Stimulation Intensity of Functional Electrical Stimulation on Hemiplegic Upper Extremity

OBJECTIVE: This study aimed to assess optimal stimulation intensity and to investigate other variables on functional electrical stimulation (FES) for hemiplegic upper limb. METHOD: We divided hemiplegic subjects into two groups, acute (n=28) and chronic (n=18), and control subjects into old (n=26) and young (n=27). Electrical stimulation was performed on the forearm of both sides in hemiplegic patients and of the nondominant side in normal controls. The stimulation site that aimed at open hand motion was targeted to the extensor digitorum and extensor pollicis brevis muscles. We measured the peak to peak amount of current and skin impedance while making hand extension. RESULTS: The acute and chronic hemiplegic groups required a greater current than the control groups (p<0.01).The hemiplegic side required a greater current than the non- hemiplegic side (p<0.001). There was no significant difference of current amount between the acute and chronic hemiplegic groups. The current amount was significantly correlated with subject's age (p=0.001). No difference of skin impedance was found among any of the groups. CONCLUSION: Irrespective of disease duration on hemiplegia, a greater current is required in the hemiplegic upper limb than in the normal upper limb. Age was an important factor in determining stimulation intensity.

Clinical Features of Lower Extremity Amputees in Hwa Sung Goon: One Korean County

OBJECTIVE: To evaluate the prevalence and prosthetic uses of lower extremity amputee in one Korean county. METHOD: We asked community health worker in Hwa Sung Goon to recruit lower extremity amputees. We contacted them by telephone and tried to know their prosthetic uses, adaptations and their behavior about prosthetic usage. Also, we recruited all lower extremity amputees in Hwa Sung Goon. RESULTS: In Hwa Sung Goon, the prevalence of lower extremity amputees was 35 persons per 100,000. 93.8% of them had prostheses, more than half of them were not satisfied with their prosthetic use. For last 10 years, they changed into new prosthesis per 2.3 years. CONCLUSION: In one Korean county, the prevalence of lower extremity amputees was 0.03%. Most of them used their prosthesis, and walked independently. Their compliances with rehabilitative intervention were very low.

Deep Vein Thrombosis in Rehabilitation Inpatients

OBJECTIVE: Immobility in stroke patients increases the risk of thromboembolism, and the pulmonary embolism following deep vein thrombosis (DVT) may lead to life-threatening state. But in Korea there has been a few studies about DVT in rehabilitation patients. So we investigated the prevalence of DVT in hemiplegic patients and the characteristics of the risk factors in these patients. METHOD: Ninety six rehabilitation inpatients with hemiplegia due to brain disease were participated and they had more than 2 scores in pretest probabilities. Muscle power and spasticity of hemiplegic lower limb were assessed. The duration of bed-ridden state and the presence of hypertension, diabetes mellitus and heart disease were evaluated and coagulation factors were also evaluated. Duplex ultrasound and venography were used for diagnosis of DVT, and perfusion scan for pulmonary embolism. RESULTS: Four patients among ninety six (4.17%) were diagnosed as DVT. In patients with DVT, the weaker muscle power and the longer bed-ridden duration were found. CONCLUSION: Prevalence of DVT in hemiplegic patients was 4.17%. The paresis of lower limb and long bed-ridden duration were suggested as risk factors of DVT in hemiplegic patients in Korea.

Ideal Carrier Waveform for Functional Electrical Stimulation in Upper Extremity

OBJECTIVE: This study was purposed to find the ideal carrier waveform in burst wave in Functional Electrical Stimulation (FES) for upper limbs after selection of proper site of electrode. METHOD: The 10 healthy men's non-dominant hands were studied. In 5 muscles (adductor pollicis, flexor digitorum sublimis, flexor pollicis longus, extensor digitorum communis and extensor pollicis brevis), the site where electric stimulus induced the best of purposed response was selected. A burst wave contains three carrier waveforms : sine, triphasic & rectangular. The amount of mean current was measured during key grip and open motion. Discomfort of subject was scored by three degree and compared among three waveforms. RESULTS: The amount of mean current in key grip and open motion is lowest at triphasic wave (31.3 mA, 50.5 mA) and highest at rectangular wave (79.4 mA, 82.1 mA). For the discomfort, rectangular waveform provoke the greatest discomfort in key grip and open motion. There is no statistical difference between sine and triphasic waveform. CONCLUSION: In FES of upper limbs, triangular wave can be an useful carrier waveform which require less amount of current for performing the same motion and less discomfort than rectangular or sine waveform.

Clinical Features and Long-term Outcome of Lower Extremity Amputees: A Follow-up Questionnaire Study in Three Regional Centers

OBJECTIVE: To evaluate the clinical features of lower extremity amputees and the process of prosthetic fitting and its use at follow up and to know the effects of prosthetic rehabilitation on adaptation to prosthesis and its long-term use. METHOD: One hundred and twenty four patients who underwent amputation surgery in 3 major hospitals in Korea from 1990 to 1997 were enrolled. They were evaluated by reviewing of medical records for anthropometry, level of amputation, causes of amputation, other coincidental medical problems, general physical states and followed up by telephone and mail questionnaire with respect to general outcome, prosthetic fitting, satisfaction of prosthesis, state of prosthetic use, functional state of prosthetic ambulation. RESULTS: The most common cause of amputation was trauma. The mean time to fit the prosthesis was 4.1 months and only 38 patients was supervised by rehabilitation programs. The patients who were supervised by rehabilitation program were fitted and able to ambulate significantly earlier than those who were not. They wore and used prosthesis significantly more often than those who were not supervised. The patients with above knee amputation who were supervised were significantly independent with walking aids. CONCLUSION: Rehabilitation training program enables amtupees to be fitted and walk earlier with prosthesis. Also, this program lowered the dependency on walking aids in above knee amputees.

Importance of Local Twitch Response Induced by Needling in Myofascial Pain Syndrome

OBJECTIVE: The diagnosis of myofascial pain syndrome (MPS) is commonly made by Simons' clinical diagnostic criteria which is mainly based on patients' complaints, so it is difficult to distinguish from malingering. The purpose of this study is to evaluate local twitch response by needling (LTR) as an objective diagnostic criterion of MPS. METHOD: Forty four industrial designers complaining of regional pain in neck, shoulder, or upper arm were examined by a physiatrist. If trigger point was detected, local twitch response by needling was confirmed and than severity was measured by 4 grades. Sensitivity, specificity, and positive predictive value of local twitch response was calculated with diagnosis made by Simons' clinical diagnostic criteria. Correlation between grade of local twitch response and sum of clinical features in Simons' criteria was also evaluated. RESULTS: Local twitch response by needling was corresponding with the diagnosis of MPS by Simons' criteria (sensitivity 100%, specificity 96.7%, positive predictive value 93.3%), and the severity of local twitch response was significantly associated with sum of clinical features in Simons' criteria (Spearman correlation 0.950; p=0.048) CONCLUSION: Local twitch response by needling is an important and objective diagnostic criterion of MPS.

The Eosinophilia-Myalgia Syndrome not Associated with L-tryptophan: A case report

We report a case of clinical features corresponding to Eosinophilia-Myalgia syndrome, with no causal relationship with L-tryptophan. Since the epidemic of L-tryptophan associated Eosinoghilia-Myalgia Syndrome in 1989, only 2% of the cases were found not to be related to L-tryptophan in America. We believe that this is the first case report of Eosinophilin-Myalgia Syndrome not related to L-tryptophan in Korea.