Feasibility and Usability of a Robot-Assisted Complex Upper and Lower Limb Rehabilitation System in Patients with Stroke: A Pilot Study

Objective@#To evaluate the feasibility and usability of cost-effective complex upper and lower limb robot-assisted gait training in patients with stroke using the GTR-A, a foot-plate based end-effector type robotic device. @*Methods@#Patients with subacute stroke (n=9) were included in this study. The enrolled patients received 30-minute robot-assisted gait training thrice a week for 2 weeks (6 sessions). The hand grip strength, functional ambulation categories, modified Barthel index, muscle strength test sum score, Berg Balance Scale, Timed Up and Go Test, and Short Physical Performance Battery were used as functional assessments. The heart rate was measured to evaluate cardiorespiratory fitness. A structured questionnaire was used to evaluate the usability of robot-assisted gait training. All the parameters were evaluated before and after the robot-assisted gait training program. @*Results@#Eight patients completed robot-assisted gait training, and all parameters of functional assessment significantly improved between baseline and posttraining, except for hand grip strength and muscle strength test score. The mean scores for each domain of the questionnaire were as follows: safety, 4.40±0.35; effects, 4.23±0.31; efficiency, 4.22±0.77; and satisfaction, 4.41±0.25. @*Conclusion@#Thus, the GTR-A is a feasible and safe robotic device for patients with gait impairment after stroke, resulting in improvement of ambulatory function and performance of activities of daily living with endurance training. Further research including various diseases and larger sample groups is necessary to verify the utility of this device.

Updates on the treatment of adhesive capsulitis with hydraulic distension / 영남의대학술지

Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.

Hand Function and Diffusion Tensor Imaging according to Response of Evoked Potentials in Post-stroke Hemiplegic Patients

OBJECTIVE: To investigate the association between evoked potentials and fractional anisotropy (FA) ratio in posterior limb of the internal capsule and hand movement scale (HMS) in post-stroke hemiplegic patients. METHOD: Thirty-six post-stroke hemiplegic patients with a lesion in the internal capsule were included in this study. Diffusion tensor imaging (DTI) was performed with a 3.0 tesla MR at about 1 month after stroke. FA ratio was measured in posterior limb of the internal capsule of the patients. Motor evoked potential (MEP) was obtained by magnetic stimulation of the motor cortex and recorded from the abductor pollicis muscle. Somatosensory evoked potential (SSEP) was obtained by electrical stimulation of the median nerve at the wrist and recorded from the somatosensory cortex. Hand movement scale was obtained at about 1 month and 3 months after stroke. RESULTS: Hand movement scale at about 1 month and 3 months after stroke and FA ratio were reduced significantly in patients who showed no response on MEP. However, no significant differences were observed between the patients who showed SSEP response and those who did not. FA ratio and hand movement scale were highly correlated to each other. CONCLUSION: MEP and FA ratio can be helpful in assessing the hand function at about 1 month and 3 months in post-stroke hemiplegic patients.

Comparison of Ultrasonographic and Arthrographic Findings according to the Severity of the Rotator Cuff Tear

OBJECTIVE: To determine the diagnostic value of ultrasonography in detection of the partial and full-thickness rotator cuff tear compared with arthrography. METHOD: One hundred twenty one cases were diagnosed as the patients with rotator cuff tear. Patients with full-thickness tear were divided into subgroups based on the size of small (3 cm) tear. With arthrography as the standard of comparison for diagnosis of rotator cuff tear, full-thickness tear was confirmed by leakage of contrast extending into the subacromial-subdeltoid bursa. RESULTS: Ultrasonography detected full-thickness tear in 90 cases, partial-thickness tear in 24 cases and no tear in 7 cases. A comparison of the results from ultrasonography and arthrography demonstrated a sensitivity of 83.8%, a specificity of 43.9% and an accuracy of 70.2% for detection of full-thickness tear. The size of supraspinatus full-thickness tear in inconsistent group of ultrasonographic and arthrographic findings was significantly smaller than that of consistent group. CONCLUSION: Ultrasonography may be used as the primary screening test for patients who may have suspected rotator cuff tears. However, other diagnostic techniques are recommended to confirm in patients who show small full-thickness tear on ultrasonography.

Lumbar Spinal Stenosis Induced by Epidural Lipomatosis: A case report

The epidural lipomatosis is the unusual result of fat deposition in the extradural space of spinal canal, and most cases are associated with the chronic systemic steroid treatment. Symptoms related to spinal stenosis are postulated to result from spinal cord and nerve root compression. MR imaging is the first choice of the investigation method. Patients with acute progressive symptoms are best treated surgically, while others with stable symptoms can initially be treated medically with immediate tapering of their steroid dose. We reported one case of lumbar spinal stenosis induced by epidural lipomatosis receiving chronic steroid treatment. Surgical treatment could not be performed because of the poor general condition. Rehabilitation care and nonoperative therapy were effective in improving symptoms in lumbar epidural spinal stenosis induced by epidural lipomatosis.