Clinical Utility of Swallowing Provocation Test and Water Swallowing Test in Stroke Patients

OBJECTIVE: To assess the clinical utility of the swallowing provocation test (SPT) and water swallowing test (WST) as a predictive factor of supraglottic penetration (SP) and subglottic aspiration (SA) in stroke patient with dysphagia. METHOD: Fourty-one patients suffered from ischemic stroke with dysphagia and 20 normal controls were recruited. We performed 2-step SPT (0.4 ml, 2.0 ml) via nasopharyngeal tube and 2-step WST (10 ml, 30 ml) per oral, combined with the videofluoroscopic swallowing study (VFSS) to determine the presence of SP and SA. RESULTS: The cutoff values of the swallowing provocation latency in SPT for the detection of SP and SA were 2.45 sec, 2.75 sec (first step) and 2.25 sec, 2.34 sec (second step). For SPT, the sensitivity and specificity were 78.8%, 64.3% (first step) and 71.4%, 77.8% (second step) for the SP, and 77.8%, 76.7% (first step) and 75.0%, 66.7% (second step) for the SA. For WST, the sensitivity and specificity were 66.7%, 90.9% (first step) and 70.0%, 90.9% (second step) for the SP, and 61.1%, 56.5% (first step) and 72.2%, 60.9% (second step) for the SA. CONCLUSION: SPT was more useful for the detection of SA than WST in stroke patient with dysphagia.

Functional Assessment of Sympathetic Nervous System in Patients with Unilateral Stroke

OBJECTIVE: To investigate the function of sympathetic nervous system in patients with first-ever unilateral stroke by measuring hand sympathetic skin response (SSR) and the relationship between sympathetic dysfunction and motor function. METHOD: Eighteen patients with first-ever unilateral stroke and eighteen normal controls were recruited. The differences of hand SSR amplitude and latency between affected and unaffected side were investigated. Motor function was classified according to the Brunnstrom stage and activities of daily living were evaluated by modified Barthel Index (MBI) and Functional Independence Measure (FIM). Orthoestatic hypotension (OH) was evaluated and graded. RESULTS: The difference of the amplitude of hand SSR between affected and unaffected side was increased in stroke patient group (p<0.05). There was significant correlation between Brunnstrom stage and the difference of hand SSR amplitude (p<0.05). There were significant correlations between MBI, FIM and the difference of hand SSR amplitude (p<0.05). There was significant correlation between OH and the difference of hand SSR amplitude (p<0.05). CONCLUSION: Evaluation of hand SSR could be useful methods to evaluate central autonomic dysfunction and motor dysfunction.

Graded Spinal Cord Contusive Rat Model by a Weight-drop Device

OBJECTIVE: To investigate the reproducibility of graded spinal cord contusion by a weight-drop device, and to establish a graded spinal cord contusive rat model based on the functional analysis and morphometric measurement. METHOD: The weight-drop device developed was composed of impactor with a guidance rod, stereotaxic frame and spine stabilizing device. We investigated the reproducibility of impact by reliability analysis two weeks later. Thirty Sprague-Dawley rats were injured by the weight-drop device from the height of 12.5, 25.0 and 50.0 mm. The three groups of each drop-height (n=10) as well as laminectomized sham group (n=10) were subjected to functional analysis by Basso Beattie Bresnahan Locomotor Scales (BBB scales) and inclined plane test after contusion for four weeks. The morphometric measurement was performed at regularly spaced intervals including the epicenter according to the graded drop-height. RESULTS: The impact of weight-drop was significantly increased according to the drop-height (p <0.05) and revealed high reproducibility. The changes of BBB scales and maximal angle of inclination had an inverse correlation with the contusion severity (p <0.05). There was an inverse correlation between the amount of residual white matter and drop-height (p <0.05). CONCLUSION: The weight-drop device newly developed provides a constant and reproducible spinal cord contusion model.

The Significance of Evoked Potentials according to the Injury Severity of Spinal Cord Contusive Rat Model

OBJECTIVE: To investigate the prognostic values of somatosensory evoked potential (SEP) and electric motor evoked potential (eMEP) studies according to the varying spinal cord injury by incremental height of weight-drop impactor and progress of functional recovery METHOD: Thirty Sprague-Dawley rats (300+/-50 grams, male) were used. The spinal cord injury was made by weight-drop device from 12.5, 25.0 and 50.0 mm height at T10 cord segment. The three groups of each drop-height (n=10) and laminectomized sham group (n=10) were subjected to functional analysis using inclined plane test and Basso Beattie Bresnahan (BBB) locomotor scales at the 1, 3, 5, 7, 14, 21 and 28th day after the contusive injury. SEP by sciatic nerve stimulation and eMEP at the gastrocnemius muscle were recorded. RESULTS: Maximal angle of inclination and BBB scales had an inverse relation with the contusion severity (p <0.05). There were significant correlations among the changes of peak latencies and amplitudes of SEP, contusion severity, and the motor recovery (p <0.05). The changes of onset latencies and amplitudes of eMEP were significantly correlated with the contusion severity and the motor recovery (p <0.05). CONCLUSION: The SEP and eMEP studies had significant values according to the contusion severity and functional recovery in contusive rat model of the spinal cord.

The Effect of Biofeedback Treatment in Children with Spastic-Diplegic Cerebral Palsy

OBJECTIVE: To investigate the effect of electromyography (EMG)-biofeedback treatment in children with spastic-diplegic cerebral palsy. METHOD: Twenty patients with spastic diplegia, who could recognize the auditory and visual stimulation, were recruited. Ten patients underwent EMG-biofeedback treatment with neurodevelopmental treatment (NDT) for 12 weeks, 3 times a week, total 1 hour a day, but age-, sex- and functional-matched ten controls underwent only NDT. Before and after the treatment, active range of motion, spasticity, muscle strength and Functional Independence Measure for Children (WeeFIM) and Gross Motor Function Measure (GMFM) were measured. RESULTS: In experimental group, there was a significant increase in active range of motion of hip and ankle joints (p0.05). Muscle strength of ankle dorsiflexor and hip extensor muscles was significantly improved (p<0.05). WeeFIM and GMFM scores significantly increased in an experimental group (p<0.05). CONCLUSION: EMG-biofeedback treatment in children with spastic-diplegic cerebral palsy might be an effective adjuvant to NDT through the muscle reeducation.

The Clinical Utility of Hand Sympathetic Skin Response in Bell's Palsy

OBJECTIVE: To investigate the correlation between the severity of paralysis and hand sympathetic skin response (SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis. METHOD: Twenty patients with Bell's palsy and twenty normal controls were recruited. The severity of paralysis was graded according to House-Brackmann Facial Grading Scale (H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS). RESULTS: The difference of hand SSR amplitude between affected and unaffected side was significant (p<0.05). There was significant correlation between H-B FGS and the difference of hand SSR amplitude (p<0.05). There was significant correlation between percent degeneration and the difference of hand SSR amplitude (p<0.05). There were significant correlations between the difference of hand SSR amplitude at 5 days and percent degeneration at 9 and 14 days (p=0.026, p=0.001). CONCLUSION: The difference of hand SSR amplitude between affected and unaffected side was useful for the indication of the severity of paralysis. And, hand SSR would be useful for an early prognostic predictor in Bell's palsy.

Effect of Botulinum Toxin A on Bruxism after Brain Injury

We wanted to report three cases of bruxism who were intractable to conventional management such as dental protection or medication but responded to motor point blocks (MPB) with botulinum toxin-A (BTX-A) on mastication muscles. Untreated, bruxism causes unfavorable complications of masseter hypertrophy, headache, temporomandibular joint destruction, and furthermore total dental wear and malnutrition. Our three patients had no previous history of bruxism or any neuromuscular disorder. They were presented with decreased cognitive function and severe bruxism about 6 months after brain injury. We managed the patients with MPB of BTX-A on each masseter and temporalis muscles. Bruxisms were markedly improved about 2 weeks after MPB without any complications. On follow-up 6 months after MPB, two of three patients remained free of bruxism and another patient revealed attenuated bruxism with decreased severity and frequency. Therefore, we think that MPB with BTX-A could be considered as a treatment option for severe bruxism in brain-injured patients.