Effect of Pneumatic Compressing Powered Orthosis in Stroke Patients: Preliminary Study

OBJECTIVE: To evaluate the feasibility and effectiveness of a knee-ankle-foot orthosis powered by artificial pneumatic muscles (PKAFO). METHODS: Twenty-three hemiplegic patients (age, 59.6+/-13.7 years) were assessed 19.7+/-36.6 months after brain lesion. The 10-m walking time was measured as a gait parameter while the individual walked on a treadmill. Walking speed (m/s), step cycle (cycle/s), and step length (m) were also measured on a treadmill with and without PKAFO, and before and after gait training. Clinical parameters measured before and after gait training included Korean version of Modified Bathel Index (K-MBI), manual muscle test (MMT), and Modified Ashworth Scale (MAS) of hemiplegic ankle. Gait training comprised treadmill walking for 20 minutes, 5 days a week for 3 weeks at a comfortable speed. RESULTS: The 10-m walking time, walking speed, step length, and step cycle were significantly greater with PKAFO than without PKAFO, and after gait training (both p<0.05). K-MBI was improved after gait training (p<0.05), but MMT and MAS were not. CONCLUSION: PKAFO may improve gait function in hemiplegic patients. It can be a useful orthosis for gait training in hemiplegic patients.

The Effect of Electric Cortical Stimulation after Focal Traumatic Brain Injury in Rats

OBJECTIVE: To evaluate the effects of electric cortical stimulation in the experimentally induced focal traumatic brain injury (TBI) rat model on motor recovery and plasticity of the injured brain. METHOD: Twenty male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT) and on a Rotarod task (RRT) for 14 days. Then, the TBI model was induced by a weight drop device (40 g in weight, 25 cm in height) on the dominant motor cortex, and the electrode was implanted over the perilesional cortical surface. All rats were divided into two groups as follows: Electrical stimulation (ES) group with anodal continuous stimulation (50 Hz and 194 micros duration) or Sham-operated control (SOC) group with no electrical stimulation. The rats were trained SPRT and RRT for 14 days for rehabilitation and measured Garcia's neurologic examination. Histopathological and immunostaining evaluations were performed after the experiment. RESULTS: There were no differences in the slice number in the histological analysis. Garcia's neurologic scores & SPRT were significantly increased in the ES group (p<0.05), yet, there was no difference in RRT in both groups. The ES group showed more expression of c-Fos around the brain injured area than the SOC group. CONCLUSION: Electric cortical stimulation with rehabilitation is considered to be one of the trial methods for motor recovery in TBI. However, more studies should be conducted for the TBI model in order to establish better stimulation methods.

Development and Application of a Newly Designed Massage Instrument for Deep Cross-Friction Massage in Chronic Non-Specific Low Back Pain

OBJECTIVE: To introduce a newly designed massage instrument, the Hand Grip T-bar (HT-bar) and use it to relieve chronic non-specific low back pain (nLBP) through deep cross-friction massage (roptrotherapy). METHOD: 22 subjects (9 males and 13 females, aged 51.6+/-6.7) with chronic nLBP were allocated randomly to a Roptrotherapy group (n=12) and a Transcutaneous Electrical Nerve Stimulation (TENS) group (n=10). The Roptrotherapy group received deep cross-friction massage with the HT-bar, which was made of metal and had a cylinder for increasing weight and grooves for an easy grip. It was applied across the middle and lower back for 20 minutes a day, 3 days a week for 2 weeks. The TENS group received TENS for 20 minutes a day, 5 days a week for 2 weeks. The outcome was measured on the pain numeric rating scale (PNRS), by the Oswestry disability index (ODI), and by the Roland & Morris Disability Questionnaire (RMDQ) at pre-treatment, at immediate post-treatment and 2 weeks later. The application of the HT-bar was assessed by a questionnaire to 19 therapists. RESULTS: At post-treatment, immediately and 2 weeks later, both groups showed significant improvement in PNRS, ODI and RMDQ. During the two weeks after post-treatment, however, the Roptrotherapy group improved in PNRS, ODI and RMDQ, but the TENS group did not. Over 80% of the therapists responded that the HT-bar was useful and comfortable. CONCLUSION: This study suggests that deep cross-friction massage can be a beneficial therapeutic technique and that the HT-bar can be a useful instrument in deep cross-friction massage for chronic nLBP patients.

Diabetic Muscle Infarction in a Chronic Stroke Patient: A Case Report

Diabetic muscle infarction is a rare complication of diabetes and is characterized by acute or subacute onset of painful and non-pitting swelling of the thigh or the calf, and rarely in the upper limbs. Diabetic muscle infarction and cerebral vascular accidents ocurr in patients with advanced diabetic complications. Painful swelling of the extremities is very common manifestation in patients with hemiplegia. Thus, early correct diagnosis and differential diagnosis of the underlying causes of painful swelling of the extremities are very important in these patients. We report a case of diabetic muscle infarction in a patient with hemiplegia, and suggest that diabetic muscle infarction should be considered as a disease of differential diagnosis for acute pain and swelling on the extremity.

Effect of the Foot Orthosis for Children Scoliosis Caused by Inequality of Resting Calcaneal Stance Position Angle

OBJECTIVE: To evaluate the effect of custom molded foot orthosis without heel lift in scoliosis patients who had different pelvic height caused by inequality of RCSPA (resting calcaneal stance position angle). METHOD: We retrospectively reviewed the medical data of all patients who had been prescribed custom molded foot orthosis without heel lift in our institution from 2005 to 2009 and chose 38 scoliosis patients with Cobb's angle (> or =10degrees) and different pelvic height (> or =5 mm) caused by inequality of RCSPA (> or =2degrees). Radiologic findings of whole spine AP and RCSPA were measured pre and post treatment and compared. RESULTS: Twenty two females and sixteen males were included in this study. Their mean age was 7.76+/-3.72 years. Their mean period of wearing orthosis was 14.11+/-3.25 months. Initial average Cobb's angle of 13.18+/-3.16degrees were reduced to 7.42+/-3.45degrees (p<0.001). Initial difference of height between right and left iliac crest of 0.87+/-0.26 cm reduced to 0.55+/-0.28 cm (p<0.01) and angle of pelvic inequality of 3.98+/-1.55degrees reduced to 2.54+/-1.27degrees (p<0.05). Initial difference of RCSPA between right and left of 3.69+/-1.54degrees decreased to 1.69+/-1.54degrees (p<0.01). Each parameter has significantly reduced 12 months after the wearing of the custom molded foot orthosis in scoliosis patients whose age was 9 or below, whose Cobb's angle at 15degrees or lower. CONCLUSION: The custom molded foot orthosis without heel lift was effective for scoliosis patients, who had different pelvic height caused by inequality of RCSPA.