The Effects of Transcutaneous Electrical Nerve Stimulation for Standing Balance in Patients with Hemiplegia

OBJECTIVE: To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) applied at lower extremity for standing balance in patients with hemiplegia. METHOD: Twenty-two hemiplegic patients were tested while standing on balance trainer under eight stimulation modes (No TENS, bilateral TENS, hemiplegic TENS, and unaffected TENS. These four conditions were applied both with and without vision). All patients were able to stand independently more than five minutes. TENS was applied with pulse width 200micron s, frequency of 100 Hz, amplitude set at the sensory detection threshold of each patients. TENS was applied thirty seconds for each stimulation modes, and resting period was 10 minutes. Postural sway was determined during the testing period by the sum of anterior-posterior (AP) center of pressure (COP) sway, medio-lateral (ML) COP sway, and total sum of COP sway. Also postural sway was determined by proportion of time of COP in three circles, which semidiameters are 10 mm, 20 mm, 30 mm each. RESULTS: When patients were applied with TENS eyes closed at the unaffected lower extremity, AP, ML, and total sum of COP sway decreased significantly. CONCLUSION: In hemiplegic patients with independent standing, TENS application at the unaffected leg over five minutes can be helpful standing balance enhancement.

Bilateral Thalamic Ischemic Injury : A case report

Thalamic infarction is frequently bilateral due to the nature of the vascular supply to the thalamic region, and is usually caused by cardiogenic embolism or emboli originating from the proximal basilar or vertebral artery. But there have been no reported case of bilateral thalamic ischemic injury. A 25-year old man was in coma after committing suicide, hanging his neck. MRI showed bilateral pulvinar ischemic injury. He showed disturbance in recent memory, calculation, and had bilateral hemianopsia, transcortical motor aphasia, intentional tremor, proprioceptive sensory dysfunction. He was treated with progressive physical therapy for ambulation, repeated stimuli with TENS for proprioception, given donepezil 5 mg and cognitive training for improvement of cognition. After discharge, he was able to walk independently at outdoors, and could do all activities of daily living by himself. All motor and sensory functions of upper and lower extremities were recovered except tremor and dynamic standing balance dysfunction.

Fibromuscular Dysplasia with Cerebral Infarction in A Young Male Professional Golfer: A case report

Stroke in young adults is uncommon and may require extensive evaluation to elucidate an underlying cause. A 21- year-old male professional golfer experienced left side weakness, dysarthria, headache during golfing. Magnetic resonance imaging (MRI) revealed broad ischemia on right basal ganglia, frontal and temporal lobes. Magnetic resonance angiography (MRA) and 4-vessel angiography revealed beading of right intracranial internal carotid and middle cerebral arteries which suggests fibromuscular dysplasia. We report a case of intracranial fibromuscular dysplasia without renal involvement resulting in cerebral infarction in young male professional golfer.