Effects of a Modified Hand Compression Bandage for Treatment of Post-Burn Hand Edemas

OBJECTIVE: To evaluate the effect of a modified hand compression bandage in patients with a post-burn hand edema. METHODS: Patients were recruited from burn centers. We classified the patients into two groups: the modified hand compression bandage group comprising of 22 patients who had a modified hand compression bandage and received conventional physical therapy and the conventionally treated group, comprising of 20 patients who received only conventional physical therapy during the 4-week period post-burn. Hand circumference, hand skin thickness, and hand function were evaluated by grip strength, active range of motion (ROM), Jebsen hand function test, and visual analogue scale (VAS). These assessments were used to evaluate treatment effectiveness prior to the first treatment, 2 weeks after the first treatment, 4 weeks after the first treatment, and 4 months after the first treatment. RESULTS: As a result of repeated-measures analysis of variance on hand circumference, skin thickness, VAS, and each metacarpophalangeal joint ROM, we found significant differences that corresponded to time effect (p0.05). CONCLUSION: The modified hand compression bandage will be clinically useful for the treatment of patients with post-burn hand edemas.

Dilemmas of Korean Athletes With a Spinal Cord Injury to Participate in Sports: A Survey Based on the ICF Core Set for Spinal Cord Injury

OBJECTIVE: To explore the experiences of athletes with spinal cord injury (SCI) in Korea with respect to dilemmas of participating in sports with regards to the facilitators and barriers, using the International Classification of Functioning, Disability and Health (ICF). METHODS: The facilitators and barriers to sports participation of individuals with SCI were examined using 112 ICF categories. A questionnaire in dichotomous scale was answered, which covered the subjects 'Body functions', 'Body structures', 'Activity and participation' and 'Environmental factors'. Data analysis included the use of descriptive statistics to examine the frequency and magnitude of reported issues. RESULTS: Sixty-two community-dwelling participants were recruited. Frequently addressed barriers in 'Body functions' were mobility related problems such as muscle and joint problems, bladder and bowel functions, pressure ulcers, and pain. In 'Activity and participation', most frequently reported were mobility and self-care problems. Highly addressed barriers in 'Environmental factors' were sports facilities, financial cost, transportation problems and lack of information. Relationships such as peer, family and friends were the most important facilitators. CONCLUSION: Numerous barriers still exist for SCI survivors to participate in sports, especially in the area of health care needs and environmental factors. Our results support the need for a multidisciplinary approach to promote sports participation.

Outcomes of Ultrasound-Guided Extracorporeal Shock Wave Therapy for Painful Stump Neuroma

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma. METHODS: Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound. RESULTS: The changes in the McGill pain questionnaire were 38.8+/-9.0 prior to treatment and 11.8+/-3.1 following the treatment. The corresponding values for the control group were 37.2+/-7.7 and 28.5+/-10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0+/-1.5 and 2.8+/-0.8 in the ESWT group, respectively, and 7.2+/-1.4 and 5.8+/-2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p0.05). CONCLUSION: The study findings imply that ESWT for stump neuroma is superior to conventional therapy.

Traumatic Atlanto-Occipital Dislocation Presenting With Dysphagia as the Chief Complaint: A Case Report

We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.

Recovery of Muscle Power Following Early Weight-Bearing and Ankle Exercise after Surgical Repair of Acute Achilles Tendon Rupture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical results of early functional treatment after surgical repair of acute Achilles tendon rupture and to evaluate the isokinetic and isometric concentric plantar flexion peak torque and muscle endurance. We wanted to provide objective results of the functional improvement and the effect of early rehabilitation. MATERIALS AND METHODS: On a retrospective basis, we studied 52 cases of acute Achilles tendon rupture who visited our clinic between March 2007 and August 2009. Eleven patients (9 male, 2 female) were available for the follow-up more than 12 months and their mean final follow-up duration was 18.2 (12 to 39) months. We performed early weight-bearing and ankle exercise after surgical repair of acute Achilles tendon rupture. At final follow-up, patients were evaluated with clinical and functional examination using Arner-Lindholm scale and American Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale and patients' subjective satisfaction. In addition, the isokinetic and isometric concentric plantar flexion peak torque and muscle endurance were evaluated. RESULTS: Evaluating the clinical results using the Arner-Lindholm scale, we had 4 excellent cases and 7 good cases. The average AOFAS score was 88.9 (68 to 100) points at final follow-up. The patients' subjective satisfaction was excellent in 5 cases and good in 6 cases. The isokinetic concentric plantar flexion peak torque was restored to 92.2% (30degrees/sec) and 97.0% (120degrees/sec) in relation to the intact side at final follow-up. The isometric concentric plantar flexion peak torque was restored to 89.4% at 10o dorsiflexion, 84.4% at neutral, and 84.0% at 20degrees plantar flexion of the ankle position in relation to the intact side. The muscle endurance of ankle plantar flexor was 62.37% for the intact side and 59.16% for the injured side that there was no difference between the intact and injured side (p=0.79). CONCLUSION: The clinical results and the satisfactory restoration of muscle power and endurance support early full weight bearing and exercise as an acceptable form of rehabilitation.

Effects of the Off-Loading Brace on the Activation of Femoral Muscles: A Preliminary Study

OBJECTIVE: To provide the off-loading knee brace was designed relief for the pain associated with osteoarthritis by reduce loads on the degenerative compartment of the knee. This study examined the effects of the off-loading knee brace on activation of femoral muscles during squatting, slow and fast walking exercise in healthy young individuals. METHOD: Ten healthy male subjects without a history of knee pain were recruited. Each subject was asked to do squatting, slow and fast walking exercises with a brace secured to the dominant leg. The same exercises were repeated without the brace. Surface electromyographic (sEMG) data was collected from the vastus medialis oblique (VMO), vastus lateralis (VL) and biceps femoris (BF) muscles from the dominant side of the leg. All dynamic root mean squre (RMS) values of sEMG were standardized to static RMS values of the maximal isometric contraction and expressed as a percentage of maximal activity. RESULTS: We found that VMO activity was significantly decreased with application of the off-loading knee brace during squatting and fast walking exercise. However there were no significant differences in VMO activity with application of the off-loading knee brace during slow walking exercise. CONCLUSION: These results suggest that the external moment of the brace which effectively stabilized the patella in the movement in which the knee joints become relatively unstable. The brace could be useful in the short term, but for long-term use, weakening of the VMO is predicted. Therefore the program of selective muscular strength strengthening for the VMO should be emphasized.

Motor Imagery and Action Observation

In the rehabilitation, the real executive movement has been considered the main tool for motor recovery and motor learning. Many studies reported that active exercising creates a flow of sensory information which can change neuroplasticity. Recently the numerous studies report that both the imagery and the observation of a movement increase corticospinal excitability of primary motor cortex and activation of M1 area similar to the real execution of the movement. And the studies also report that these central activations occur in a specific manner. Now many people consider the imagery and observation can be a new therapeutic tool in rehabilitation especially for who can not execute a real motion at all due to neurologic deficit. We will review the articles reported the central nerve system changes by the imagery and observation of an action compared with the executive motion. And most of these experimental studies were based on the results of the healthy subjects, we discussed about the limitation of these therapeutic strategies according to the aging process and to the brain dysfunction.

Validity of Two Kinds of Physical Activity Tracker for Measuring Total Calorie Expenditures and Activities above Moderate Intensity

OBJECTIVE: To evaluate the validity of two kinds of physical activity trackers (PAT) during treadmill exercise. METHOD: 14 healthy people performed cardiopulmonary exercise test by means of Bruce protocol. The omnidirectional PATs were placed onto the right wrist and ankle, and the temperature sensing PATs were placed onto the right arm and lower leg. Simultaneous measurement of body motion was continuously recorded during cardiopulmonary exercise test. Then we checked total calorie expenditure and duration above moderated intensity activity (>3 METs) from each PATs and gas analyzer. RESULTS: Total calorie expenditures of PAT were significantly underestimated than gas analyzer, except the temperature sensing PAT applied onto the leg, but all of them showed significant correlation. The duration above moderate intensity activity of the PAT did not show significant difference comparing with gas analyzer, except the omnidirectional PAT applied onto the arm, but all of them showed significant correlation. CONCLUSION: Both omnidirectional PATs and temperature sensing PATs could estimate the total calorie expenditure and the duration above moderate intensity activity. But it is necessary to apply exercise-specific protocol to PAT to enhance the accuracy of estimating energy expenditure during periods of exercise.

The Activities of Trapezius and Deltoid in Rotator Cuff Tear Patients Injected Local Anesthetics in Subacromial Space

OBJECTIVE: To investigate the activities of upper trapezius and deltoid muscles in shoulder abduction in full can and empty can position in rotator cuff tear patients. METHOD: Twelve subjects with right rotator cuff tear patients participated in this study. Each subject performed scapular plane abduction with humeral external rotation (full can position) and with humeral internal rotation (empty can position). Electromyography (EMG) was recorded with surface electrodes at the both upper trapezius, anterior, lateral, and posterior deltoid muscles during shoulder abduction. The EMG activity of each muscle was normalized according to the highest EMG activity during a maximum manual muscle test for the corresponding muscle. RESULTS: Muscle activities of the lesion side's upper trapezius and lateral deltoid were significantly greater than those of the normal side in full can position. In empty can position, the activities of upper trapezius, anterior, and lateral deltoid increased in lesion side. In comparison between full can and empty can exercises, over 30degrees abduction arcs, empty can exercise showed increased muscle activities of upper trapezius and all deltoid muscle in lesion side. In contrast, anterior and lateral deltoid only showed increased in the muscle activities under empty can exercise in sound side. CONCLUSION: Rotator cuff tear is involved in changed the activities of upper trapezius and deltoid muscles. And these results suggested that in rotator cuff tear patients, the changed pattern of muscle contraction should be considered in shoulder exercise.

Effect of Intradermal Injection of Placenta Hydrolysate to Postburn Hyperpigmented Skin

PURPOSE: The skin hyperpigmentation or hypermelanosis caused by burns results in social withdrawal due to cosmetic problem and depression as a psychiatric aspect. The treatment of the skin hyperpigmentation includes sunscreen, whitening material, skin massage, laser therapy and plastic surgery. Placenta extract can be used to reduce and inactivate the synthesis of the important enzyme (tyrosinase) that compose melanin. This study was performed to estimate the effect of intradermal injection of placenta extract (placenta hydrolysate) for the postburn hyperpigmentation. METHODS: Total 10 subjects who have postburn hyperpigmentation were selected. Two sites of skin area from each subject were randomly selected as possible as symmetrical body area, the one site was to be 'treated site' with placenta extract, the other site was untreated 'control site'. The injection was performed weekly for about 4 weeks only to the 'treated site', not to the control site. The both site were measured by pigment index using Mexameter. The index was also converted to the percentage that indicate a change of after-injection to before-injection. RESULTS: The pigment index of 'treated site' was 399.5+/-63.9 before treatment, and then it had decreased to 333.6+/-59.5 after 4 weeks of injection. The change after injection compared to before injection was significant statistically (p0.05). CONCLUSION: As a result, in the posttburn hyperpigmentation scar, the intradermal injection of placenta extract may be helpful in the management of hyperpigmentation or rehabilitation process of the hypertrophic scar.

Comparison of Peak Torque according to Size of the Rotator Cuff Tear Patients

OBJECTIVE: To investigate the peak torque of shoulder according to the size of the rotator cuff tear. METHOD: With 26 patients of unilateral rotator cuff tear, we measured the concentric isokinetic peak torque of shoulder, using Con-Trex isokinetic dynamometer (CMV AG, Deubendorf, Switzerland). We measured flexion, extension, abduction, adduction, external rotation, and internal rotation torques and calculated the peak toque ratio of flexion/ extension, abduction/adduction and external rotation/internal rotation. Before the test, we injected 1% lidocaine to the subacromial bursa to minimize the error that can be caused by pain. The difference of peak torque according to the size of tear was compared. RESULTS: Comparing the peak torque between affected and sound side, significant difference in flexion, extension, abduction, adduction, internal rotation, and external rotation were shown, but there were no difference in peak torque's ratio in flexion/extension, abduction/adduction, and internal rotation/external rotation. When we compared the peak torque according to the tear size, it didn't show significant difference and also there were no difference of peak torque's ratio in flexion/extension, abduction/adduction, internal rotation/external rotation. CONCLUSION: When we measured the shoulder's strength of rotator cuff tear, peak torque decreased in all motion. But the peak torque's loss and peak torque's ratio is not related with size of tear.

The Modulation of Cortical Excitability by Observation and/or Imagery of Action

OBJECTIVE: To better delineate the changes in cortical excitability that accompany perceptual to motor transformations when people are asked to observe and/or image two kinds of action. METHOD: Twenty right handed young adult without neurological deficit were included. Motor evoked potentials (MEPs) from transcranial magnetic stimulation were recorded in the abductor pollicis brevis of the dominant hand in six different conditions: (1) passive observation (PO) of the slow (1 Hz) action (abduction of right thumb); (2) imagery of the slow action; (3) active observation (AO) of the slow action; (4) PO of the fast (4 Hz) action; (5) imagery of the fast action; and (6) active observation of the fast action. MEPs were also recorded at resting state. RESULTS: The mean amplitude of MEPs at rest condition was 0.85+/-0.84 mV; PO of the slow action, 1.27+/-1.13 mV; imagery of the slow action, 1.76+/-1.49 mV; AO of the slow action, 2.46+/-2.02 mV; PO of the fast action, 1.90+/-1.31 mV; imagery of the fast action, 2.35+/-1.32 mV; and AO of the fast action, 3.44+/-1.85 mV. And at a constant speed of action, AO produced the largest amplitude of MEPs. A comparison between the slow and fast action revealed the latter produced larger amplitude of MEPs than the former during each task. CONCLUSION: The observed and/or imagined action can alter cortical excitability without actual execution of movement. And active observation of the fast action might be more useful for facilitating cortical excitability.

Changes in Ipsilateral Motor Cortex Excitability during Hand Exercise in Normal Subjects

OBJECTIVE: To observe the effect of complexity of unilateral hand activity or dominance of hand on ipsilateral motor cortex excitability. METHOD: Twenty healthy volunteers of right handedness were recruited. We applied the transcranial magnetic stimulation on right hemisphere, and measured motor evoked potential (MEP) at left first dorsal interossei (FDI). We observed the changes of MEP amplitude during the execution of three different complexities of right finger movement. We set the motor tasks as (1) relaxed state, (2) repetitive opposition of 3rd finger (simple exercise) and (3) opposition of 3rd, 5th, 2nd, 4th finger (complex exercise). These tasks were performed within one minute, and repeated 3 times. To observe the effect of hand dominance, we also measured MEP at right FDI during left hand movements. RESULTS: Ipsilateral motor cortex was significantly facilitated by ipsilateral voluntary hand activity (p<0.01). And the MEP amplitude was also increased by complexity of hand exercise. CONCLUSION: We found that the excitability of ipsilateral motor cortex was changed by unilateral hand exercise, and the excitability was increased by complexity of hand exercise.

The Effect of Sub-threshold 1 Hz and 20 Hz Repetitive Transcranial Magnetic Stimulation on Corticospinal Excitability

OBJECTIVE: This explored whether the effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on corticospinal excitability are dependent on the stimulation frequency. METHOD: Ten subjects were investigated using either 20 Hz or 1 Hz rTMS. To reduce inter-individual variability, we explored same subject in one week interval with different frequency. TMS was conducted with intensity of 90% of motor threshold. The effect of rTMS with EMG amplitude evoked in First Dorsal Interossei by TMS. Test motor evoked potentials were evaluated with intensity of 110% of motor threshold before rTMS, during the interval and immediately, 5 minutes, 20 minutes after the end of train. RESULTS: The analysis showed a significant decrease of cortical excitability after 1 Hz rTMS and an increase after 20 Hz rTMS. In low-frequency, Motor Evoked Potential (MEP) amplitude decreased quickly after initial 300 pulses stimulation. In high-frequency, there were some variation of individual MEP in the response to rTMS. The changes of MEP amplitude after 1200 stimulation continued until 20 minutes. CONCLUSION: These results provided basic evidence of rTMS for modulation of cortical excitability and could be further applied in patients group.