Ambulatory Outcome after Hip Fractures in Patients with Cerebrovascular Accident

OBJECTIVE: The purposes of this study were (1) to determine the effectiveness of intensive rehabilitation on ambulatory recovery in patients after hip fracture with previous cerebrovascular accident; (2) to define the difference in the ambulatory outcome of the hip fracture patients according to their previous history of stroke. METHOD: One hundred and seventy-three cases with hip fracture were studied. All patients were divided into two groups: Group A with and Group B without a history of stroke prior to the fracture. The following information was obtained in each patients: age, sex, type and side of fracture, side of hemiplegia, duration of hospitalization, concurrent disease. Ambulatory status was divided as satisfactory (walking with quad-cane or walking frame or mono-cane) or nonsatisfactory (confined to wheelchair or to a bed) accordong to their recovery after rehabilitation. RESULTS: Twenty three percent of patients have the history of stroke with hip fracture on hemiplegic side and 51.4% of them regained their prefracture level of ambulation. No significant difference was found in the incidence of concurrent disease, length of hospital stay, and functional recovery between hip fracture patients with and without a history of stroke. CONCLUSION: We conclude that rehabilitation of the stroke patient with hip fracture is worthwhile and comprehensive rehabilitation should be done in hip fracture patients with or without hemiplegia.

Clinical Features and Electrodiagnostic Findings of Ulnar Neuropathy at the Elbow

OBJECTIVE: To evaluate the clinical and electrodiagnostic findings of ulnar neuropathy at the elbow. METHOD: Sixty-two patients with ulnar neuropathy at the elbow were reviewed retrospectively to establish causes, severity and type of neuropathy, symptom, sign, operation name and operative findings. RESULTS: 1) Of total 62 cases, 41 were male and 21 were female and the most often were in their forties and fifties. 2) The main cause of the neuropathy is bone deformity caused by previous fracture or dislocation (43.6%). 3) The symptoms observed were motor weakness (66.1%), sensory change (79%) and muscle atrophy (35.5%). 4) Forty-nine cases showed abnormality in nerve conduction study and needle electromyography study, and 9 cases showed abnormality only in the needle electromyography study. 5) On needle electromyography, sparing of flexor carpi ulnaris was shown in 50 cases (80.6%). 6) Operative treatment was performed in 15 cases. Among them, electrodiagnostic and operative diagnosis coincided in only 12 cases (80%). CONCLUSION: We conclude that above clinical and electrodiagnostic findings are useful for the diagonosis ulnar neuropathy at the elbow with consideration of etiology, localization and for the selection of operative treatment.

The Relationship of MMSE to Functional Improvement in Brain Injured Patients

OBJECTIVE: To determine the relationship of the Mini-Mental State Examination (MMSE) scores to the functional improvement of the brain-injured patients with a traumatic brain injury or cerebrovascular accident. METHOD: Thirty patients who were admitted to a rehabilitation hospital for their initial brain injury were retrospectively studied. Subjects were administerd a MMSE as cognitive assessment and a Functional Independence Measure (FIM) and Modified Barthel Index (MBI) as functional assessment upon referral for the rehabilitation and at discharge. RESULTS: MMSE scores, FIM scores and MBI scores at discharge increased significantly compared to the scores at the start of rehabilitation. The changes of MMSE scores significantly correlated with the changes of FIM scores and MBI scores in 30 brain injured patients (p<0.001). Among the subitems of FIM, the social cognition, communication, self care, and sphincter control were strongly correlated with the MMSE scores. CONCLUSION: We conclude that the MMSE can be a relevant predicting factor for the changes of functional status of brain-injured patients from a inpatient stroke rehabilitation and post brain- injury rehabilitation.