Transfer Activities in Patients with Spinal Cord Injury after Discharge from Hospital

OBJECTIVE: To investigate the transfer activities in patients with spinal cord injury (SCI) after discharge, and assess the caregivers' pain related to patient transfer in the community residence. METHOD: One hundred seventeen SCI patient and 35 caregivers for the patients dependent on bed-wheelchair transfer activities were included. As for SCI patients, motor index score (MIS), one transfer item from the Korean version of modified Barthel index (K-MBI), and three items related to transfers from the spinal cord independence measure (SCIM) II were evaluated. Regarding caregivers, musculoskeletal pain with patient transfer, ease-of-use and safety of transfer methods including an electric-powered lift were measured. RESULTS: The degree of transfer activity changed in 21 patients (17.9%). During follow-up, all patients with SCI at and above C6 showed dependent transfer activities. Eight from 10 patients with SCI at C7, and all patients with SCI at and below C8 performed independent bed-wheelchair transfer activities. Thirty caregivers complained of chronic musculoskeletal pain. The degree of pain at the time of patient transfer was significantly lower in those who used electric-powered lifts compared to manual transfer methods. Caregivers using electric-powered lifts showed significantly better ease-of-use scale than those using manual transfer methods. However, there was no significant difference in the safety scale. CONCLUSION: The use of electric-powered lifts is essential for patients who cannot perform independent transfers, especially those with SCI at and above C7.

Rehabilitation of Drivers with Brain Injury Using Virtual Reality Based Driving Simulator

OBJECTIVE: To investigate the effect of driving-simulator based training for the persons with brain injury. METHOD: Twenty-seven brain injury patients and 19 healthy volunteers were included in this study. Driving simulator program was composed of an aptitude test (which have 4 items) and simulated road driving. The brain injury patients had 4 sessions of driving simulator training with assessment performed during the first and the last session. Healthy volunteers underwent only one driving simulator session for assessment. To evaluate subjective satisfaction in terms of training effect and the sense for the real, a survey was administered after the training. RESULTS: In brain injury patients, there were significant improvements in both aptitude test and simulated road driving test after training (p <0.01). There were no significant differences between the scores of patients taken at the last session and the scores of healthy volunteers, while the scores of patients taken at the first session were significantly lower than those of healthy volunteers. The patients group reported positively in terms of training effect (81.5%) and the sense for the real (62.9%). CONCLUSION: A driving-simulator based training was effective for brain injury patients to regain driving skill.

Selection of Aerobic Exercise Intensity Using Heart Rate Reserve in Stroke Patients

OBJECTIVE: To determine the intensity of aerobic exercise in stroke patients using heart rate reserve (HRR) by comparing maximal oxygen consumption (VO2max) and VO2 at % HRR in maximal exercise test of treadmill, arm ergometer and bicycle ergometer. METHOD: Twenty nine stroke patients who could walk independently were included. Maximal exercise test using treadmill, arm ergometer and bicycle ergometer was performed. Heart rate, rating of perceived exertion, minute ventilation, oxygen consumption and respiratory exchange ratio were measured through respiratory gas analysis. When the standard criteria for maximal oxygen consumption (VO2max) was achieved, each test was terminated. We compared the measured VO2max with the VO2 at % heart rate reserve (HRR) and figured out the statistically significant % HRR point. RESULTS: Twenty-four (82.7%), twenty-four (82.7%) and twenty-five (86.2%) patients completed maximal exercise test using treadmill, arm ergometer and bicycle ergometer. Most patients who completed maximal exercise test satisfied the VO2max criteria with VO2 plateau at the end of the exercise test (41.3~48.2%) or RER > 1.0 (79.3~82.7%) or peak HR >age-predicted maximal heart rate (APMHR)-10 or peak HR > 70% {208-(0.7 x age)} when they took beta- blockers (6.8~13.7%). The differences between measured VO2max and VO2 above 60% HRR at treadmill test, 65% HRR at arm ergometer test, 65% HRR at bicycle ergometer test were not statistically significant (>0.05). CONCLUSION: Exercise above 60% HRR at treadmill test, 65% HRR at arm and bicycle ergometer test can be useful as aerobic exercise intensity in stroke patients.

Impact of Sitting Time on Seat-Interface Pressure of Spinal Cord Injured Patients

OBJECTIVE: To examine changes in seat-interface pressure in wheelchair seated spinal cord injured patients. METHOD: Twenty-six spinal cord injured patients, who were motor complete tetraplegic and paraplegic patients, were included in this study. After 5 cm air-filled cushion (ROHO(R)) was placed on their own wheelchair seat, patients were seated on wheelchair with neutral position for sixty minutes. The interface pressure and contact area of buttock was measured every 5 minutes. RESULTS: Significant increases of interface pressure were found in maximal and mean interface pressure during 0 to 25 minutes of sitting (p<0.05). An increased tendency of contact area of buttock was observed during sitting time but it was not significant. CONCLUSION: There were no significant changes of interface pressure after 25 minutes of sitting in spinal cord injured patients. Therefore, twenty-five minutes may be a reasonable sitting time before interface pressure is recorded.

Effect and Safety of Oral Desmopressin for Nocturia in Brain Injured Patients

OBJECTIVE: To assess the effect of oral desmopressin administration for nocturia and sleeping in brain injured patients and to confirm its safety. METHOD: 20 brain injured patients waking up more than twice a night for urination during sleeping have been subjected to take 0.1 mg of desmopressin at 9 p.m. everyday for 30 days. To analyze the effect of the drug before and after its administration, the frequency of patient's awakening for urination, duration of time to first urination after sleeping, total urination volume during sleeping and Pittsburgh sleep quality index (PSQI) were evaluated. All newly found symptoms one month after taking the medication were recorded to confirm the safety of the drug. RESULTS: After taking the medication, the mean urination frequency of 20 patients was reduced from 2.4 to 1.4, the mean duration of time to the first urination after sleeping was increased from 3.4 hours to 4.9 hours (p<0.01). The mean PSQI score of 20 patients was decreased from 9.7 to 4.8 (p<0.01). 2 patients had side effects (hyponatremia, headache). CONCLUSION: The oral administration of desmopressin was relatively safe and effective on brain injured patients with nocturia.

The Effect of Gabexate Mesylate in vivo Model of Intimal Hyperplasia on the Activity of Matrix Metalloproteinase and Proliferation of Smooth Muscle Cell

PURPOSE: Migration and proliferation of vascular smooth muscle cells (VSMCs) are important for neointimal formation after arterial injury. Migration of VSMCs requires the degradation of basement membrane and extracellular matrix surrounding the cell. There is increasing evidence that VSMCs produce extracellular matrix-degradating proteinases, such as matrix metalloproteinases (MMPs) after arterial injury. METHOD: To assess the effect of gabexate mesylate, an MMP inhibitor, in VSMCs proliferation, migration and intimal thickening, the gelatinolytic activity of MMPs and the expression of VSMC alpha-actin mRNA were analyzed in the balloon-injured rat aorta model. Forty male Sprague-Dawley rats, weighing of 250 to 300 g, underwent aortic intimal denudation with a 2 F balloon catheter. The rats were divided into two groups: the control group (n=20: no medication), and the treatment group (n=20: daily intraperitoneal injection of gabexate mesylate (5.0 mg/kg)). The aorta was harvested at various time intervals, 1, 5, 7, and 21 days after the injury. MMP expression was analyzed by using gelatin zymography, the VSMC alpha-actin mRNA expression was analyzed by RT-PCR, and the intima to media area ratio (IMAR) were evaluated microscopically. RESULT: The treatment group showed significant suppression of intimal hyperplasia compared to the control group on day 21 (P<0.05). Mean IMAR on day 21 were 1.18+/-0.2 in the control group and 0.61+/-0.06 in the treatment group. The gelatinolytic activity of MMP-9 on day 1 after injury was significantly lower in the treatment group compared to the control group (P<0.05). The gelatinolytic activity of activated MMP-2 on days 5, 7, and 21 after injury, decreased significantly in the treatment group compared to the control group (P<0.05). The expression of VSMC alpha-actin mRNA increased on days 7 and 21 after injury. Although the expression of VSMC alpha-actin mRNA was lower in the treatment group, it was not statistically significant. CONCLUSION: These results suggest that gabexate mesylate suppresses intimal hyperplasia formation after arterial injury by decreasing activation of MMP.