Quality of Life after Stroke

OBJECTIVE: The purposes of this study were to examine overall quality of life (QOL) in long term stroke survivals and to identify variables that predict QOL after stroke. METHOD: Subjects were 51 stroke patients (male; 28, female; 23) with stroke onset at least 6 months previously. Interview, measurement of depression and QOL were performed at outpatient clinic after discharge. Review of medical records included characteristics of stroke and communication disorders. Interview questionnare included caregiver, religion, education level, occupation and income. Depression and functional status was measured by the Beck depression inventory (BDI) and modified Barthel index (MBI), respectively. QOL was measured with the use of 5-item (activity, daily living, health, support, outlook) version of the Quality of Life Index (QLI) and its range of scores is 0~10. We compared QLI scores according to various factors obtained from medical records and questionnaire. RESULTS: Mean duration after onset of stroke was 33.6 months (range, 6~216 months). The mean score of QLI were 7.0+/-2.1. Low MBI score, communication disorder and depression had a negative effect on QOL (p0.05). CONCLUSION: Low MBI score, depression and communication disorders would be negative predictors of QOL and identification of these factor may assist stroke patients in coping their personal and social life.

How to Deal with the Latency of Unobtainable Responses in the Statistical Analysis

OBJECTIVE: To evaluate the usability of near-nerve needle recording techniques in cases of unrecordable sensory nerve action potentials (SNAPs) with a surface electrode and to determine a proper alternative value of the missing latencies. METHOD: Twenty six hands of 23 patients with a carpal tunnel syndrome (CTS) and an unobtainable median SNAP by surface electrode were evaluated by the near-nerve needle recording of median SNAPs. Using the nerve conduction data of 113 patients with CTS, we have established 3 alternative values: maximal, 95 percentile and predictive latencies. The alternative values were compared with the mean onset latencies by the near-nerve needle recordings of median SNAPs. RESULTS: Median SNAPs were obtainable in the 22 out of 26 hands by the near-nerve recording technique. The mean onset latency was 5.51+/-0.36 ms. The alternative values from 113 patients with CTS were as follows: maximum latency, 6.9 ms; 95 percentile latency, 5.6 ms; and predictive latency, 5.52 ms (Y = 0.123x X 5.52491; Y, onset latency; X, amplitude; r2=0.564; p=0.00). The Predictive latency was nearest to the mean onset latency. CONCLUSION: To minimize the selection bias and statistical errors, the near nerve recording techniques proved to be a valuable method in cases of unrecordable SNAPs with surface electrode. For compensation of missing data, a proper alternative value can be obtained by the predictive latency calculated from a linear regression.

Retrograde Changes of Median-Nerve Fibers in Carpal Tunnel Syndrome

Slowing in forearm median nerve conduction in patients with carpal tunnel syndrome(CTS) has been described. But the cause of slowing is still unclear whether it is related to a technical artifact on electrodiagnostic appr oach or pathophysiologic changes in the proximal segment of median nerve. To investigate the possible retrograde degeneration of median nerve in the forearm segment(wrist to elbow) in patients with known carpal tunnel syndrome, the median nerve conduction studies were performed in 23 normal persons as control and 25 patients with carpal tunnel syndrome. To evaluate the median nerve conductions in the forearm, the recording bar-electrode were placed at the volar aspect of the wrist and stimulating electrodes were applied at the elbow area. The mixed nerve action potentials and conduction velocities were measured. The median mixed nerve action potential(FNAP) amplitudes recorded at the wrist and motor nerve conduction velocity(MMCV) in patients with carpal tunnel syndrome patients were significantly reduced compared to those of control group(p<0.05). However, the median mixed nerve conduction velocity(FNCV) was not reduced significantly. The median mixed nerve action potential amplitudes demonstrated positive correlation with the decrease of motor and sensory action potential amplitudes and velocities. This result suggests that the retrograde degeneration progresses as the carpal tunnel syndrome progresses and the retrograde degeneration may play a major role in reduced motor nerve conduction velocity of the median nerve in the forearm. We propose that FNAP amplitude and MMCV might be used to evaluate the severity of retrograde degeneration in patients with carpal tunnel syndrome.