motility and nutrients intake in adults with cerebral palsy (CP) and to compare the results with those of normal adults. METHOD: Thirty-nine adults with CP were participated. They took the radioopaque markers for 3 successive days. Then, abdominal X-ray was taken on the fourth day. The total and segmental colon transits were estimated by the simplified assessment of a single-film technique by Metcalf et al. The amounts of nutrients intake for 3 days were recorded and nutritional factors were analyzed by ESHA(r) Food Processor. Then, daily intakes of the nutrients were compared with Recommended Dietary Allowance of Korean Nutrition Society. RESULT: Colon transit time were more than 2 times delayed in adults with CP as compared with those of normal controls. Colon transit time was significantly prolonged in non- functional ambulators (p<0.05). Colon transit time tended to be delayed in subjects with spastic type, but not related with the degree of cognitive function. On the evaluation of daily nutrients intake, several nutritional factors were inadequate in adults with CP. CONCLUSION: Adults with CP had the problems in colonic motility and nutritional intake. Also, delayed colon transit time was significantly related with poor mobility, and possibly related with spasticity.

Assessment of Bladder Function in Adults with Cerebral Palsy; A Preliminary Study

OBJECTIVE: The aim of this study was to evaluate the bladder function in adults with cerebral palsy (CP). METHOD: Thirteen adults with CP were participated in this study. Nine of these thirteen subjects had urological symptoms. The urological history taking, urine analysis, urine culture, voiding cystourethrography (VCUG) and urodynamic study were done. RESULT: The urinary incontinence was the most common presenting symptom. All subjects without urological symptoms showed normal urodynamic findings. Eight of the subjects who had urological symptoms had abnormal findings on urodynamic study. All subjects showed normal findings on voiding cystourethrography. Based on urodynamic findings, six subjects were treated with anticholinergic drug and five (83.3%) of these subjects showed improvement of their urological symptoms. CONCLUSION: Many adults with CP might have the problems in urination. Our study showed that many symptomatic subjects had abnormal urodynamic findings and much of these urological symptoms was improved with proper treatment. These adults with CP would, therefore, benefit from proper assessment and treatment, expecially in the subjects who have urological symptoms.

Psychological Health Status in Adults with Cerebral Palsy

OBJECTIVE: To evaluate the psychological health status in adults with cerebral palsy (CP) and to find out affecting factors on psychological health status. METHOD: Eighty-six adults with CP and 146 age matched controls participated in this study. Psychological health status of all participants was evaluated by the interview and questionnaire including Beck Depression Inventory (BDI), Brief Symptoms Inventory (BSI) and Affect Balance Scale (ABS). RESULT: Depressive symptom on BDI was common in adults with CP. Study group showed significantly higher scores in BSI and lower scores in ABS compared with the control group (p<0.05). Employment, severity of disability and health perception were significantly related to the psychological health status in adults with CP (p<0.05). CONCLUSION: This study revealed that psychological problems were greater in adults with CP, compared with the controls. Psychological health status in adults with CP was related to employment, severity of disability and health perception. Therefore, active medical and social interventions for providing employment, minimizing disability and improving health perception will be helpful for enhancing their psychological health.