Quantitative Assessment of Intention Tremor after Brain Injury Using Tri-axial Accelerometry

OBJECTIVE: The aims of this study were to assess intention tremor severity caused by brain injury using tri-axial accelerometry and also to determine the reliability and the correlation with clinical measurements. METHOD: Twenty two patients with intention tremor caused by brain injury were included. The quantitative measurement of tremor was performed using tri-axial accelerometry during finger to nose test. The dominant frequency and amplitude of tremor were acquired using Fast Fourier transformation analysis. The severity of tremor was also clinically rated by clinical rating scale for tremor, hand writing test, figure drawing test, pouring water test. The correlation between clinical measurement and tri-axial accelerometry measurement, and the inter-rater reliability were assessed. RESULTS: The tri-axial accelerometry measurement showed good inter-rater reliability. The mean dominant frequency was 3.10 Hz. The amplitudes at dominant frequency were significantly correlated with clinical rating scale for tremor, pouring water test (p<0.05) but not with hand writing test, figure drawing test. CONCLUSION: Quantitative measurement of intention tremor using tri-axial accelerometry may be very useful to assess the tremor severity caused by brain injury.

The Relationship between Weight-Bearing and Stiff-Knee Gait in Hemiplegic Patients

OBJECTIVE: To determine whether insufficient weight-bearing on the hemiparetic side has a correlation with the degree of stiff-knee gait in hemiplegic patients. METHOD: Fifty hemiplegic patients were included. In all patients, 3-dimensonal gait analysis and static and dynamic foot pressure measurements were taken. The degree of stiff-knee gait was evaluated using the peak knee flexion angle and the knee flexion slope at toe-off in hemiplegic limb. The degree of weight-bearing was evaluated using the percentage of hemiplegic foot pressure and pressure-time integration on the non-hemiplegic side. RESULTS: The static and dynamic mean pressure ratios and pressure-time integration ratio were statistically correlated with peak knee flexion angle and knee flexion slope (p<0.01). CONCLUSION: As a result, insufficient weight-bearing had a correlation with the degree of stiff-knee gait in hemiplegic patients. Insufficient weight-bearing should be further investigated to determine whether it is one of the characteristic findings of stiff-knee gait, or another cause of stiff-knee gait.

Effect of Constraint-Induced Movement Therapy in Chronic Hemiplegic Patients

OBJECTIVE: To evaluate the effectiveness of constraint-induced movement therapy (CIT) for chronic hemiplegic patients and to investigate the factors that influence on the effectiveness of CIT. METHOD: Forty two chronic stroke patients were enrolled and classified into two groups, experimental and control group. The experimental group took CIT for 2 weeks. CIT consisted of restraint of the unaffected upper extremity with massive training of the affected upper extremity. The motor function of patient's upper extremity was assessed by Manual Function Test (MFT) and Jebsen Hand Function Test before treatment, at 2 weeks and at 8 weeks after the treatment. RESULTS: The withdrawal rate was 46.7% during CIT period. There was substantial significant improvements in MFT and Jebsen Hand Function Test after 2 weeks of treatment in the experimental group (p<0.05). The effects in the experimental group were maintained at 6 weeks after cessation of the treatment. CONCLUSION: CIT is considered to be an effective treatment for motor function of the chronic hemiplegic upper extremity motor function, and will be useful as an additional thera peutic tool.

Intrahemispheric Diaschisis in Subcortical Lesions

OBJECTIVE: The aim of this study was to investigate the incidence of intrahemispheric diaschisis in subcortical lesions and relationships between involved structures and intrahemispheric diaschisis using positron emission tomography (PET). METHOD: Thirty stroke patients with unilateral subcortical lesions without cortical structural abnormality were recruited. The findings of [18F]Fluoro-2-Deoxy-D-Glucose PET were interpretated by experienced radiologist. RESULTS: In the lesions around basal ganglia, hypometabolism of ipsilateral whole hemisphere was observed in 8 of 20 patients and ipsilateral parietal, frontal, temporal, occipital lobe was observed in order of incidence. Intrahemispheric diaschisis had a tendency to expand when the centrum semiovale was involved. Crossed cerebellar dia-schisis was observed in 17 of 20 patients. In the lesions around thalamus, hypometabolism of ipsilateral whole hemisphere was observed in 6 of 8 patients, and ipsilateral frontal, temporal, parietal lobe was observed in order of incidence. Intrahemispheric diaschisis had a tendency to expand when the internal capsule was involved. Crossed cerebellar diaschisis was observed in 5 of 8 patients. CONCLUSION: This study shows that intrahemispheric diaschisis was observed in all patients with subcortical lesions without cortical structural abnormality and had a tendency to expand to larger area of the cerebral cortex when the connecting fibers between cortical and subcortical structures were involved.

Kinematic and Kinetic Comparison between Stair Climbing and Level Walking

OBJECTIVE: The aims of this study were to investigate the characteristics of stair climbing through the comparison between the stair climbing and level walking, and to present the standard values of stair climbing. METHOD: Twenty healthy young adults were recruited. The kinematic and kinetic data of level walking and stair climbing on the specially designed stair were obtained through 3 dimensional motion analyzer (Vicon 370 system) with the force plate. RESULTS: The sagittal range of motion of all examined joints at stair climbing was significantly increased compared as at level walking (p<0.05). The maximal flexion angle at swing phase of all examined joints were significantly increased at stair climbing compared than at level walking (p<0.05). At loading response, the kinetic data showed the significant differences between stair climbing and level walking. The time when the maximal extensor moment of knee developed was significantly earlier than when that of hip developed (p<0.05). CONCLUSION: As a results, we found that stair climbing was different from level walking and had the unique pattern in the kinematic and kinetic aspect. The motion analysis of stair climbing may be useful to the further studies.

The Analysis of Sit-to-Stand Motion in Stroke Patients

OBJECTIVE: The ability to get up from a chair is an important component in maintaining independence and a prerequisite for upright mobility for stroke patients. The purpose of this study was to compare the sit-to-stand movement in stroke patients with that in healthy adult. METHOD: Twenty-three stroke patients and thirty-seven young healthy subjects were included in this study. Subjects sat on an adjustable chair with their feet on force plates and performed the standing up movement at a self-paced, comfortable speed. The study patients were tested barefoot. The changes in joint angle, maximal moment, power, and ground reaction force in lower limb were calculated using 3 dimensional motion analyzer throughout the sit-to-stand transfer. RESULTS: The mean time needed was significantly longer in stroke patients than in young healthy subjects. Pelvic tilting and hip flexion angle at initial and final angle were significantly greater in stroke patients than in young healthy subjects. Maximal momentum, power and change of ground reaction force in ankle joint were significantly lower in stroke patients than in young healthy subjects. Hip external rotation angle at standing point showed significant correlation with maximal hip external rotation and slow walking speed during the comfortable walking. CONCLUSION: We concluded that the analysis of sit-to-stand movement in stroke patients may provide a useful guide for gait recovery and training.