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.

Effects of the Electrical Stimulation for the Neurogenic Bowel of the Spinal Cord Injured Patients

OBJECTIVE: To evaluate effects of the electrical stimulation to the sacral dermatomes for the neurogenic bowel of the spinal cord injured patients. METHOD: Eleven patients with cervical and thoracic cord injury were enrolled, and classified into two groups, control and electrical stimulation (ES) group. The colon transit time before and after electrical stimulation for 4 weeks to the sacral dermatomes were measured on the ES group, and measured at the same time on control group. The rectoanal manometries were performed after studies of colon transit time on the ES group. RESULTS: The colon transit time measured before electrical stimulation were 16.1+/-13.8 hours for the right colon; 20.1+/-23.3 hours for the left colon; 14.7+/-12.3 hours for the rectosigmoid colon; and the total transit time was 51.0+/-23.4 hours. The time of after electrical stimulation was 8.0+/-5.7 hours for the right colon; 12.8+/-2.2 hours for the left colon; 15.4+/-13.8 hours for the rectosigmoid colon; and the total transit time was 36.2+/-12.8 hours. The left colon transit time and total colon transit time before electrical stimulation were significantly improved compared to after electrical stimulation on the ES group (p<0.05). The left colon transit time of the ES group was significantly improved compared with control group (p<0.05). In the rectoanal manometry, the mean resting anal pressure and threshold of rectoanal inhibitory reflex were increased after the electrical stimulation. CONCLUSION: The electrical stimulation to the sacral dermatomes on the spinal cord injured patient could effectively enhance colon transit, especially on the left colon. In addition, muscular activity of the anal sphincter was enhanced.

Evaluation of the Neurogenic Bowel by Colon Transit Time and Anorectal Manometry in the Spinal Cord Injured Patients

OBJECTIVE: To evaluate changes of colon transit time according to prokinetic medication and characteristics of the anorectal manometry in patients with neurogenic bowel due to spinal cord injury. METHOD: Twelve patients with cervical and thoracic cord injury were enrolled, and classified into complete and incomplete spinal cord injury according to the severity of injury. The colon transit time before and after prokinetic medications were measured. The anorectal manometry was performed after the first study of colon transit time. RESULTS: The colon transit time of pre-prokinetic medications were 17.1+/-12.6 hours for the right colon, 26.9+/-13.2 for the left colon, 21.5+/-14.0 for the rectosigmoid colon, and the total transit time was 65.5+/-5.3 hours. The time of post-prokinetic medications was 14.3+/-7.6 hours for the right colon, 25.8+/-10.3 for the left colon, 7.4+/-5.3 for the rectosigmoid colon, and the total transit time was 33.1+/-11.5 hours. The rectosigmoid colon transit time and total colon transit time were significantly different between pre- and post-prokinetic medications (p<0.05). In the anorectal manometry, mean resting anal pressure was 33.3+/-10.7 mmHg and maximal resting anal pressure was 99.0+/-43.4 mmHg. There were no difference in the colon transit time and anorectal manometry between complete and incomplete injured patients. CONCLUSION: The difficulties of defecation in spinal cord injured patients were not only due to uncontrolled anal sphincter but also due to dysfunction of colon motility. The prokinetic medications were effective in reducting the rectosigmoid and total colon transit time.

Characteristics of Language Disorder in Patients with Traumatic Brain Injury

OBJECTIVE: To identify the incidence and characteristics of language disorders in patients with traumatic brain injury (TBI), and to understand the differences of language disorder according to the degree and lesion of brain damage and the outcomes after proper language training programs. METHOD: The subjects were 24 adult TBI patients. Seventeen patients with language disorder were examined with language disorder screening test. The characteristics of the language disorders were evaluated according to the degree and lesion site of the brain injury. Prognosis of the language disorders was studied. The tests were performed at the initiation and termination of the language treatment program. RESULTS: The incidence of language disorders was 91.7%. At the initial evaluation, all items showed a low rate of correct response, but at the final evaluation, the statistically significant improvement was noted in all items. There was no difference between moderate and severe brain damages at final evaluation. Focal lesion group revealed higher rate of correct response than diffuse lesion group on comprehension, expression, reading, and calculation at final evaluation. CONCLUSION: The TBI patients showed diffuse language dysfunction on fluency, comprehension, expression, reading, writing, and calculation. But the majority of these patients showed satisfactory recovery, especially the focal brain lesion showed the better outcome. These patients with focal lesion were needed precise language evaluation and more intensive language treatment program.