Clinical Effect of Selective Neuroablative Technique Using Radiofrequency on Spasticity in a Patient with Stroke

Radiofrequency energy, such as that used in neuroablation, has been applied in various medical and surgical fields. However, no consensus exists regarding neuroablation protocols using radiofrequency. This study aimed to report the effect of a radiofrequency neuroablative technique on spastic foot management in a patient with stroke and present its safety and persistence. A 59-year-old man with hemiplegic gait by the intracerebral hemorrhage had radiofrequency ablation of the motor nerve branch supplying the medial gastrocnemius. The patient’s subjective and objective measurements of the spastic limb improved after the intervention. The effect lasted for 3 months. Radiofrequency neuroablative technique may be beneficial for treating spastic gait in patients with stroke. The above technique must be used to verify patients with spasticity, and research should be investigated to determine appropriated parameters.

Architectural Changes in the Medial Gastrocnemius on Sonography after Nerve Ablation in Healthy Adults

Architectural changes in healthy muscle after denervation have not yet been reported. This study aimed to investigate architectural changes in the medial head of the gastrocnemius muscle (GCM) after aesthetic tibial nerve ablation in healthy adults using ultrasonography (US). The effects of tibial nerve ablation were verified by visual observation and surface electromyography analysis. US images of medial GCMs were taken by one trained physician using B-mode and real-time US with a linear-array probe before nerve ablation, at 1 week after nerve ablation and at 3 months after nerve ablation in an anatomic standing position with the feet about shoulder-width apart in 19 healthy adults (17 females and 2 males). Muscle thickness was significantly reduced on the left side at 1 week and 3 months after the procedure and on the right side at 3 months after the procedure (p<0.050). Although fascicle length was not significantly changed, pennation angle was significantly reduced on both sides at 3 months after the procedure (p<0.050). Muscle thickness and pennation angle of the muscle fascicle were significantly reduced, although fascicle length was not significantly changed, after tibial nerve ablation in the medial GCM of healthy adults.

An Motion Analysis of Sit-to-Stand Transfer in Young Children with Spastic Diplegic Cerebral Palsy

OBJECTIVE: This study is aimed to evaluate a sit-to-stand (STS) pattern in the children with spastic diplegic cerebral palsy in comparison with the normal children. METHOD: Fifteen young children with spastic diplegic cerebral palsy and 21 normally developed children were recruited as subjects. A motion analysis system using a Motion analyzer (Vicon 370 M.A. with 6 infrared cameras) was used to examine the STS task. The changes in joint angle, moment, and power of each joints in lower limbs, total duration of STS transfer and each transitional points were assessed. RESULTS: Total duration of STS in patients was 2.44 sec, which was significantly prolonged in comparing with 1.10 sec in normal control. The major prolongation of STS occurred in the phase of vertical movement of center of mass (CoM). Cerebral palsied children showed more anterior pelvic tilting and hip flexion throughout STS transfer than normal control. Asymmetries in initial angle of ankle and maximal momentum of knee extension were shown in spastic diplegic children with cerebral palsy, but not in normal control. Less extension momentum and power of knee joint and more plantar flexion momentaum of ankle joint were observed in cerebral palsy in comparing with those of normal children. CONCLUSION: This study showed that STS pattern in spastic diplegic cerebral palsy was quite different from that of normal children. The characteristics of STS pattern in these children was slowness of speed; mainly from slowness of vertical displacement of CoM, and more anterior pelvic tilt, hip flexion and earlier abrupt change of knee extension. As well, the major moments required for this task in these patients occurred at hip and ankle joints instead of knee joint.

Effects of Therapeutic Exercise on Patients with Osteoarthritis of Knee

OBJECTIVE: To investigate the effect of therapeutic exercise on patients with osteoarthritis of knee in view of functional capacity. METHOD: The subjects were 80 patients with osteoarthritis of knee. Patients were randomly allocated to exercise or no exercise (control) group. Osteoarthritis was diagnosed on the base of clinical features, X ray findings. Therapeutic exercise was consisted of quad-setting exercise, isokinetic exercise, squatting exercise. Effects of therapeutic exercise were evaluated by muscle function, functioal performance and degree of pain. RESULTS: In exercise group, muscle function such as torque and endurance of extensor and flexor of knee were increased significantly compaired with control group (p<0.05). Increment was more apparent in extensor. In both group, pain was decreased but more apparent in exercise group (p<0.05). Functional performance was assessed in terms of dependency, difficulty and amount of pain. Exercise group showed improvement of functional performance in walking inside, climbing stairs (p<0.05) but control group did not show improvement. Seventy percent of patients with osteoarthritis of knee showed increment of body weight above 10 kg compaired with their twenties. CONCLUSION: When we manage the osteoarthritis of knee, therapeutic exercise should be included in the treatment regimen as well as physical and medical therapy.

Quantitative Sensory Test in Normal Adult

OBJECTIVE: To obtain normal data of quantitative sensory test (QST) in Korean adult. METHOD: The subjects were 85 normal adults aging from 30 to 69 years old, who had no abnormal sensory and neurologic problem. We performed following three QSTs on dominant side and one verbal questionnaire. 1) Semmes-Weinstein monofilament wire system (0.05 G, 0.2 G, 2 G, 4 G, 10 G, 300 G) for touch sensation, 2) Rydel-Seiffer Tuning Fork for vibration sensation, 3) TSA-2001 Thermal sensory analyser for thermal sensation, 4)University of Texas Subjective Peripheral Neuropathy verbal questionnaire. RESULTS: 1) Touch perception score measured with Semmes-Weinstein monofilament wire system, declined with age (p<0.01). 2) Vibration perception score measured with the tuning fork, declined with age in foot (p<0.01). 3) Warm sense and heat pain threshold measured with TSA-2001 thermal sensory analyser increased with age, and cold sense and cold pain threshold declined with age. 4) Weight showed negative correlation with vibration perception score in man's foot. CONCLUSION: Normal data of three sensory test obtained from this study could be used for the early detection of peripheral neuropathy or loss of "protective sensation".

Prosthetic ambulation in a paraplegic patient with a transfemoral amputation and radial nerve palsy

Great importance and caution should be placed on prosthetic fitting for a paraplegic patient with an anesthetic residual limb if functional ambulation is to be achieved. The combination of paraplegia with a transfemoral amputation and radial nerve palsy is a complex injury that makes the rehabilitation process difficult. This article describes a case of L2 paraplegia with a transfemoral amputation and radial nerve palsy on the right side. Following the rehabilitation course, the patient independently walked using a walker at indoor level with a transfemoral prosthesis with ischial containment socket, polycentric knee assembly, endoskeletal shank and multiaxis foot assembly and a knee ankle foot orthosis on the sound side. The difficulties of fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.

The usefulness of minimal F-wave latency and sural/radial amplitude ratio in diabetic polyneuropathy

The possibility of whether minimal F-wave latency and a simple ratio between the sural and superficial radial sensory response amplitudes may provide a useful electrodiagnostic test in diabetic patients was investigated in this report. To evaluate the diagnostic sensitivity of minimal F-wave latency, the Z-scores of the minimal F-wave latency, motor nerve conduction velocity (MCV), amplitude of compound muscle action potentials (CMAP), and distal latency (DL) of the median, ulnar, tibial, and peroneal nerve were compared in 37 diabetic patients. For the median, ulnar, and tibial nerves, the Z scores of the minimal F-wave latency were significantly larger than those of the MCV. In addition for all four motor nerves, the Z scores of the minimal F-wave latency were significantly larger than those for the CMAP amplitude. Furthermore, 19 subjects showing abnormal results in the standard sensory nerve conduction study had a significantly lower sural/radial amplitude ratio (SRAR), and 84% of them had an SRAR of less than 0.5. In conclusion, minimal F-wave latency and the ratio between the amplitudes of the sural and superficial radial sensory nerve action potential are sensitive measures for the detection of nerve pathology and should be considered in electrophysiologic studies of diabetic polyneuropathy.

Foot screening technique in a diabetic population

Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population