Neurologic Recovery According to Early Magnetic Resonance Imaging Findings in Traumatic Cervical Spinal Cord Injuries

The aim of this study was to determine the usefulness of early magnetic resonance imaging findings in predicting neurologic recovery at or below the injured level in traumatic cervical spinal cord injuries. Thirty patients with traumatic cervical spinal cord injuries were included. All of the patients received a magnetic resonance imaging and a neurologic examination in the emergency room, within 7 days of injury and at 6 months following the injury. To quantify neurologic recovery below the injured level, we modified clinical scales, particularly the motor ratio and the sensory ratio. We used the neurologic level to quantify recovery around the injured level. We assessed neurologic recovery according to MRI patterns and lesion extents. The pure hemorrhagic MRI pattern was not observed. In edematous and mixed types, the improvement of neurologic levels was not significantly different. The motor ratio and sensory ratio improved significantly more in edematous type patients than in mixed type patients. Based on MRI lesion extent, the improvement of neurologic levels was not significantly different, and motor ratio and sensory ratio improved significantly more in those with one or two segments involved than in those with more than two segments involved. In conclusion, early MRI pattern and lesion extent after traumatic cervical spinal cord injury may provide important information to help predict neurologic recovery, especially below the injured level.

Prediction of Functional Outcome after Stroke Using Acute Clinical Factors

OBJECTIVE: To plan the goals of the rehabilitation management after stroke, it was important to know functional prognosis of the patients. The purpose of this article was to predict functional outcomes of stroke patients by means of an analysis of the well-known prognostic factors of function at admission. METHOD: This study was performed retrospectively on 102 patients with acute stroke who were admitted to Department of Rehabilitation Medicine. The inpatients, clinical and functional evaluation were carried out at admission. Functional abilities were measured with the use of the Functional Ambulatory Category (FAC) and the modified Barthel Index (MBI). RESULTS: The significant prognostic factors of FAC improvement rate were age, National Institute of Health Stroke Scale (NIHSS), Morticity Index, MBI, Mini-Mental State Examination (MMSE), aphasia and Trunk Control Test (TCT) (p<0.01). The most valuable single factor of FAC improvement rate was TCT. The significant prognostic factors of MBI improvement rate were age, NIHSS, Morticity Index, MMSE, aphasia and TCT (p<0.01). The most valuable single factor of MBI improvement rate was TCT. CONCLUSION: We concluded that TCT could be the most valuable prognostic factor in rehabilitation management outcome of stroke.

Sleep Apnea Syndrome and Prognosis in Stroke Patients

OBJECTIVE: The purpose of this study was to evaluate the prognostic value of sleep apnea syndrome in stroke patients by polysomnography. METHOD: Fifteen patients with ischemic stroke were studied with polysomnography. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded. Patients were observed by physician for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Modified Barthel Index (MBI). To evaluate the autonomic nervous system, heart rate variability (HRV) study was done. RESULTS: Mean SaO2 during polysomnography was 88.2%, and mean recording time was 321 minutes. Apnea types were obstructive, mixed, and central. Respiratory Distress Index (RDI) correlated with functional outcome and mean SaO2. HRV study showed no significant changes under the orthostatic stress in apnea patients. CONCLUSION: We concluded that the sleep apnea syndrome could be a prognostic factor in rehabilitation outcome of stroke.

Comparison of Gait Analysis and Energy Consumption between Various Types of Plastic Ankle Foot Orthoses in Hemiplegic Patients

OBJECTIVE: The purpose of this study were to investigate the temporospatial, kinematic data and energy consumption in hemiplegic patients according to the types of ankle-foot orthosis (AFO), and to determine the most effective type of AFO for gait training. METHOD: A prospective study was performed for 10 patients with hemiplegia who was able to walk independently at indoor level. The temporospatial, kinematic data and energy consumption were compared in each five different conditions: 1) barefoot, 2) donning AFO with posterior leaf spring (PLS), 3) donning PLS with the distal part of metatarsal head trimmed off (PLS-C), 4) donning hinged PLS (HPLS), 5) donning hinged PLS with the distal part of metatarsal head trimmed off (HPLS-C). RESULTS: With four types of PLS, maximal ankle plantar flexion was significantly decreased, however we didn't find any difference in kinematic data of the pelvis and hip as compared with barefoot and with PLS, HPLS, HPLS-C and maximal knee extension angle was significantly decreased compared with barefoot. With HPLS-C, cadence and walking speed significantly increased and double support time and oxygen cost significantly decreased as compared with barefoot. CONCLUSION: This study showed increased walking speed, decreased energy cost and improvedgait pattern after donning HPLS-C especially in hemiplegic patients. So HPLS-C may be effective in hemiplegic patients for gait training.