Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction

Objective@#To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction. @*Methods@#Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience. @*Results@#There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups. @*Conclusion@#Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

Dysphagia after Cervical Intradiscal Electrothermal Therapy: A Case Report / 대한연하장애학회지

ntradiscal electrothermal therapy (IDET), which is a minimally invasive treatment, was performed to treat cervical HNP. Although IDET has a relatively short recovery time and lower cost compared to surgical treatment, it can still cause complications, such as nerve injury due to improper insertion of the catheter and temperature of the heating coil. This paper reports a rare case of dysphagia following IDET in Korea. A 71-year-old male complained of hoarseness and dysphagia after IDET on the C6-7 level. A Video Fluoroscopic Swallowing Study revealed vallecula and a pyriform sinus remnant, as well as incomplete vocal cord adduction. Subglottic aspiration was observed in the entire examination. The main cause of the dysphagia was attributed to recurrent laryngeal nerve injury during IDET through the right anterior approach at the C6-7 level. In conclusion, even in the case of minimally invasive procedures, the anterior approach may cause neurological damage, such as the recurrent laryngeal nerve. A fter the procedure, it is necessary to observe the patient’s symptoms, consider further evaluations, and perform rehabilitation treatment.

Changes in Blood Glucose Level After Steroid Injection for Musculoskeletal Pain in Patients With Diabetes

Objective@#To investigate changes in blood glucose level after steroid injection in patients with type 2 diabetes mellitus (DM) and factors affecting those changes. @*Methods@#We retrospectively studied 51 patients with type 2 DM who underwent steroid injection for shoulder and back pain. Mean fasting blood sugar (FBS) levels for 7 days before steroid injection was used as the baseline blood glucose level, which was compared with FBS levels for 14 days after steroid injection. We compared the differences in blood glucose changes between HbA1c >7% and HbA1c ≤7% groups and those between insulin and non-insulin treated groups. Demographic data, injection site, and steroid dose were analyzed. @*Results@#Compared to baseline, blood glucose significantly (p=0.012) elevated 1 day after steroid injection but not 2 days after injection. In the HbA1c >7% and insulin groups, blood glucose was significantly increased 1 day after injection compared to that in the HbA1c ≤7% (p=0.011) and non-insulin (p=0.024) groups, respectively. Higher HbA1c level before injection was significantly (p=0.003) associated with the degree of blood glucose increase 1 day after injection. No significant differences were noted in the degree of blood glucose increase according to injection site or steroid dose. @*Conclusion@#Higher HbA1c level was associated with greater elevation in blood glucose 1 day after steroid injection. Careful monitoring of blood glucose is required on the first day after steroid injection in patients with poorly controlled DM.

Insufficiency Fracture of Proximal Tibia in a Young Male Patient with Osteoporosis

We report a case of a healthy 38-year-old man presenting with insufficiency fracture of proximal tibia associated with unrecognized osteoporosis. Radiologic bone DEXA (Dual Energy X-ray Absorptiometry) assessment revealed osteoporosis, but the patient displayed no apparent risk factors for insufficiency fractures and osteoporosis except for a history of smoking. Following right proximal tibial open reduction and internal fixation, the patient commenced smoking cessation and began taking alendronate.The patient was treated for gait rehabilitation, which included quadriceps strengthening exercises and his condition improved with independent walking. This report highlights an unusual site of proximal tibial insufficiency fractures and the potential effect of smoking on low bone mineral density in a young male patient.

Insufficiency Fracture of Proximal Tibia in a Young Male Patient with Osteoporosis

We report a case of a healthy 38-year-old man presenting with insufficiency fracture of proximal tibia associated with unrecognized osteoporosis. Radiologic bone DEXA (Dual Energy X-ray Absorptiometry) assessment revealed osteoporosis, but the patient displayed no apparent risk factors for insufficiency fractures and osteoporosis except for a history of smoking. Following right proximal tibial open reduction and internal fixation, the patient commenced smoking cessation and began taking alendronate.The patient was treated for gait rehabilitation, which included quadriceps strengthening exercises and his condition improved with independent walking. This report highlights an unusual site of proximal tibial insufficiency fractures and the potential effect of smoking on low bone mineral density in a young male patient.

The Correlations between Pulse Pressure and Functional Outcomein Acute Middle Cerebral Arterial Ischemic Stroke

OBJECTIVE: To investigate the correlation between the pulse pressure (PP) and functional outcome in acute middle cerebral arterial (MCA) ischemic stroke. METHOD: We reviewed the medical records of 52 first-ever hemiplegic MCA ischemic stroke patients (age 61.5+/-9.7 years; 35 men, 17 women). Functional outcomes were evaluated with Korean-modified Barthel index (K-MBI), functional independence measure (FIM), Korean-national institutes of health stroke scale (K-NIHSS), and Korean-mini mental state examination (K-MMSE) on 3 days and 3 months after the onset of stroke in all the subjects. The PP was measured six times within initial 24 hours after stroke onset and then the highest PP was selected for the analysis. RESULTS: The degree of PP elevation revealed the significant correlations with male gender, over the age of 55 years, diabetes mellitus, and current smoking history, respectively (p<0.05). In TOAST (Trial Org 10172 in Acute Stroke Treatment) classification, the large artery atherosclerosis group showed significantly the higher PP rather than the other groups (p<0.05). There were inverse correlations between the PP and each of FIM and K-MBI scores on 3 months after stroke onset (p=0.000, 0.009; r=- 0.479, -0.358). There was an inverse correlation between the PP and the change of FIM (p=0.000, r=-0.532). CONCLUSION: The PP within initial 24 hours after stroke onset revealed significant correlation with functional outcome. The management for the proper PP gives the favorable effect on the functional outcome in acute MCA territory ischemic stroke.

The Effectiveness of Pulmonary Rehabilitation Program on Functional Improvement in Patients with Spinal Cord Injury

OBJECTIVE: To investigate the effectiveness of pulmonary rehabilitation program on functional improvement in patients with spinal cord injury and the difference between tetraplegics and paraplegics. METHOD: Twenty one patients without previous history of pulmonary pathology were recruited for this study. Fourteen patients were tetraplegic (12 males, 2 female; mean duration of disease, 42.2+/-7.9 days; mean age, 52.7+/-3.4 years old), seven patients were paraplegic (6 males, 1 female; mean duration of disease, 48.8+/-6.3 days; mean age, 42.1+/-3.7 years old). All patients received pulmonary rehabilitation composed of respiratory muscles strengthening exercise, positive inflation exercise, and breathing exercise with Breather(R) for 30 minutes a session, twice a day, five days per week for 4 weeks. We evaluated arterial blood gas analysis, pulmonary function test (PFT), modified Borg scale (MBS), Spinal Cord Independence Measure (SCIM), and Functional Independence Measure (FIM) as outcome measures at the beginning and 4 weeks after treatment. RESULTS: After the pulmonary rehabilitation program, both of PaO2 and SaO2 increased in tetraplegia and paraplegia groups. MBS improved at rest and on exercise in both of paraplegia and tetraplegia groups (p<0.05). FEV1 and FVC increased in both groups (p<0.05). Both SCIM and FIM scores increased in both groups (p<0.05). The difference of the improvement ratio of PFT, MBS and functional scales between tetraplegia and paraplegia groups was not significant. CONCLUSION: It is suggested that pulmonary rehabilitation program would be useful to improve the functional improvement including of pulmonary function and subjective dyspnea scale in both of tetraplegia and paraplegia groups.

Correlation between Functional Evaluation Scales and Cognitive Evoked Potentials in Patients with Chronic Stroke

OBJECTIVE: To investigate the correlation between functional evaluation scales and cognitive evoked potentials (CEPs) in chronic stroke patients. METHOD: Ten chronic stroke patients with middle cerebral arterial infarction (age 53.6+/-15.7 years, 5 men, 5 women, duration 210.5+/-143.2 days) were recruited. Korean mini-mental status examination (K-MMSE) scores of the subjects were ranked between 15~24 points and the grades of Rancho Los Amigos level of cognitive function of the subjects were VI or VII. They received physical therapy using neuro-developmental technique and cognitive rehabilitation twice a day, 5 times a week, for total 4 weeks. Before and after the treatment, cognitive function tests including K-MMSE, Loewenstein occupational therapy cognitive assessment (LOTCA) and motor-free visual perception test (MVPT) and functional ability tests including functional independence measure (FIM) and Korean version of National Institutes of Health stroke scale (K-NIHSS) were done and CEPs were recorded. RESULTS: The scores of K-MMSE, LOTCA, MVPT, FIM and K-NIHSS showed significant improvement, respectively (p<0.05). The P300 latencies significantly decreased from 420.2+/-34.8 msec to 391.5+/-36.4 msec (p<0.05). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of K-MMSE, LOTCA and MVPT (r=0.863, p=0.001; r=0.745, p=0.013; r=0.806, p=0.005). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of FIM and K-NIHSS (r=0.758, p=0.011; r=0.743, p=0.014). CONCLUSION: The CEPs would be a useful method for reflecting the effect of neuro-cognitive rehabilitation treatment and predicting the functional recovery in chronic stroke patients.

Pain Evaluation with Surface Electromyography in Temporomandibular Myofascial Pain Dysfunction Syndrome

OBJECTIVE: To investigate usefulness of surface electromyography (sEMG) for the pain evaluation in the patients with temporomandibular myofascial pain dysfunction syndrome (TM-MPDS). METHOD: Twenty unilateral TM-MPDS patients (10 males, 10 females, duration of disease 6.6+/-5.6 months, age 28.5+/-3.0 years) and twenty healthy controls (10 males, 10 females, age 30.1+/-6.2 years) were recruited for this study. The patients were treated with trigger point injection therapy and cryotherapy once a week, and ultrasound thermotherapy four times a week for 2 weeks. Active electrodes were attached on temporalis and masseter muscles with reference electrode on chin and ground electrode on forehead. All of subjects were instructed to clench teeth for 5 seconds after full relaxation. For temporalis and masseter muscles, the amplitudes of clenching-EMG activities were obtained and the mean value of five biting cycles was calculated on both sides. sEMG, visual analog scale (VAS) and asymmetry index (AI) were assessed before and 2 weeks after treatment. RESULTS: For temporalis and masseter muscles, the amplitudes of affected side-EMG activity significantly decreased, and the AI of the patient group significantly increased compared with those of the control group (p<0.05, p< 0.05). The AI of the patient group significantly decreased after treatment (p<0.05, p<0.05). Higher AI in masseter muscle before treatment was significantly correlated with lower VAS after treatment (r=-0.487, p<0.05). CONCLUSION: It is suggested that sEMG would be useful for diagnosing and evaluating the pain in TM-MPDS.