Evaluation of Exercise Efficiency with Change in Oxygen Uptake and Work Rate in Stroke Patients

OBJECTIVE: To evaluate exercise capacity of subacute stroke patients with nonambulatory exercise stress test and to determine whether reduced exercise efficiency is associated with functional performance. METHOD: Experimental design was prospective and observational study. Eighteen patients with moderate to severe impairment after recent stroke performed exercise stress test by repeated knee flexion and extension exercise using isokinetic dynamometer. Work rate, oxygen consumption, heart rate were assessed during exercise stress test. The dynamic response, the ratio of change in oxygen uptake to change in work rate, was measured for correlation with FIM (Functional Independence Measure) scores. Occupational therapist recorded FIM scores on the day of transfer to inpatient rehabilitation unit and on discharge. Age-matched healthy group also performed exercise stress test in same settings. RESULTS: The patients group who had similar dynamic response with age-matched healthy group showed higher FIM scores than the patients group having higher dynamic response. CONCLUSION: Nonambulatory exercise stress test could be effectively used in subacute stroke patients and the ratio of change in oxygen uptake to change in work rate was a useful variable to reveal low exercise efficiency in subacute stroke patients who had a abnormal skeletal muscle metabolic capacity.

Effect of Conditioned Ischemic Stresses on NF-kappaB Activation in Rat Skeletal Muscle

OBJECTIVE: To investigate the effect of conditioned ischemic stresses on NF-kappaB activities and the protective role of genistein in rat skeletal muscle. METHOD: Rectus femoris muscles of rats were divided into 4 groups according to conditioned ischemic stresses as followings: sham-operated control group; 2 hour ischemia group by clamping the proximal femoral vessel; ischemia-reperfusion group by 30 minutes of reperfusion following 2 hours of ischemia; ischemia-reperfusion-electrical nerve stimulation group in which current was applied at the femoral nerve during 30 min of reperfusion period to induce repetitive muscle contraction. Either genistein-5% dimethyl sulfoxide (DMSO) or DMSO was injected 2 hours before ischemic induction. NF-kappaB activities were analysed by electrophoretic mobility shift assay. RESULTS: NF-kappaB activities pretreated with DMSO were significantly increased in ischemia, ischemia-reperfusion and ischemia-reperfusion-electrical nerve stimulation group compared with those of control group and in ischemia-reperfusion-electrical nerve stimulation group compared with those of ischemia group. Muscle edema was increased in ischemia-reperfusion-electrical nerve stimulation group. But, NF-kappa activities and muscle edema pretreated with genistein were attenuated in ischemia-reperfusion-electrical nerve stimulation group compared with those pretreated with DMSO alone. CONCLUSION: NF-kappaB activities reflect the severity of ischemic stresses. Pretreatment with genistein can attenuate NF-kappa activities and muscle edema in ischemic stress of rat skeletal muscle.

Anterior Displacement of Humeral Head in Hemiplegic Shoulder Subluxation

OBJECTIVE: To measure anterior displacement of the humeral head and to observe its relationship with clinical findings in the subluxed hemiplegic shoulders. METHOD: Seventeen hemiplegic patients, having the subluxed shoulder over one finger breadth were subjected. We measured shoulder pain, muscle power of the shoulder abductors, Brunnstrom stage and spasticity in the affected upper extremity. To measure the humeral displacement of the shoulder subluxation, the AP and transthoracic lateral views of simple radiologic picture were taken on both affected and unaffected shoulders, and repeated after donning three kinds of arm slings. RESULTS: Its anterior displacement as well as the inferior displacement occured in all subjects, and was significantly related with the value of shoulder pain and spasticity, and the inferior displacement with Brunnstrom stage and muscle power of the shoulder abductors in the subluxed hemiplegic shoulder (p<0.05). Correction of the humeral displacement occured significantly in anterior direction as well as inferior by use of all tested arm slings. CONCLUSION: Clinical implications of the shoulder subluxation were different according to direction of the humeral displacement, and anterior displacement will be considered for its symptom in hemiplegic shoulder.

Organophosphate Induced Peripheral Polyneuropathy with Delayed Myelopathy: A case report

Organophosphate is known to damage both the peripheral and central nervous system. We report a case of organophosphate-induced peripheral polyneuropathy with myelopathy. A 46 years old woman who had ingested a large amount of insecticide (organophosphate) was transported to our hospital. Following medical treatment, she was transferred to the Department of Rehabilitation Medicine 1 month later. Upon admission to rehabilitation medicine, the patient was quadriplegic with markedly decreased muscle tone and strength. Electrodiagnostic examination revealed low amplitude of sensory nerve action potential (SNAP), unevokable compound muscle action potential in distal muscles and abnormal spontaneous activities with needle electromyography, which were compatible with peripheral polyneuropathy. Three months later, motor and sensory function of upper extremities were normalized. The muscle tone of lower extremity increased to Ashworth grade II. Follow-up electrodiagnostic examination revealed normalization of SNAP and disappearance of spontaneous activities, but somatosensory evoked potential which were initially normal, revealed prolonged P40 latencies in the lower extremities. These electrophysiological findings were thought to result from the spinal cord lesion and correlated with clinical findings. We diagnosed the patient as peripheral polyneuropathy with delayed myelopathy induced by organophosphate.

Pattern of Post-Stroke Swallowing Disorder according to the Brain Lesion

OBJECTIVE: Post-stroke dysphagia occurs in the form of lingual discoordination, pharyngeal dysmotility, and delayed swallowing reflex. The purpose of this study is to define the pattern of post-stroke swallowing disorder according to the location of brain lesion. METHOD: Thirty-nine post-stroke patients and ten normal persons participated to perform the videofluoroscopic swallowing study (VFSS) with fluid and semisolid gastrograffin. Brain lesions were classified by cortical, subcortical, or brainstem groups and by the involved hemisphere. RESULTS: There was no difference of swallowing pattern between the cortical and subcortical lesions. However patients with brainstem lesion more frequently showed incomplete laryngeal elevation, prolonged pharyngeal transit time, failure of cricopharyngeal muscle relaxation, and aspiration than with cortical and subcortical lesions (p<0.01). In the patients with cortical and subcortical lesions, aspiration occurred before the laryngeal elevation due to discoordination of laryngopharynx. Whereas in the brainstem lesion, aspiration occurred after the laryngeal elevation due to incomplete laryngeal closure. Premature posterior spillage (p<0.05), poor laryngeal elevation(p<0.05), and tracheal aspiration (p<0.01) were more frequently seen in the patients with right hemispheric dysfunction than the left. CONCLUSION: Discoordination of the tongue, oropharynx, and laryngopharynx is predominant in the cortical and subcortical lesion, whereas incomplete laryngeal closure and failure of cricopharyngeal muscle relaxation are predominant in the brianstem lesion.

The Neurophysiologic Response of Anterior Horn Cell Activity to Paraspinal Electrical Stimulation

OBJECTIVE: This study was proposed to evaluate the electrophysiologic changes in central motor conduction and in silent period (SP) after paraspinal transcutaneous electrical stimulation near caudal area of the spinal cord. METHOD: Conditioning stimulation was applied to T12 paraspinal area for 20 minutes using interferential current therapy (80~100 Hz) in 11 healthy subjects. The amplitude and latency of central motor conduction and duration of SP were measured in motor evoked potential (MEPs) by using magnetic stimulator, before and after the conditioning stimulation. These variables were recorded in both tibialis anterior muscle, innervated from stimulated spinal area, and both abductor pollicis brevis, innervated from cervical cord not directly stimulated by electrical stimulation. RESULTS: After conditioning stimulation, the amplitudes of central motor conduction decreased (p<0.01), and the latencies did not change in both cervical and lumbar muscles in transcranial and spinal MEP studies, and the duration of SP was decreased in same manner (p<0.01). CONCLUSION: These results mean that the excitability of anterior horn cells decreases and the supraspinal inhibitory mechanism of the central motor conduction is suppressed by a certain conditioned electrical cutaneous stimulation in entire spinal cord.

Swallowing Difficulties in Polio Survivors

OBJECTIVE: In patients with a history of acute paralytic poliomyelitis, late progressive muscle weakness, fatigue, pain may arise, a symptom complex of known as post-poliomyelitis syndrome (PPS). Dysphagia may also develop in some PPS patients. The purpose of this study was to assess the presence of is swallowing difficulty in polio survivors and to describe the nature of the swallowing difficulty. METHOD: Polio survivors answered the questionnaire pertaining to swallowing function and received a videofluroscopic evaluation of the oral and pharyngeal phases using 3 consistencies of material: liquid barium; semisolid barium paste; boiled yolk of an egg coated with barium. RESULTS: Of the 16 subjects, 8 had subjective symptoms of swallowing difficulties. All of the 6 PPS patients, regardless of whether they had symptoms of swallowing difficulties, had some abnormal oropharyngeal function through video fluoroscopic swallowing study. CONCLUSION: In patients with post-polio syndrome, there is progressive deterioration of swallowing functions similar to that in the muscles of the limbs. This swallowing dysfunction is not related with their subjective symptoms.

Clinical Features of Post-Polio Syndrome Patients in Korea

OBJECTIVE: This study was performed to evaluate the prevalence of new neuromuscular symptoms and disabilities and the psychological characteristics-depressioin, anxiety, type A behavior, loneliness, and also to determine any relationships between physical and neuropsychological characteristics in a group of post-polio syndrome (PPS). METHOD: By 70 answered questionnaire, the polio survivors were grouped into PPS and Non- PPS. This questionnaire consisted of questions about acute polio problems; new health problems, fatigue severity scale, visual analog scale, weakness scale, Frenchay activity index, ambulation disability index; socio-economic problems; neuro-psychological inventories, Beck depression index, Spielberger state-trait anxiety inventory, revised UCLA loneliness scale, type A personality score. RESULTS: The median time from polio to the onset of new health problems was 27.6 years. Fatigue, muscle and/or joint pain, weakness in previously affected and unaffected muscles were most common newly appearing problems. The symptoms of PPS was consistent with the distribution of the anterior horn cell; spinal cord, brain stem, cerebral hemisphere, Reticular Activating System (RAS). Neuro-psychological evaluations revealed that fatigue scale was correlated with depression, type A personality. CONCLUSION: In PPS group, pain, weakness, fatigue, autonomous symptoms, decreased concentration were more serious than in Non-PPS group. The fatigue in PPS group was correlated with type A personality, depression, sleep disturbance and concentration problem.

Dose-dependent Responses to Botulinum Toxin A Injection on Compound Muscle Action Potential Amplitude and Electromyography: Local and Distant Effects

OBJECTIVE: The purpose of this study was to investigate the dose-dependent responses to botulinum toxin A (BTX-A) injection on compound muscle action potential (CMAP) amplitude and needle electromyography (EMG) in local and distant muscles. METHOD: The BTX-A (Botox , Allergan Co.) was injected to the left tibialis anterior (TA): 2, 4, 6, 8 U for each 4 Sprague-Dawley rats; 5, 10, 15, 20 U for each 2 rats. The sciatic nerve conduction and needle EMG were performed in the right and left TA immediately before BTX-A injection, on 2 days after injection, weekly for 1 to 10 weeks, and then monthly for 4 months. RESULTS: The range of dose-dependent maximal paralysis of the injected muscle was from 94% to 99.2% on 7 days after injection. With the lapse of time, the amplitudes in the left sciatic nerve conduction recovered, the abnormal spontaneous activities disappeared, and the power in spectral analysis of motor unit action potential increased. The range of dose-dependent reductions of the CMAP amplitude of the right TA was from 41.8% to 69.9% in the distant muscle, but there was no abnormal spontaneous activity in needle EMG study. As higher doses of BTX-A were injected, the degree of amplitude reduction became larger and the duration of amplitude reduction became longer in both local and distant TA muscles. CONCLUSION: We observed the dose-dependent muscle paralysis with injection of BTX-A. The systemic effects by local injection were induced and the durations of local and systemic effects were proportional to the BTX-A dosage.

Assessment of Developing Feet Aged From 9 to 72 Months Using Harris Mat Footprint

OBJECTIVE: Purposes of this study were to measure the optional five kinds of parameters in children's footprint, to seek what parameters are significant to follow the change of the children's feet and to get the values of normal ranges in children aging from 9 to 72 months. METHOD: Subjects were 286 children (572 feet) having no neurologic or musculoskeletal problems. They were divided into seven groups according to age. Five optional parameters of footprint are medial arch angle, lateral concave ratio, angle between transverse axis and long axis, fifth metatarsal angle, and angle between long axis and fifth metatarsal line. RESULTS: 1) Medial arch angles were significantly increased from 10.03o (group I) to 41.23o (group VII). 2) Lateral concave ratios were significantly increased from 31.75% (group I) to 61.48% (group VII). 3) Angles between long and transverse axes were not significantly different. 4) Fifth metatarsal angles were significantly increased from 83.00o (group I) to 91.04o (group VII). 5) Angles between long axis and fifth metatarsal line were not significantly changed. CONCLUSION: These results suggest that three components-the medial arch, the transverse axis and the fifth metatarsal line-were considered to be available parameters to follow the development of feet. And it is also proposed that our values of their normal range will be helpful to detect abnormalities of children's developing feet.

Significance of Mento-Blink Reflex Study in Lesion of Inferior Alveolar Nerve

OBJECTIVE: This study was designed to observe how the mento-blink reflex (MBR) study is valuable in evaluating the inferior alveolar nerve injury. METHOD: Eleven patients, suffering from the sensory discomfort after extraction of the third molar, and a control group consisting of 20 healthy individuals participated in the clinical neurosensory test (CNST) and the MBR study. The score of CNST was from 0 (normal) to 5 (worst) according to sensory deficit, and the results of MBR were divided into 3 groups: normal; prolongation of R2 latency; no response. RESULTS: In the control group, R2 latencies of right and left were 31.9+/-6.1 msec and 31.5+/-5.9 msec, respectively with the difference of 1.3+/-0.9 msec. The abnormality in the MBR study in patients was correlated with the subjective sensory symptoms (p=0.017) and the abnormality of MBR response was proportional to the score of the CNST. CONCLUSION: We concluded that the MBR study is a useful diagnostic tool in reflecting the inferior alveolar nerve lesion.

Respiration Patterns and Abdominal Muscle Activities during Speech Production in Athetoid Cerebral-Palsied Patients

OBJECTIVE: To evaluate the relationship of the respiration patterns and the abdominal muscle activities during various speech productions in the adults with athetoid cerebral palsy (CP). METHOD: Subjects were 7 athetoid CPs and 7 healthy controls. Respirography and abdominal muscle activities were recorded by use of the pneumobelt and the surface EMG during their performances of six kinds of non-speech and speech tasks. RESULTS: The followings were observed in the athetoid CP. 1) Respiratory phase was irregular and variable in the intensity and period of revolution. The frequency of the respiratory phase was not different from the control in usual respiration, but higher in deep breathing. The time to persist one vowel phonation was shorter. 2) Inappropriate and frequent inspirations were occurred during speech task and the number of syllables was fewer and irregular for one speech breath. 3) The abdominal muscle activities were abrupt, irregular, inconsistent with the respiratory phase during all kinds of non-speech and speech tasks. CONCLUSION: These findings suggest that the abnormal respiration patterns and abdominal muscle activities contribute to the abnormal speech production of athetoid CP and their incoordination is similar to athetoid movement of the extremities. We should consider the athetoid speech production as well as the dysarthria in the athetoid CP.

The Significance of Brainstem Auditory Evoked Potential in High-Risk Neonates

OBJECTIVE: To observe the prognostic value of brainstem auditory evoked potentials (BAEP) for prediction of cerebral palsy (CP) in the high-risk neonates. METHOD: Eighty-one high-risk neonates were subjected to take the history of illness, neurological examination, developmental assessment, BAEP study within one month after birth. They had been checked for detection and management of the CP in period of 12 to 56 months after birth. Associating factors were observed about their gestational age at birth, 1-minute Apgar score, history of asphyxia and/or intubation, and hyperbilirubinemia and/or exchange transfusion. RESULTS: Abnormal BAEP findings were seen in 38 of 81 (46.9%) high-risk neonates and 6 of 81 (7.4%) were diagnosed as a CP. Five of 6 CPs and 42 of 75 non-CPs had been abnormal in BAEP study. Neonatal BAEP study showed 83.3% sensitivity, 44% specificity, 98.4% false positive and 2.9% false negative in predicting CP. Asphyxia showed high correlation with abnormality of BAEP and CP (p<0.01). Gestational age, low birth weight, toxemia, germinal matrix hemorrhage (GMH) grade II and intubation were correlated with CP (p<0.05) but not with the abnormality of BAEP. CONCLUSION: It is suggested that BAEP study of high-risk neonate is useful in prediction of CP because of low false negative and high sensitivity.

Respiratory Patterns Associated with Swallowing in Athetoid Cerebral-Palsied Patients

OBJECTIVE: To evaluate the changes of the respiratory patterns associated with swallowing in athetoid cerebral palsied patients (CP), and to understand its relationship with their dysphagia and aspiration. METHOD: Seven adult athetoid CP and seven control subjects were selected for this study. Each subject performed swallowing tasks in upright sitting position, and submental electromyography and respirography by pneumobelt on mid-abdomen were recorded simultaneously. Swallowing tasks were composed of swallowing 5 cc, 75 cc of water, and chewing a cookie. And athetoid subjects performed videofluoroscopic swallowing study (VFSS) for each food texture. RESULTS: 1) In athetoid CP, respiratory patterns during swallowing were variable and more irregular than the resting tidal breathing. 2) In athetoid CP, completion time of the swallowing task and recovery time to the resting tidal breathing after swallow were significantly prolonged (p<0.01). 4) Athetoid subjects had significantly higher rate of postdeglutitive inspiration than that of the controls (p<0.01). 5) In correlation with the VFSS findings, aspirated group of the athetoid subjects had significantly higher rate of postdeglutitive inspiration than that of non-aspirated group (p<0.05). CONCLUSION: Respiratory-swallowing coordination was disrupted in the athtoid CP, and their higher rate of postdeglutitive inspiration suggested the higher risk for aspiration of the food materials, especially in drinking of large amounts of liquid.

Electrophysiologic Responses to the Electrical Stimulation: A Peripheral Nerve Conditioning Near the Spinal Cord

It has been reported that the electrical stimulation of nerves can cause the changes of anterior horn cell excitability and conduction velocity of the nerves in vivo and vitro studies. The purpose of this study is to evaluate the electrophysiologic changes of the peripheral nerves near the spinal cord by the electrical stimulation. Subjects were 20 healthy volunteers, with the age of 21 to 27 years. The conditioning current was an interferential current of 10 Hz and 100 Hz with the maximal tolerable intensity (18~20 mA). Conditioning stimulation was applied to the paraspinal area between T9 and T12 for 15 minutes. Before and after the conditioning stimulation, we measured the peripheral nerve conduction, H-reflex, F-wave, and somatosensory evoked potential (SEP) of the tibial nerve. The results after the conditioning revealed that the tibial motor and sensory conductions were unchanged but the latency of the H-reflex was significantly prolonged with a significant reduction of H amplitude and H/M ratio (p0.05). There was no statistical difference between the changes by a high or low frequency stimulation. These results suggest that a certain conditioned electrical stimulation of peripheral nerves near the spinal cord may cause the decrement of anterior horn cell excitability, and the inhibition of the alpha motor nerve and sensory nerve conductions near the spinal cord.

Electrophysiologic Response to Electrical Stimulation Proximal Peripheral Nerve Conditioning

The effect of electrical nerve stimulation are controversial because of the inconsistent variables of stimulating current and electrophysiologic study. The purposes of this study are to reconfirm the electrophysiolgic changes by electrical stimulation of the peripheral nerve that had been reported in 1993, and to monitor how long they will be maintained. In this study, the following conditioning stimulations were applied to 20 healthy volunteers; interferential current (frequency: 80 - 100 Hz, intensity: 27 - 34 mA) on the sacral paraspinal area. The H reflex, the Fresponse, and the somatosensory evoked potential (SEP) of the tibial nerve were evaluated as the electrophysiologic study before, immediately after, 30 minutes, 60 minutes, and 120 minutes after the above conditioning stimulation. The following results were obtained; 1) Latencies of the H reflex, the F response and the SEP (P1), and the F wave conduction time, the F wave conduction velocity and the F ratio in the tibial nerve conduction study were increased by conditioning stimulation of the proximal peripheral nerves (P>0.01). 2) Changes of the amplitude of the H reflex, the H/M ratio, and the amplitude (P1N1) of the tibial SEP were not significant in the same conditioning stimulation (P>0.05). 3) Prolongations of the latencies of H reflex, F response and P1 SEP of the tibial nerve were the most significant immediately after conditioning stimulation and sustained for 45 minutes after conditioning on average (P<0.01). The above results suggest that certain conditional electrical stimulation of the peripheral nerves causes reversible changes in the conduction of the H reflex, the F response and the SEP and they may be inhibitory effect of the proximal conduction via the spinal cord.

Spinal Cord Injury in Diffuse Idiopathic Skeletal Hyperostosis: A case report

Diffuse idiopathic skeletal hyperostosis(DISH) is a relatively common disorder. It is a noninflammatory disease occuring predominantly in middle aged elderly men characterized by calcification and ossification of the anterolateral aspects of vertebral column. It's clinical manifestations are minor: usually cervical stiffness, trunk stiffness and moderate pain. However some severe neurologic complications can occur due to spinal cord compression. We report a case with DISH who got spinal cord injury after minor trauma. A 65-year-old man admitted to the neurosurgery department with a complaint of weakness in lower extremities and paresthesia in upper extremities which were developed after slip down. He had a 10 year history of slowly progressive neck stiffness and weakness in lower extremities. Plain X-ray does not reveal any evidence of fracture in cervical spine or sacroilitis but showed calcification of the anterior longitudinal ligament. The disc spaces were maintained well. MRI showed ossification of the posterior longitudinal ligament causing severe narrowing of the vertebral canal and compression of the spinal cord. Under the diagnosis of spinal cord injury with DISH, the patient was treated conservatively. Despite these treatment, neurologic impairment aggrevated. Surgical decompression of cervical and thoracolumbar spinal cord was done and the patient improved to the quadcane ambulation level.

Electrophysiologic Changes of Tibial Nerve by Low Frequency Stimulation in Peripheral Polyneuropathic Patients

The changes of anterior horn cell excitability and conduction of the nervous system by the electrical stimulation of nerve have been reported in both vivo and vitro studies. Purpose of this study is to observe the neurophysiologic changes of nerves by 10 Hz electrical stimulation on polyneuropathic peripheral nerves. Subjects were 18 diabetic polyneuropathic patients diagnosed by the conduction studies. Electrophysiologic studies were performed in both right and left tibial nerves before and after conditioning of the right tibial nerve. Electrophysiologic studies included five tests which were the sural sensory and tibial motor conduction(abductor hallucis), F response(abductor hallucis), H reflex(gastrosoleus) and somatosensory evoked potential(ankle, SEP). Ten Hz rectangular electrical current was used for the conditioning stimulation. It was applied to the popliteal tibial nerve with the tolerable maximal intensity(10-24 mA) for 5 minutes. Following changes were statistically significant in statistics after the conditioning. Prolongation of F latency (p<0.05), increases of F chronodispersion, duration and area(p<0.05), prolongation of H latency(p<0.05), increase of H amplitude(p<0.05), decrease of P1 latency of SEP(p<0.01) and increase of P1N1 amplitude of SEP(p<0.01) were seen in both conditioned and unconditioned legs. Increase of F wave conduction time(FWCT) and decrease of F wave conduction velocity (FWCV) were seen in conditioned leg(p<0.05). Above findings suggest that certain electrical stimulation of polyneuropathic nerve may cause increase of the anterior horn cell excitability, fascilitation of the SEP conduction and slowness of alpha motor conduction to and from the spinal cord.

Somatosensory evoked potential of the sensory estension of the musculocutaneous nerve: normal value in Korean

No abstract available.

Isolated injury of the lateral antebrachial cutaneous branch and its clinical utility in musculocutaneous nerve(case report)

No abstract available.