Atrophy of Multifidus Muscle on Low Back Pain Patients

OBJECTIVE: To investigate the correlation of multifidus muscle atrophy on MRI findings with clinical findings in low back pain patients. METHOD: Medical records of 80 patients presenting with low back pain were retrospectively reviewed. Their MR images were visually analysed to know lumbar multifidus muscle atrophy, disc herniation, disc degeneration, spinal stenosis and nerve root compression. RESULTS: Multifidus muscle atrophy increased from the upper lumbar level to the most caudal intervertebral level. It was bilateral in the majority of the cases. Multifidus muscle atrophy was well correlated with patient's age, referred leg pain, and disc degeneration. However, duration of low back pain, disc herniation, spinal stenosis, nerve root compression, sex, weight, height and BMI had no correlation with multifidus muscle atrophy. CONCLUSION: Examination of multifidus muscle atrophy should be considered when assessing MR images of lumbar spine. It may help for further evaluation and planning the treatment modalities of low back pain.

Survey of the Demands of the Parents of Children with Cerebral Palsy

OBJECTIVE: Because the treatment of children with cerebral palsy needs much time and efforts, the parents are suffering from longstanding treatment and financial problems. Home therapy based on the neurodevelopmental treatment strategy might help to solve these problems extending the time of treatment and helping carry over the effects of the treatment. The purpose of this study is to evaluate current difficulties in managing the children with cerebral palsy and needs of the parents, so that we can obtain a basic information to make the educational program for home therapy. METHOD: A cross-sectional study was performed by questionnaire from the parents of cerebral palsy. RESULTS: The parents recognized the importance of home therapy and were enthusiastic to manage their children at home in 72.7%. However, 38.2% of the parents were lack of practical idea about the skill and knowledge of home therapy, and 51.7% had much burden about time and the expenses of the treatment. CONCLUSION: The needs of home therapy for cerebral palsy by parents were high enough to develop the home program. Thus, practical program of home therapy with education of the parents can improve motor development of the children with cerebral palsy and reduce the time and expenses.

Current Physical Therapy Status for the Children with Cerebral Palsy in Korea

OBJECTIVE: Treatment of children with cerebral palsy needs much time and effort, so it is very hard for many patients to get hospital based treatment. To develop the home treatment program with the parents, we tried to elucidate the current difficulties to which therapists were facing during the treatment of cerebral palsies. METHOD: A cross-sectional study was performed to 250 physical therapists in 110 hospitals with a questionaire by mail. Sixty two universities and general hospitals, 37 rehabilitation centers and 31 community rehabilitation centers were involved in treatment for cerebral palsy, 51% of them are located in Seoul and Kyungi-do. RESULTS: 1) The current treatment time was 33.7 minutes, but most therapists replied that 45 minutes would be optimal. 2) Fifty four therapists (86.1%) had reviewed on introduction or basic course of the Bobath or Vojta program; the duration of the course ranged from 5 days to 1 to 2 months. 3) Fifty five cerebral palsy patients (66.7%) continued treatment for 1 to 2 years and 25% received treatment for more than 2 years. 4) Twenty nine patients (35%) received home therapy from trained parents, 75% of the cases noted significant improvement. CONCLUSION: Cerebral palsy treatment programs require more time than the actural duration of time given during therapy sessions. Thus, parent education for home therapy is considered to be an essential part of cerebral palsy management.

Auditory Brainstem Evoked Potentials in Preterm Infants

OBJECTIVE: To investigate the change of peak latency, interpeak latency and amplitude of auditory brainstem evoked potentials (AEPs) in normal preterm infants in accordance with the age, and to find out the correlation between reproducibility of AEPs and high risk of premature infants. METHOD: AEP studies were performed on 266 premature infants (male 143, female 123) within a month of the birth. Acquired potentials were grouped by the reproducibility of waveforms, and latency, interpeak latency and amplitude were measured in each group of potentials to interpret age appropriate changes of AEPs. RESULTS: 1) Peak latency of peak I, III and V were shortened in accordance with the age, especially latency of peak V was significantly decreased from 7.42 msec to 6.84 msec. 2) There was no significant change in interpeak latency or amplitude of AEPs according to the postmenstrual age. 3) Reproducibility of AEPs was worse in premature infants with history of asphyxia. CONCLUSION: Considering the results, the latency of peak V can be used as one of the useful parameter to investigate and follow up the premature infants. Significant negative correlation between low grade reproducibility and history of neonatal asphyxia was found.

Mild Diabetic Neuropathy in Elderly Patients

OBJECTIVE: To determine whether electrophysiologic findings of mild diabetic neuropathy in elderly patients is due to age or diabetic mellitus itself. METHOD: Electrophysiologic examination was performed in patients with diabetes mellitus and in normal control subjects over the age of 60. Electrophysiologic results of 55 diabetic neuropathy patients and the normal control subjects were compared. RESULTS: 1) Effect of age or diabetes mellitus on the electrophysiologic parameters: In normal controls over 60 years of age the motor and sensory parameter demonstrated a significant difference compared to those under 60. In diabetic patients, motor and sensory parameters demonstrated a significant difference compared to the control group. 2) Interaction of age and diabetes mellitus: Concerning the effect of age, significant differences were observed in amplitude in both motor and sensory responses. Regarding the effect of diabetes, significant differences were observed in latency or velocity in the motor and sensory nerves compared to the control group. CONCLUSION: Eletrophysiologically, prolonged latency is the result of the diabetic process, whereas decreased amplitude is thought to be due to the effect of age. In diagnosing mild diabetic neuropathy in elderly patients, we should consider the differential effects of age itself and diabetes mellitus.

Self-Esteem of Adults with Cerebral Palsy

OBJECTIVE: To estimate the self-esteem and to understand the psychosocial needs of people with cerebral palsy(CP). METHOD: Thirty-seven adult CP with age from 19 to 30 years and 24 controls with age from 19 to 33 years were evaluated for their self-esteems. The self-esteem was estimated by the standardized Korean-version of manual which was originally developed by Fitts(1965). RESULTS: The CP group scored significantly lower than the control group on 5 items of the physical self-esteem, personal self-esteem, self identity, self satisfaction, and self behavior among the 14 self-esteem items. Males scored higher than females on the personal self-esteem and self behavior. Personal self-esteem score was higher with the increasing age. The type of CP and the independent gait had no influence on the positive self. CONCLUSION: The differences on self-esteem between CP and control group suggest the needs of psychosocial support for the adults with cerebral palsy.

Visual Evoked Potentials in Premature Infants

Visual evoked potentials(VEPs) are the cerebral electrical activities recorded from the occipital scalp following a flash or pattern stimulation and can detect the lesions of sensory visual pathways. Although the VEPs change with the maturation of CNS in children, a few studies have documented the maturational changes in premature infants. Using the light- emitting diode goggles, VEPs were studied in 131 neurologically intact infants of 28~41 weeks gestational age or 34~59 weeks postmenstrual age. The VEPs were analysed by three waveforms; normal, abnormal, and flat, and four patterns; N300, P200-N300, P100-N155-P200-N300, and P100 pattern. Normal waveforms were 63 of 131 VEPs(48.1%). Of the normal waveforms, N300 patterns were 38.1%, P200-N300 36.5%, P100-N155-P200-N300 19.0%, and P100 6.4%. Each pattern correlated with the postmenstrual age. These findings support the hypothesis of VEP pattern changes according to the maturation of the visual system with age.

Median Motor Nerve Conduction and H-reflex Studies in Premature Infants

Many factors have been identified which to affect the rate of propagation of impulses along motor fibers. These include temperature changes around the nerve, diameter of the axon, degree of myelinization, age of infants, and local environment of the nerve. Motor nerve conduction velocity and Hoffman's reflex latency have been used to assess the degree of myelination and maturation of the nervous system. The conduction velocities in infants of a short gestational age are significantly lower than those of the fullterm infants. The extrauterine myelination and maturation might increase nerve conduction velocity. We measure the median motor nerve conduction velocity, compound muscle action potentials amplitude and H-reflex latency of premature infants to determine the neurological maturation after birth. The premature infants with gestational age above 37 weeks have a significantly higher conduction velocity and a shorter H-reflex latency than those of gestational age below 37 weeks. The premature infants with weight over 2.5 kg have a significantly higher conduction velocity, larger compound muscle action potentials amplitude and a shorter H-reflex latency than those of weight below 2.5 kg. And there is a statistically significant negative correlation of the H-reflex latency with the postmenstrual age. The determination of motor nerve conduction velocities and H-reflex latencies seem to be an additional method in assessing the degree of maturity in infants after birth.

Somatosensory Evoked Potentials in Neonates

The purpose of this study was to investigate the maturation characteristics of neonates. Ninety three neonates underwent a somatosensory evoked potentials(SEPs) testing. Twenty four point seven percent of them were neonates at risks including the neonatal asphyxia, low birth weight under 1500 g, or a suspicious CNS abnormality. Seventy five point three percent of neonates showed normal median SEPs, and 24.7% of them showed abnormal or a flat response. The mean latency of the first cortical component(N1) was 25.3+/-5.4 msec, duration 16.3+/-5.5 msec and amplitude 1.00+/-1.27 V. Thirty one point two percent of neonates showed normal posterior tibial SEPs, and 68.8% showed abnormal or a flat response. The mean latency of the first cortical component(P1) was 44.9+/-5.6 msec, duration 17.5+/-3.9 msec and amplitude 0.47+/-0.38 V. This result suggests that the maturation of rostal nervous system develops earlier than the caudal system. Linear decrease of the cortical latency with post-menstrual age reflects maturation of the central pathway and not merely maturation of the peripheral nerves. But our study showed much less frequency of recordings of the tibial nerve SEPs than the median nerve responses, which suggested that the maturation of spinal cord and lower-limb nerves would be slow, in addition to that the length of pathway was increasing. This result suggests that the maturation of the proximal shorter nervous pathway develops earlier than the distal longer pathway.

The Effects of High Heeled Shoes on Plantar Pressure and Muscle Fatigue

The purpose of this study was to determine the effects of high heeled shoes on plantar pressure and muscle fatigue. The subjects were 36 women who were divided into three groups, i.e., high heel, middle heel and low heel. The mean height of each heel was over 7 cm, 5 cm and below 2 cm respectively. The plantar pressure was measured by F scan system. The fatigue of subjects was evaluated with endurance time and voluntary maximal contraction that was measured by Cybex 6000 system and the degrees of foot pain and fatigue by visual analogue scale. With high heeled shoes, the plantar pressure was shifted from hindfoot to forefoot, and from the lateral part to the medial part in forefoot. With all shoes, the plantar pressure was generally increased in the forefoot after 8 hours. Especially the pressure of medial and middle parts of forefoot was significantly increased on high heeled shoes. Voluntary maximal contraction and endurance time was significantly decreased in subjects with high heeled shoes for 8 hours. The degrees forefooot pain and fatigue by visual analogue scale were very significantly increased in subjects with high heeled shoes. With low heeled shoes, the fatigue was the least degree and the middle heeled shoes are recommendable for cosmetic needs and lesser fatigue and pain. In conclusion, when women were in high heeled shoes for a long time, the pressure of forefoot and foot pain and fatigue were increased. Therefore, these effects of high heeled shoes on the plantar pressure and fatigue should be considered in women with high heeled shoes.

Skeletal Muscle Changes Following Injection of Local Anesthetics

To investigate the skeletal muscle changes, intramuscular injections of local anesthetics were performed using animal, Sprague-Dawley rat. The experiments were composed of two procedures, experiment I and II. In experiment I, single injection was performed using 0.4 cc of 1 and 2% of procaine and lidocaine. In experiment. II, repeated injection of 0.4 cc of 2% lidocaine on weekly bases 3 times were performed. The experimental rats were divided into five groups in five groups in experiment I: Four experimental group 40(10 rats for each local anesthetics) and Control 10 and were divided into two groups in experiment II: Experimental group 8 and Control 4. The muscle biopsies were performed in 15 minutes, 2, 4, 8 and 16 days after injection in two experiments. No muscle fiber changes were shown in control group, and 1~2% procaine, and 2% lidocaine injected groups of experiment I and control group of experiment II. In the groups of single and repeated injections of 2% lidocaine, muscular inflammatory changes were shown on 2 and 4 days after injection. The changes were more extensive in the group of repeated injections. The inflammatory reaction was usually abated on 8 days after injection and the muscles appeared to be normal in quality and quantity on 16 days after injection These histopathologic results indicated reversible muscular changes. Although the muscular changes are reversible after local anesthetics injection, the concentration of local anesthetics and injection interval should be considered to minimize the muscle fiber changes in the repeated injections.

Neurofibromatous Polyneuropathy

Peripheral neuropathy constitutes a rare clinical manifestation in the neurofibromatosis. Eleven cases of peripheral neuropathy associated with the neurofibromatosis have been reported. We report a sensorymotor peripheral neuropathy in 2 cases of neurofibromatosis.