Association Between Length of Stay in the Intensive Care Unit and Sarcopenia Among Hemiplegic Stroke Patients

Objective@#To discuss the association between the length of stay at the intensive care unit (ICU) and sarcopenia among hemiplegic stroke patients. @*Methods@#This study evaluated 66 hemiplegic stroke patients with history of ICU admission using handgrip strength and bioelectrical impedance analysis to obtain height-adjusted appendicular skeletal muscle mass. The diagnosis of sarcopenia was made according to the muscle mass based on the Asian Working Group for Sarcopenia. The patients were divided into sarcopenic and non-sarcopenic groups. The two groups were statistically analyzed, and the significant factors with differences were studied. A multivariate logistic regression analysis was performed to examine the association between length of stay in the ICU and sarcopenia, after adjusting for potential confounders. @*Results@#Among 66 hemiplegic patients with an ICU admission history, 12 patients were diagnosed with sarcopenia. Sarcopenia patients showed lower scores on the Korean version of the Modified Barthel Index and the Korean version of the Mini-Mental State Examination. Additionally, patients with sarcopenia had a longer length of stay in the ICU, and univariate and multivariate analyses confirmed that the ICU length of stay was significantly related to sarcopenia (adjusted odds ratio=1.187; 95% confidence interval, 1.019–1.382; p=0.028). @*Conclusion@#The length of stay in the ICU was significantly associated with sarcopenia in hemiplegic stroke patients.

Determining the Most Appropriate Assistive Walking Device Using the Inertial Measurement Unit-Based Gait Analysis System in Disabled Patients

Objective@#To evaluate the gait pattern of patients with gait disturbances without consideration of defilades due to assistive devices. This study focuses on gait analysis using the inertial measurement unit (IMU) system, which can also be used to determine the most appropriate assistive device for patients with gait disturbances. @*Methods@#Records of 18 disabled patients who visited the Department of Rehabilitation from May 2018 to June 2018 were selected. Patients’ gait patterns were analyzed using the IMU system with different assistive devices to determine the most appropriate device depending on the patient’s condition. Evaluation was performed using two or more devices, and the appropriate device was selected by comparing the 14 parameters of gait evaluation. The device showing measurements nearer or the nearest to the normative value was selected for rehabilitation. @*Results@#The result of the gait evaluation in all 18 patients was analyzed using the IMU system. According to the records, the patients were evaluated using various assistive devices without consideration of defilades. Moreover, this gait analysis was effective in determining the most appropriate device for each patient. Increased gait cycle time and swing phase and decreased stance phase were observed in devices requiring significant assistance. @*Conclusion@#The IMU-based gait analysis system is beneficial in evaluating gait in clinical fields. Specifically, it is useful in evaluating patients with gait disturbances who require assistive devices. Furthermore, it allows the establishment of an evidence-based decision for the most appropriate assistive walking devices for patients with gait disturbances.

The Effect of Polydeoxyribonucleotide on Chronic Non-healing Wound of an Amputee: A Case Report

Polydeoxyribonucleotide (PDRN) is safe and effective in wound healing, cellular growth, synthesis of extracellular matrix protein, and inflammation reduction via activation of adenosine A2 receptors. We report a 28-year-old male patient treated with PDRN injections for chronic non-healing wound refractory to negative pressure wound therapy, skin graft, or growth factors. Three injections of PDRN were administered at the wound site into the anterior and medial sides of the left stump on the 1st, 4th, and 9th days of hospitalization. The PDRN ameliorated wound healing by enhancing cell growth, tissue repair, and angiogenesis. PDRN application represents a potential treatment for non-healing wounds obviating the need for additional therapies, and hospitalization, as well as improve patient’s activities of daily living.

Computed Tomography as an Objective Measurement Tool for Secondary Lymphedema Treated With Extracorporeal Shock Wave Therapy

Two patients with stage three secondary lymphedema of the upper extremities underwent treatment for breast cancer, including surgery, chemotherapy, and radiotherapy. They were examined with computed tomography (CT) before and after extracorporeal shock wave therapy (ESWT). We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities. There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT. CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema. Therefore, CT may have good clinical potential for treatment and follow-up in the management of lymphedema.

Usefulness of Permanent Tracheostoma in Chronic Brain Injured Patients: A Case Series

Patients with severe neurological deficit, such as hypoxic ischemic injury, cerebral infarction, and traumatic brain injury, often show comatose mental status and require maintenance of long-term tracheostomy for pulmonary toileting. However, several complications, which are mostly related to the cannula, invariably occur. Permanent tracheostoma is a short, skin-lined, noncollapsing, self-sustaining opening by suturing the denuded skin lining to the margin of the tracheal stoma. This tube-free method is a useful alternative to make long-term airway without tube-related complications in chronic diseases, such as obstructive sleep apnea, and laryngeal cancer, however, it has not yet been reported in chronic brain injured patients. This case report illustrates 3 cases of vegetative patients in our rehabilitation clinic who underwent successful procedure of permanent tracheostoma. Permanent tracheostoma has some benefits associated with the free of tube-related complications, and can be considered as a useful alternative way for chronic brain injured patients with long-term tracheostomy.

Change in Electromyographic Activity of Wrist Extensor by Cylindrical Brace

PURPOSE: To verify the effect of a newly-developed cylindrical type forearm brace, which was designed to give focal counterforce perpendicularly on the muscle belly of the wrist extensor. MATERIALS AND METHODS: The dominant hands of 24 (12 males, 12 females) healthy subjects were tested. Two types of forearm braces (focal cylindrical type and broad pneumatic type) were examined. The braces were applied at the extensor carpi radialis brevis, 5 to 7 cm distal to the lateral epicondyle. Two surface electrodes were attached to the proximal and distal parts of the brace. By quantitative electromyography, the mean amplitudes of voluntary extensor carpi radialis brevis contraction before and after applying each brace were recorded and analyzed. RESULTS: The mean amplitudes of the focal cylindrical brace and broad pneumatic brace were reduced significantly compared to no brace (p<0.05), with a larger reduction for the cylindrical brace than the pneumatic brace (p<0.05). There was no significant difference between the proximal and distal mean amplitudes with each brace. CONCLUSION: A cylindrical type brace decreased electromyographic activity in the wrist extensor more effectively than did the pneumatic type brace.

Clinical Outcomes of Extracorporeal Shock Wave Therapy in Patients With Secondary Lymphedema: A Pilot Study

OBJECTIVE: To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment. METHODS: In a prospective clinical trial, ESWT was performed consecutively 4 times over two weeks in 7 patients who were diagnosed with stage 3 secondary lymphedema after breast cancer treatment. Each patient was treated with four sessions of ESWT (0.056-0.068 mJ/mm2, 2,000 impulses). The parameters were the circumference of the arm, thickness of the skin and volume of the arm. We measured these parameters with baseline values before ESWT and repeated the evaluation after each ESWT treatment. Subjective data on skin thickness, edema and sensory impairment were obtained using a visual analogue scale (VAS). RESULTS: The mean volume of the affected arm after four consecutive ESWT was significantly reduced from 2,332 to 2,144 mL (p<0.05). The circumference and thickness of the skin fold of the affected arm were significantly decreased after the fourth ESWT (p<0.05). The three VAS scores were significantly improved after the fourth ESWT. Almost all patients were satisfied with this treatment and felt softer texture in their affected arm after treatment. CONCLUSION: ESWT is an effective modality in the treatment of stage 3 lymphedema after breast cancer treatment. ESWT reduced the circumference and the thickness of arms with lymphedema and satisfied almost all patients with lymphedema. Therefore, this treatment provides clinically favorable outcome to patients with breast cancer-related lymphedema.

Factors that Influence Quiet Standing Balance of Patients with Incomplete Cervical Spinal Cord Injuries

OBJECTIVE: To investigate the factors influencing the quiet standing balance of patients with incomplete cervical spinal cord injuries. Also to find the correlations between posturographic parameters and clinical balance tests as well as to find the correlation between posturographic parameters and functional independence. METHOD: We conducted a tetra-ataxiometric posturography, lower extremity motor score (LEMS), Korean version of the Berg Balance Scale (K-BBS), Timed Up and Go test (TUG), and Korean Version of the Modified Barthel Index (K-MBI) of 10 patients. 10 healthy adults carried out the posturography. We checked stability, weight distribution, Fourier and synchronization indices of eight positions, and the fall index of the posturography. RESULTS: The patient group showed significantly higher stability and weight distribution indices in all eight positions. Stability indices significantly increased with eyes closed or standing on pillows. Weight distribution indices were significantly higher with eyes closed or the head bent backwards. The patient group showed significantly higher Fourier indices of low, low-medium, and high frequency in eight positions. The Fourier indices at high-medium frequency were significantly higher with eyes closed on pillows or in variable head positions. There were no significant differences of synchronization indices between the patient and the control group. The falling index of the patient group significantly correlated with K-BBS, TUG, and K-MBI. LEMS had significant correlation with some synchronization indices, but not with the falling index. CONCLUSION: The quiet standing balance of the patients was influenced by somatosensory limitations or insufficient visual compensation. We should try to improve the postural balance and functional independence of patients through proper proprioceptive and lower extremity strength training for better postural and pedal control, and to make efforts to minimize environmental hazards.

The Effects of Extracorporeal Shock Wave Therapy on Spasticity in Chronic Stroke Patients

OBJECTIVE: To evaluate the immediate and short term effects of extracorporeal shock wave therapy (ESWT) on elbow flexor spasticity after stroke, to compare the treatment effects according to the ESWT applied site (muscle group and musculotendinous junction group) and to assess the factors affecting the treatment effect. METHOD: A total of 32 stroke patients were enrolled, 23 of them were ESWT group and 9 were control group. ESWT was applied 1 session/week, total 3 sessions and 12 patients were applied at biceps muscle belly and 11 patients were applied at biceps musculotendinosus junction. Patients were evaluated using modified Ashworth scale (MAS), modified Tardieu scale (MTS), Korean-modified Barthel index (K-MBI) at baseline, immediately, 1 week and 4 weeks after ESWT. RESULTS: MAS and MTS were significantly improved immediately after ESWT, but were not significantly changed at 1 week, 4 weeks in ESWT group. The scores of K-MBI improved but were not different between ESWT group and control group. The treatment effect was greater in musculotendinous junction group than muscle belly group in MTS and MAS immediately after ESWT. We could not find out any significant factors affecting the effects of ESWT. CONCLUSION: Spasticity after chronic stroke improved immediately after ESWT, but was not changed significantly at 1 week and 4 weeks after ESWT. Further studies about ESWT parameters for spasticity and factors affecting treatment effect are needed.

Development of a Personal Health Record System Based on USB Flash Drive and Web Service / 대한의료정보학회지

OBJECTIVE: The development of information communication technology (ICT) and the demand for managing the healthy lives of individuals are accelerating the informatization of the health and medical field. Considering this environment and the needs of the individual, this paper has designed and developed a web and mobile storage device-based personal health record (PHR) system that individuals can manage by themselves anywhere, anytime, whether on-line or off-line. Based on the experience of implementing the system, its development method, results, and relevant technical issues are described. SYSTEM DESIGN AND DESCRIPTION: This system is implemented to manage PHR, including vital signs and ingested/consumed calories for a lifetime by connecting a PHR-integrated web server to each hospital's information system, and the PHR programs installed in the individual's PC or USB flash memory drive. To achieve this, an interface module, web server system, and PHR viewer program for individuals are developed. RESULTS: When it is off-line, the PHR program is operated to inquire the data saved in the DB, and the self-measured information can be inputted. When it is on-line, it calls the web service function to inquire the medical information, including hospital visit history, prescription history, diagnosis result, image inspection result and medical treatment result. CONCLUSION: This system connects home and mobile healthcare to hospitals but minimizes information leakage because the data is not accumulated. By loading a plug & play, PHR viewer to an easy-to-carry mobile storage device, the systems supports a sustainable health management.

Sports for the Disabled: History and the Classification / 한양의대학술지

There has been growing movement to need the Sports for the disabled. The International Paralympic Committee (IPC) and National Paralympic Committee (NPC) have been structured more systematically and more specialized. For the detailed understanding of the Sports for the disabled, we reviewed the history, international and national organization, and functional classification systems of the sports for the disabled. The biggest difference compared with able-bodied sports is the classification system by degree of the disability for the fair play. There are 3 major classification systems for physically disabled person and each sports organization has a sports specific classification system. At first, we have to classify using major classification systems and sports specific classification system. The most important thing in the Sports for the disabled is exact classification of the disability before event.

Sports for the Disabled: History and the Classification / 한양의대학술지

There has been growing movement to need the Sports for the disabled. The International Paralympic Committee (IPC) and National Paralympic Committee (NPC) have been structured more systematically and more specialized. For the detailed understanding of the Sports for the disabled, we reviewed the history, international and national organization, and functional classification systems of the sports for the disabled. The biggest difference compared with able-bodied sports is the classification system by degree of the disability for the fair play. There are 3 major classification systems for physically disabled person and each sports organization has a sports specific classification system. At first, we have to classify using major classification systems and sports specific classification system. The most important thing in the Sports for the disabled is exact classification of the disability before event.

Clinical Findings of Swallowing Difficulties in Patients with Post-poliomyelitis Syndrome

OBJECTIVE: To evaluate the presence of swallowing difficulties in patients with post-poliomyelitis syndrome (PPS) by characterizing their swallowing patterns with videofluoroscopic swallowing study. METHOD: Eleven patients diagnosed with PPS were enrolled. All subjects answered the self assessment questionnaire for swallowing difficulty and gastric symptoms. We assessed the ability of tongue control, the oral transit time, cricopharyngeal opening time, and pharyngeal transit time. We also assessed the presence of aspiration or penetration and the amount of residue in the vallecular and pyriform sinus by four grade scales. A gastroenterologist examined esophagus, stomach and duodenum through an esophagogastroduodenoscopy. RESULTS: Six patients complained swallowing difficulty and nine patients showed symptoms of esophageal regurgitation. Although finding of penetration or aspiration was not seen, all patients showed swallowing dysfunction in the videofluoroscopic swallowing study. In the esophagogastroduodenoscopy, chronic superficial gastritis was observed in all enrolled patients (n=11) and reflux esophagitis was found in 4 patients (36%). CONCLUSION: About half patients with PPS complained of dysphagia. Routine evaluation of dysphagia with videofluoroscopic swallowing study and esophagogastroduodenoscopy is needed in all patients with PPS due to the low reliability in their subjective symptom.

Factors Affecting Drooling in Adult Patients with Traumatic Brain Injury

OBJECTIVE: To investigate whether drooling in patients with traumatic brain injury (TBI) is due to hypersalivation or cognitive dysfunction or disability. METHOD: The subjects were 24 TBI patients with drooling and 17 TBI patients without drooling and 20 unaffected healthy volunteers who had no known physical or mental disabilities. All participants had no known history of diabetes mellitus, hypertension, thyroid dysfunction or chronic alcoholism. And, we excluded the subjects who take the anticholinergics, beta-agonist or steroid. Salivary pH and flow rate were compared between the TBI groups and the control group. We also measured Korean mini-mental state examination (K-MMSE) and disability rating scale (DRS) and compared mean values between TBI groups. RESULTS: There was no statistical difference in the mean salivary pH and flow rate between the tested groups. The drooling severity and frequency showed no correlation with salivary flow rate in all groups. The drooling severity and frequency showed significant correlations with K-MMSE, but not with DRS in TBI groups. CONCLUSION: The results of this study suggested that the cause of drooling in patients with TBI may not be the hypersalivation and functional disability, but cognitive dysfunction.

Gait Analysis of Unilateral Transfemoral Amputees with Prosthetics on an Inclined Surface

OBJECTIVE: The aim of this study was to investigate the characteristics of prosthetic gait of unilateral transfemoral amputees on an inclined surface compared with those of normal persons. METHOD: Five male unilateral transfemoral amputees and ten normal persons were recruited. Uphill and downhill walking of inclined surface on slopes of 10 and 20 degrees and level walking were investigated. Kinematic data were obtained with VICON 370 system (Oxford Metrics Ltd., UK). RESULTS: The kinematic data of the transfemoral amputees showed significantly decreased peak hip extension at all situation and peak hip flexion at 20 degrees uphill walking, significant increased knee extension at 20 degrees downhill and all uphill walking, and significant decreased knee flexion at all situation, and significant decreased ankle dorsiflexion at all situation and plantarflexion at all situation except 20 degrees downhill walking compared with those of normal persons. Also they showed significant decreased cadence, speed and increased step time, double support at all situation compared with normal persons. CONCLUSION: Analysis of prosthetic gait of unilateral transfemoral amputees on an inclined surface support the basic data for induction of normal gait pattern.

Swallowing Pattern according to Controlled Food Viscosity in Patients with Brain Lesion

OBJECTIVE: The response of the pharyngeal phase during swallowing is influenced by various factors including viscosity, shape, firmness, fracturability, and cohesive power. These factors affect the pharyngeal phase simultaneously, but little research has been conducted into their individual effects on the pharyngeal phase. This study investigated the relationship between controlled viscosity and pharyngeal transit time (PTT). METHOD: The subjects were 81 patients with naso-gastric tube due to brain dysfunction. PTT was assessed by video- esophageal fluoroscopy and the viscosity of the processed starch by Brookfield viscometer. High viscosity was defined as a controlled viscosity of 12% and 9%, medium viscosity as a controlled viscosity of 7.5%, 6%, and 4.5%, and low viscosity as a controlled viscosity of 3%, 1.5%, and 0% (liquid viscosity). RESULTS: PTT was prolonged with increasing viscosity in the experimental group. There were no significant differences between PTT of the experimental and control groups at any viscosity. Aspiration prevalence was 1.85%, 7.82%, and 22.22% in the high, medium, and low viscosity groups, respectively, and the three prevalences showed significant differences. CONCLUSION: PTT showed a tendency to be prolonged with increasing food viscosity in the experimental group.

Kinematic Gait Analysis in Children with Spastic Diplegic Cerebral Palsy after Selective Posterior Rhizotomy: Long Term Follow Up

OBJECTIVE: To evaluate the changes of kinematic gait patterns at long-term follow up study after selective posterior rhizotomy (SPR) in children with spastic diplegic cerebral palsy. METHOD: Eighteen children with spastic diplegic cerebral palsy participated in this study. Gait patterns on sagittal plane were studied before and at average 3.5 years after SPR. Kinematic and temporospatial data were obtained by the VICON 370 system. RESULTS: The spasticity of hip adductor and ankle plantar flexor were improved significantly after SPR. The maximal angle of pelvic tilt, ankle dorsiflexion angle at initial contact, peak ankle dorsiflexion angle during stance phase, at toe-off and during swing phase, mid-range point of flexion-extension motion on ankle were significantly improved after SPR. The temporospatial data tended to improve after SPR at long-term follow up. CONCLUSION: The SPR reduced spasticity and the gait pat terns were improved in children with spastic diplegic cere bral palsy at long-term follow up.

Kinematic Gait Analysis of Ramp Walking in Normal Adult

OBJECTIVE: To investigate the characteristics of ramp walking. METHOD: The sagittal kinematic and temporospatial data of ramp and level walking were obtained by a motion analyzer for ten healthy young adults. RESULTS: Compared with the values of level walking, the range of motion of ankle at all degrees for up-hill walking and the ROM of hip at 20o down-hill and all degrees for up-hill walking were significantly different (p<0.05). The peak dorsiflexion of ankle at 20o of up-hill and at 20o down-hill walking increased significantly (p<0.05) and peak plantar flexion of ankle at all degrees of up-hill walking increased significantly (p<0.05). The peak flexion of knee at 20o of up-hill walking increased significantly (p<0.05) and peak extension of knee at 20o of up-hill and down-hill walking also increased significantly (p<0.05). The peak flexion angles of hip at all degrees for up and down-hill walking were significantly different (p<0.05) and peak extension angles of hip at 10o of up-hill walking increased significantly (p<0.05). The temporospatial data showed no significant difference. CONCLUSION: Ramp walking showed a different kinematic gait pattern. So, this study may be useful to evaluate the effect of gait training on the ramp and pathologic gait patterns.

The Effect of Conservative Treatment in Spinal Cord Injured Patients for the Vesicoureteral Reflux

OBJECTIVE: To evaluate the effectiveness of conservative treatment for the vesicoureteral reflux (VUR) in spinal cord injured patients. METHOD: Twelve spinal cord injured patients were diagnosed as VUR which was graded as the International Classification System by voiding cystourethrography (VCUG). They received conservative treatment including clean inter mittent catheterization, administration of anticholinergics and intravesical oxybutynin instillation therapy. Pre-treat ment urodynamic studies and VCUG were compared with follow-up studies after conservative treatment. The results of follow-up VCUG were graded as controlled or remained group. RESULTS: After conservative treatment, VUR was controlled in 8 patients (67.0%) and remained in 4 patients (33.0%) On urodynamic studies after conservative treatment, mean maximal bladder capacity increased from 225.0 to 370.6 ml (p<0.05), mean bladder compliance increased from 12.1 to 31.5 ml/cmH2O (p<0.05), mean maximal detrusor pressure decreased from 63.8 to 21.8 cmH2O (p<0.05) in controlled group. But in remained group, there was no significant difference between pre &post-treatment. There was singnificant difference in change ratio of maximal detrusor pressure between two groups (p<0.05). CONCLUSION: This study showed 67.0% controlled rate of VUR by VCUG with improved urodynamic parameters after conservative treatment. We conclude that VUR can be effectively managed by the conservative method in spinal cord injured patients.

Parry-Romberg Syndrome with Intracranial Vascular Dysplasia: A case report

Parry-Romberg syndrome is characterized by slowly progressive but self-limited atrophy of the facial subcutaneous fat, which can be followed by wasting of associated skin, cartilage, connective or ocular tissue, muscle and bone. The possible etiologies of Parry-Romberg syndrome are infection, immunological, trauma, sympathetic innervation, hereditary and cranial vascular malformation. The major features of this syndrome, which have been reported previously, are atrophy of the soft tissues on one side of the face with hyperpigmentation of the overlying skin and various neurologic findings, including migraine-type headache, trigeminal neuralgia and focal epilepsy. We describe the improvement of functional level related to Parry-Romberg syndrome in a child who presented the unilateral neurologic deficits and epilepsy with intracranial vascular dysplasia after comprehensive rehabilitative management.