Sensitive Balance Parameters in Detecting Age-related Changes of Balance Control in Elderly

OBJECTIVE: To determine stability parameters in clinical balance tests and posturography that can assess age-related changes in posture control sensitively METHOD: Thirty nine healthy elderly people over 60 years old and twenty young controls were recruited. Elderly people were subdivided into 3 groups by age (aged 60~69, 70~79, over 80). Subjects were evaluated with clinical balance tests and posturography. In posturography, center of pressure (COP) parameters were obtained as total path distance, sway area, mean frequency of sway in comfortable standing. Visual feedback system (VFS) was added to posturography and then subjects were asked to move their COP into the target circle on monitor with active movement on force plate. In VFS, time to get in the circle, total path of deviation, time in the circle were measured. RESULTS: Time in the circle assessed by posturography with VFS showed significant difference between age groups (p<0.05). Significant correlations between time in the circle and clinical balance tests were also found (p<0.01). CONCLUSION: A posturography with VFS was considered to have clinical usefulness in sensitive evaluation of age-related change of balance control in healthy elderly people.

Effect of Characteristics of Joint Motion of Lower Extremity according to Aging on Balance in Elderly

OBJECTIVE: To investigate the effect and the correlation of characteristics of joint motion of lower extremity according to aging on balance in elderly. METHOD: There were thirty nine healthy elderly subjects aged 60 and older. The subjects were divided into 3 groups by their age. Each group was measured with joint motion of bilateral lower extremities by goniometer. The subjects were evaluated with clinical balance tests [(Berg balance scale (BBS), Functional reach test (FRT), Tinetti's performance oriented mobility assessment (POMA), and one leg standing (OLS)]. RESULTS: The flexibilities of lower extremities were decreased according to the increase in age. The balance ability was also decreased according to the increase in age by tested clinical balance scores. The flexibility of the ankle joints showed the strongest correlation with clinical balance scores (BBS, FRT, POMA and OLS) according to the increase in age, and the flexibility of hip joints also correlated with clinical balance scores (POMA and OLS). CONCLUSION: Among clinically validated balance tests, the decline of balance performance related with aging. Correlation exists between ankle ROM and balance in healthy elderly people. Additional research is needed to add the ankle ROM to reflect the excise for balance tests and balance ability.

Predicting the Effect of Complex Physical Therapy: Utility of Manual Lymph Drainage Performed on Lymphoscintigraphy

OBJECTIVE: To evaluate the utility of manual lymph drainage (MLD) during lymphoscintigraphy (LS) in predicting the effect of complex physical therapy (CPT). METHOD: Forty seven patients were included in this study. MLD was done for 30 minutes after one hour LS image was obtained. 24 patients were followed up for 3~6 months. According to one hour LS image, patients were assigned to visible lymph node or lymphatic vessel group (Either group) and invisible lymph node and lymphatic vessel group (Neither group), and also according to LS changes after MLD, good and poor response group. The limb volume was checked before, and immediately after CPT, and at 1 month and 3~6 months after CPT. The treatment response was evaluated by percent volume reduction (PVR). RESULTS: There were no significant differences in volume reduction between Either group and Neither group. Otherwise, good response group showed significantly greater volume reduction after CPT than poor response group. Mean PVR in the good response group was 37.02% immediately after CPT, 41.2% at 1 month after CPT, and 47.4% at 3~6 months after CPT. Mean PVR in the poor response group was 19.22% immediately after CPT, 13.0% at 1 month after CPT, and 5.21% at 3~6 months after CPT. CONCLUSION: LS changes after MLD reflected the effects of CPT more accurately than one hour LS image.

Nonaka Myopathy: A case report

Nonaka myopathy (NM) or distal myopathy with rimmed vacuoles was an autosomal recessive muscle disease with preferential involvement of the tibialis anterior and sparing quadriceps muscles in young adulthood. Patients with NM usually showed slightly elevated serum creatine kinase (CK) levels and characteristic rimmed vacuoles in muscle biopsy. Recently, the UDP-N-acetylglucosamine-2-epimerase/N-ace-tylmannosamine kinase (GNE) gene was identified as the identified as the causative gene for NM. Here we reported a NM patient carrying homozygous mutations (V572L) of the GNE gene. To the best of our knowledge, this was the first report of genetically confirmed NM in Korea and NM should be included in the differential diagnosis of slowly progressive weakness of distal legs.

Gabapentin-induced Neutropenia: A case report

Gabapentin, a novel anti-convulsant, is recently used to manage symptomatic treatment of neuropathic pain. Gabapentin is known to have few side effect profiles such as drowsiness, dizziness, somnolence, and nausea. We experienced a case of neutropenia associated with gabapentin. A 74-year-old man was hospitalized because of left side weakness caused by acute thalamocortical infarction. He complained of tingling sen- sation, aching pain, and dysesthesia on his left side. We prescribed gabapentin to manage his symptoms. Fever developed at 22 days of gabapentin therapy and peripheral blood examination revealed neutropenia. At 2 days after stopping gabapentin, neutrophil counts started to revert.

The Effects of Botulinum Toxin A on Upper Limb Function in Children with Cerebral Palsy

OBJECTIVE: To evaluate the efficacy of botulinum toxin type A in the treatment of spasticitc and dystonic upper limbs in a group of cerebral palsy children METHOD: Eighteen children with cerebral palsy who did not have fixed contractures in the wrist and hand were enrolled (mean age 9.0 years; range 6~15). Measurements were obtained before and at 1 and 3 months after botulinum toxin A injections. Assessments included spasticity (modified Ashworth scale), range of motion of thumb and functional assessments including Melbourne assessment of unilateral upper limb function and Jebsen Taylor hand function test. Hand and forearm muscles were injected with 1~3 u/kg botulinum toxin. RESULTS: Spasticity measured by modified Ashworth scale decreased by 1 month and diminished spasticity continued for 3 months. Range of motion of thumb increased by 1 and 3 months. In Jebsen hand function test, patients showed functional improvements in item 6 (lifting light weight object) and item 7 (lifting heavy object). Melbourne assessment of unilateral upper limb function scores improved from a mean value of 92 at baseline to a mean value of 101 at 1 month and a mean value of 105 at 3 months. CONCLUSION: Botulinum toxin A would be helpful in some selected cerebral palsy patients with upper limb dysfunction. But further research including randomized controlled study is needed on the use of botulinum toxin A to improve function.

The Effects of Dilution Volume and Muscle Activity on the Paralysis of Gastrocnemius Muscle of Rabbit after Botulinum Toxin A Injection

OBJECTIVE: To evaluate the effects of botulinum toxin A (BT) dilution volume and post- injection exercise with electrical stimulation on muscle paralysis. METHOD: Eighteen New Zealand white rabbits are randomly assigned to 0.1 ml dilution group, 0.5 ml dilution group or control group. Control group did not receive any injection and 10 units of BT was diluted with 0.1 ml (B1) or 0.5 ml (B5) normal saline and injected to the both gastrocnemius muscles. The right lower limbs of experimental groups did not have any treatment after botulinum toxin A injection (B1C, B5C) and left lower limbs had stretching exercise after injection (B1S, B5S) for 2 hours using the pneumatic kicking machine. Electrical stimulation was also applied to the gastrocnemius muscle with the intensity of 20 mA to 30 mA to evoke plantar flexion of ankle joint. Muscle paralysis effect of BT was evaluated with compound muscle action potential (CMAP) amplitude of gastrocnemius muscle with the sciatic nerve stimulation before and 1 week after injection. RESULTS: There were significant CMAP amplitude decreases in all animals after BT injection. There were significant decreases of CMAP amplitudes in B5 group compared with that of B1 group (p<0.001). Left limbs with stretching exercise and electrical stimulation showed lower CMAP amplitude (p=0.01) compared with right limbs which did not have any treatment after BT injection. CONCLUSION: To maximize muscle paralysis effect of the botulinum toxin A, increasing dilution volume and performing post-injection stretching exercise with electrical stimulation are considered a good strategy.