Electrodiagnostic Study of Retrograde Degeneration in Carpal Tunnel Syndrome

OBJECTIVE: We investigated the useful electrodiagnostic indicators and the extent of retrograde degeneration (RD) in carpal tunnel syndrome (CTS). METHOD: We measured median mixed nerve action potentials (MMNAP) in 26 CTS and 37 normal hands by recording at the elbow and stimulating 0, 3, 6 and 9 cm proximal to the distal wrist crease. The 3 MMNAP parameters such as amplitude, latency and conduction velocity were compared between CTS and control group. The most useful indicator was compared between subgroups of CTS (mild and severe) and control group. RESULTS: The amplitudes of all MMNAPs in CTS group, except stimulating 9 cm proximal to the wrist (MA9), were significantly smaller than those in control group (p<0.05). MA9 in severe CTS subgroup, not mild subgroup, was significantly smaller than that in control group (p<0.05). CTS and control group were not significantly different in the MMNAP latencies, except stimulating 9 cm proximal to the wrist (p<0.05), and in the MMNAP conduction velocity, except stimulating in 0 cm to 3 cm segment proximal to the wrist. CONCLUSION: The amplitude of MMNAP in forearm can be the most useful indicator of RD in CTS, and the conduction velocity, a less useful indicator. We believe that RD progresses as the severity of CTS increases, and dose beyond 9 cm proximal to the distal wrist crease.

Waveform Effects of Electrical Stimulation on Wound Healing in Rats

OBJECTIVE: To examine the effects of two stimulation waveforms on wound healing in rats. METHOD: 30 Sprague-Dawley rats with a 7-mm diametrical round incision including skin and subcutaneous tissue on the dorsum were divided into three groups. A(n=10) and B groups(n=10) were given rectangular and triangular monophasic pulsed current 1 hr daily until the wound healed completely (duty cycle 10%, absolute spatial current density 0.022 mA/cm2 for A group and 0.011 mA/cm2 for B group), and C group (n=10) received no electrical stimulation. As the indicator of wound healing effect, percentage of reduction in wound area, duration of complete healing and antibacterial effect were evaluated and statistically compared among three groups. RESULTS: The mean values of percentage of reduction in wound area were 75.1+/-3.0% for A group, 74.2+/-5.1% for B group and 68.7+/-5.4% for C group. The mean values of duration of complete healing were 11.1+/-1.3 days for A group, 12.0+/-1.4 days for B group and 16.1+/-1.0 days for C group. The mean antibacterial effect were 0.5+/-0.5 for A group, 0.6+/-0.5 for B group and 2.1+/-0.6 for C group on 2 days post wounding, and 0.4+/-0.5 for A group, 0.5+/-0.5 for B group and 1.4+/-0.7 for C group on 6 days post wounding. Although those for A and B groups were significantly different from those for C group, no significant difference in all values of three indicators existed between A and B groups. CONCLUSION: Results suggest that two stimulation waveforms have no significantly different effects on wound healing in rats.

Glycogen Storage Disease Type II: A Case Report

Glycogen Storage Disease Type II is caused by the deficiency of acid maltase resulting in lysosomal accumulation of glycogen. There are two major clinical syndromes, a severe generalized and invariable fatal disease of infancy, and a myopathy starting in juvenile or adult life. The clinical and laboratory findings of a patient with Glycogen Storage Disease Type II are presented. The patient, a 17-year-old male, experienced slowly progressive weakness of muscle of the pelvis shoulder girdles and trunk. Muscle biopsy showed vacuolar myopathy and electromyograph showed features of myopathy with fibrillation potentials, positive sharp waves, myotonic discharges, without clinical myotonia at rest, and polyphasic potentials on volition. Clinical features, histopathologic and electrophysiologic findings of this disease and differential diagnosis were reviewed.

The Relationship between Loewenstein Occupational Therapy Cognitive Assessment and Functional Assessments in Brain-Injured Patients

The Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) battery provides an initial profile of the cognitive abilities of the brain-injured patient that can be used as a starting point for occupational therapy intervention and as a screening test for further assessment. Reliability and validity for the LOTCA have been reported in the literatures. This study investigated the relationship between LOTCA scores and functional assessments in 34 brain-injured patients, consisting of 21 stroke patients and 13 traumatic brain injury patients. Subjects were administered the LOTCA and, as functional assessment tools, the Cognitive Capacity Screening Examination(CCSE) and the Modified Barthel Index(MBI) upon referral to occupational therapy initially, and again at discharge. The initial and the last LOTCA scores were significantly related to the initial and the last CCSE scores and the MBI scores, respectively, in brain-injured patients. Each of the last LOTCA scores, CCSE scores, and MBI scores increased significantly compared to the initial scores. There were no significant differences in the initial and the last LOTCA scores, CCSE scores, and MBI scores between stroke patients and traumatic brain injury patients. Greater LOTCA gain was significantly related to greater MBI gain. These results suggest that the LOTCA battery for brain-injured patients is related not only to cognitive function, but also to functional evaluation as activities of daily living and functional recovery at discharge.