The Effects of Shoe Lifts to the Unaffected Limb on Gait Pattern in Hemiplegic Stroke Patients

OBJECTIVE: To evaluate the effects of shoe lift to the unaffected limb on hemiplegic gait after stroke. METHOD: Three dimensional gait analysis was performed in 20 chronic hemiplegic patients with shoe lifts (5, 10, 15 mm) to the unaffected limb. The order of experimental series was randomized among subjects. Temporal gait parameters were measured and compared according to the height of shoe lifts in the affected and unaffected limbs. RESULTS: The stride time of both limbs and step time of the affected limb were decreased, and stride length of both limbs and step length of unaffected limb were increased after shoe lift apply (p<0.05). Thus walking velocity and cadence were increased. In gait cycle, there was decreased double limb support phase of affected limb (p<0.05). These improvement of gait patterns of hemiplegics was maximum after shoe lift of 10 mm height. CONCLUSION: Weight bearing with shoe lift may contribute to improved postural control and gait performance in hemiplegics. Furthermore, the study about long-term effects of shoe lifts to the unaffected limb may be necessary.

Determination of Follow-up Time of Abnormal Brainstem Auditory Evoked Potential in Infancy

OBJECTIVE: To determine optimal follow-up time of BAEP for the infants with abnormal BAEP at the initial screening test. METHOD: Control group consisted of 85 infants with normal BAEP and experimental group consisted of 41 infants with abnormal BAEP at the first examination but normalized on regular follow-up examinations. Gestational age (correctional age), intrauterine period, birth weight, delivery method, presence of perinatal asphyxia, Apgar score after 1 minute, the highest serum bilirubin level, and the results of cranial ultrasonography were recorded. The above parameters, peak and interpeak latencies of BAEP were compared between both groups. RESULTS: Lower correctional age at the first BAEP, shorter intrauterine period, and lower birth weight were noted in experimental group (p<0.001). The average correctional age when BAEP had normalized in experimental group was 45.0+/-5.8 weeks, which was much later than 40.2+/-2.8 weeks in control group (p<0.001). 90.2% of infants among experimental group revealed normalized BAEP within 48 weeks, and 95.1% within 51 weeks according to correctional age, or within 12 weeks after initial examination. CONCLUSION: We recommend that BAEP should be rechecked after 48 weeks by correctional age for the high risk infants who were abnormal with initial screening BAEP.

A Survey of Defecation Pattern after Discharge in Stroke Patients

OBJECTIVE: To investigate the defecation pattern after discharge in stroke patients with bowel problems. METHOD: Subjects were 50 stroke patients who underwent rehabilitation program and discharged to home. The information about the defecation pattern were taken through interview or review of medical records as follows: anatomical lesion site, consciousness, admission period, operation history, co-morbidity, ambulation distance, water & food intake, assistive device use, voiding dysfunction, urine output, stool softner use, fecal incontinence, and defecation frequency. We compared the defecation frequency according to the various factors obtained from the medical records and interview. RESULT: The defecation frequency were significantly higher in patients without co-morbidily or fecal incontinence, with longer-distance ambulation, large amount of water & food intake (p0.05). CONCLUSION: Considering the various factors noted above, comprehensive rehabilitation program to relieve bowel problems should be established in the rehabilitation management of stroke patients.

Median Nerve Conduction Study in different Wrist Position in Normal Persons and the Patients with Diabetes mellitus

OBJECTIVE: To determine whether flexion and extension of the wrist joint produce the change in the conduction study of the median nerve in the normal and diabetic patients, and to compare the susceptibility of median nerve compression injury in two groups. METHOD: Thirty healthy adults as control and thirty diabetic patients without carpal tunnel syndrome were studied. The wrist joint was maintained in flexion or extension position for 5 minutes before performing conduction study. The variables used for statistical analysis included the mean difference of amplitude and latency in median motor and sensory responses in neutral, flexion, and extension positions. RESULTS: The results showed that significant differences in the latency and amplitude of median motor and sensory responses between neutral, extension, and flexion of wrist within each group (p<0.01). The differences in the median sensory latency (p<0.01), amplitude (p<0.05) and the change of wrist-palm segmental conduction velocity (p<0.01) were statistically significant between the diabetes and the normal control. CONCLUSION: The results of this study suggest that median nerves are susceptible to compression pressure in diabetic patients. Therefore, the position of the wrist joint should be considered in the median nerve conduction study.

Assessment of Peripheral Hemodynamics Using the Doppler Ultrasound in Diabetes Mellitus

OBJECTIVE: To evaluate peripheral hemodynamics using the doppler ultrasound in the diabetic patients. METHOD: We measured mean blood flow velocity (MBFV), resistance index (RI), pulsatility index(PI) in the dorsalis pedis artery (DPA), posterior tibial artery (PTA), and radial artery (RA) from 18 normal controls (n=36), 17 diabetes patients without neuropathy (n=34), and 21 diabetes patients with neuropathy (n=42) by use of Angiodine 2 Doppler system operating at 8 MHz frequency. RESULTS: MBFV of all the examined arteries increased significantly in the diabetes with neuropathy in comparison to controls and the diabetes without neuropathy (p<0.05). RI and PI of DPA and PTA decreased significantly in the diabetes with neuropathy in comparison to controls and diabetes without neuropathy (p<0.05). The blood flow velocity profile was changed from triphasic to monophasic pattern in the diabetes with neuropathy in DPA and PTA. CONCLUSION: The Doppler ultrasound is considered as a useful tool for screening change of peripheral blood flow in the diabetic patients with neuropathy.

Cerebral Hemodynamic Evaluation of Diabetes Mellitus by Transcranial Doppler Sonography

OBJECTIVE: The purpose of this study was to evaluate hemodynamics for diabetes mellitus (DM) by transcranial Doppler sonography (TCD) and to evaluate the influences of risk factors to cerebral hemodynamics in DM. METHOD: We examined 54 normal persons, 17 patients with DM without risk factors, and 15 patients with DM and risk factors. The risk factors were hypertension, smoking, and hyper lipidemia (total cholesterol >240 mg/dl, low density lipoprotein >160 mg/dl). Mean blood flow velocity (MBFV) was also analyzed by Angiodine 2 Doppler system operating at 2 MHz frequency from each subjects. RESULTS: There was a significant decrease of MBFV in the diabetes in comparison to control groups (p<0.05). There was a significant decrease of MBFV in the diabetic risk group as compared to diabetic non-risk group (p<0.05). There was significantly increased total cholesterol, low density lipoprotein, low density lipoprotein/high density lipoprotein ratio in the diabetic risk group as compared to diabetic non-risk group (p<0.05). MBFV significantly decreased with increasing concentration of HbA1C and duration of DM (p<0.05). CONCLUSION: We suggest that transcranial Doppler sonography can be used as one of the useful screening tests for early detection of cerebrovascular diseases in DM.

Assessment of Cerebral Hemodynamics Using Transcranial Doppler Sonography in Normal Adults

OBJECTIVE: To establish the normal values of the transcranial doppler sonography in healthy Korean adults according to the increasing age and sex. METHOD: We examined 68 healthy adult volunteers who had no history of diabetes mellitus, hypertension, cerebrovascular disease or other neurological illness. The study included 54 subjects from whom good doppler signals from the middle, anterior, and posterior cerebral arteries could be obtained. Mean blood flow velocity (MBFV), Resistance index (RI), and Pulsatility index (PI) were analyzed by Angiodine 2 Doppler System operating at 2 MHz frequency. RESULTS: MBFV significantly decreased with the increasing age in the middle, anterior and posterior cerebral arteries (p0.05). There was no significant difference in the RI and PI between the male and female subjects. CONCLUSION: We suggest that the transcranial doppler sonography can be used as one of the useful screening tools for the diagnosis of cerebrovascular diseases.

A Comparison of Therapeutic Effects of Lidocaine Injection and Dry Needling in the Treatment of Myofascial Pain Syndrome Using Digital Infrared Thermographic Imaging

OBJECTIVE: To analyze the diagnostic value of digital infrared thermographic imaging(DITI) and to compare the therapeutic effects of lidocaine injection(LI) and dry needling(DN) in the treatment of myofacial pain syndrome(MPS) by using the DITI and visual analogue scale(VAS). METHOD: After 20 minutes adaptation time, 41 patients with MPS and 15 controls undertook DITI. LI and DN were randomly given in the trigger points of the patient group and to either side of the upper trapezius muscle in the controls. The effects of treatment were immediately assessed by measuring the temperature difference(deltaT) of the involved area and the corresponding area on the opposite side of the body using the DITI and VAS. Follow up assessments of VAS, change of VAS, deltaT and change of deltaT were performed 1, 3, 5 and 7 days after the treatment, respectively. RESULT: 1) The sensitivity and specificity of hot spots for TrP were 78.1% and 73.3 %, respectively. 2) deltaT and VAS continuously declined for 7 days after the treatment as compared to before the treatment in groups Ia (n= 16, deltaT>0.6degrees C, LI) and Ib (n=16, deltaT>0.6degrees C, DN). 3) deltaT and VAS ware not statistically different for groups Ia and Ib. 4) There was no statistically significant correlation between deltaT and VAS in both groups I and Ib. CONCLUSION: These data suggest that DITI can be used as one of the valuable tools for the evaluation of trigger points. No significant difference noted in the therapeutic effects of LI and DN for MPS.

Clinical Application of Digital Infrared Thermographic Imaging for the Prediction of Foot Ulcer Development in Diabetic Patients

OBJECTIVE: To investigate the regional differences of skin blood flow and to evaluate the effects of foot temperature on the severity of neuropathic pain and to predict the development of plantar foot ulceration by measuring of the temperature variations on the plantar surface of feet in the diabetic patients. METHOD: We measured the temperature variations on plantar surface of the feet in controls (n=18) and diabetic patients with(n=20) or without(n=23) polyneuropathy. The surface temperature from the 3rd metatarsal head(MTH), greater toe(GT), heel, medial and lateral longitudinal arch(LA) was measured by Digital Infrared Thermographic Imaging(DITI). RESULTS: The mean foot temperature of diabetic patients with polyneuropathy was significantly increased compared to controls or diabetic patients without polyneuropathy(p<0.001). The surface temperature readings of the GT, medial LA and the 3rd MTH tended to be increased in controls and patients with polyneuropathy. The mean plantar surface temperature was significantly increased according to the duration of diabetes mellitus(DM)(p<0.05). CONCLUSION: The results suggest that DITI provides a diagnostic modality in the prediction of neuropathic foot and increased risks of foot ulcer development in the diabetic patients.

Localization of Lumbosacral Radiculopathy by Needle Electromyography of Multifidus Muscle

OBJECTIVE: To increase the accuracy and consistency in determining the level of radiculopathy by a needle electromyography (EMG) of multifidus muscle. METHOD: We performed the EMGs on 29 patients with a low back pain to investigate an evidence of radiculopathy. All patients had the herniated nucleus pulposus (HNP) by a myelography, CT or MRI. The exclusion criteria were the patients with a scoliosis, spondylolisthesis or history of back surgery. We examined 5 points (P 1~5) of the lumbosacral paraspinal muscles according to the paraspinal mapping by Haig et al and scored from 0~4 according to the degree of abnormalities. The scores according to the points were correlated with the segments of radiculopathy and the levels of HNP. RESULT: The maximal mean scores were 1.80+/-0.83 at P2 and 2.00+/-1.41 at P3 in a lumbar (L) 3, 4 radiculopathy, 2.00+/-0.56 at P5 in a L5 radiculopathy, and 2.13+/-0.64 at P4 and 2.63+/-0.51 at P5 in a S1 radiculopathy. The sensitivity/specificity was high at P2, P3 in a L3, 4 radiculopathy, at P4 in a L5 radiculopathy, at P5 in a S1 radiculopathy. CONCLUSION: The results suggest that the localization of lumbosacral radiculopathy by a needle EMG of multifidus muscles provides an easy accessibility, better accuracy and consistency to determine the level of radiculopathy.

Effect of Postures on Residual Urine Following Catheterization in Spinal Cord Injured Patients

Intermittent catheterization has reduced the frequency of urinary tract infection(UTI), calculus formation and vesicourethral reflux in spinal cord injured(SCI) patients. Still the residual urine (RU) following catheterization has been suggested as one of the possible causes of UTI. The purpose of this study was to identify the effect of postures on RU following catheterization, for the rehabilitation of neurogenic bladder in SCI patients. The inclusion criteria were: SCI patients with neurogenic bladder; completion of bladder rehabilitation program; good sitting balance and intact hand function. twelve SCI patients fulfilled the criteria and completed ultrasonographic RU measurement in sitting and supine posture following catherterization, respectively. We also studied the frequency of UTI, the functional type of neurogenic bladder and the postures during bladder evacuation at home. All patients had ultrasonographical evidence of RU following catheterizations both in sitting and supine postures. Residual urine volume following catheterization was significantly smaller in sitting posture than in supine posture(p<0.05). Frequency of UTI was significantly lower in the patients who performed catheterizations in sitting posture than in supine posture(p<0.05). In conclusion, bladder training in sitting posture would be better than in supine posture to minimize RU in SCI patients with good sitting balance and intact hand function.

Therapeutic Evaluation of Myofascial Trigger Points by Digital Infrared Thermographic Imaging

Treatment of the trigger points(TrP) is the most important thing for management of myofascial pain syndrome(MPS). The most effective treatment of TrP is local injection with various types of drug or dry needling, but the effectiveness of each drug was not the same by each investigator. The purposes of this study are to evaluate diagnostic value of Digital Infrared Thermographic Imaging(DITI) for trigger points and therapeutic effects of lidocaine and normal saline by DITI. This study included 15 patients who have TrP on upper trapezius muscles as a patient group and 10 normal adults as a control group. 2 cc of 2% Lidocaine was injected to the TrP of upper trapezius muscles in a patient group and to one side of upper trapezius muscles in a control group. One week after the first injection, 2 cc of normal saline was injected by the same method in a patient group. DITI was taken sequentially, preinjection(Pre), immediately after injection(P0), 15(P15), 30(P30), 60(P60) minutes and 24 hours(P24h) after injection. The parameters, temperature difference(deltaT) of both sides, changes of deltaT(deltadT), visual analogue scale(VAS) were recorded at each point. It was considered abnormal, when the deltaT was above 0.6oC. The patient group was subdivided as Group I(hot spot), Group II(cold spot) and Group III(no difference) according to preinjection thermographic findings of TrP. The results were as follows: 1) deltaT of control group was within 0.52oC(95% confidence interval), 2) the numbers were 9 in Group I, 3 in Group II and 3 in Group III, and the sensitivity and specificity of hot spots for MPS were 81.8% and 57.1%, respectively, 3) deltaT was more reduced after lidocaine- than normal saline-injection, 4) VAS was more reduced after lidocaine- than normal saline-injection, especially in Group I and II. It is concluded that DITI can be used as one of the diagnostic tools for TrP and lidocaine is more effective than normal saline for the treatment of TrP.

Effect of physical exercise on plasma beta-endorphin level and pain threshold

No abstract available.

A comparative study of sensory nerve action potentials between median nerve and ulnar nerve in healthy adults

No abstract available.

Congenital hypothyroidism: a case report

No abstract available.