Feasibility and Usability of a Robot-Assisted Complex Upper and Lower Limb Rehabilitation System in Patients with Stroke: A Pilot Study

Objective@#To evaluate the feasibility and usability of cost-effective complex upper and lower limb robot-assisted gait training in patients with stroke using the GTR-A, a foot-plate based end-effector type robotic device. @*Methods@#Patients with subacute stroke (n=9) were included in this study. The enrolled patients received 30-minute robot-assisted gait training thrice a week for 2 weeks (6 sessions). The hand grip strength, functional ambulation categories, modified Barthel index, muscle strength test sum score, Berg Balance Scale, Timed Up and Go Test, and Short Physical Performance Battery were used as functional assessments. The heart rate was measured to evaluate cardiorespiratory fitness. A structured questionnaire was used to evaluate the usability of robot-assisted gait training. All the parameters were evaluated before and after the robot-assisted gait training program. @*Results@#Eight patients completed robot-assisted gait training, and all parameters of functional assessment significantly improved between baseline and posttraining, except for hand grip strength and muscle strength test score. The mean scores for each domain of the questionnaire were as follows: safety, 4.40±0.35; effects, 4.23±0.31; efficiency, 4.22±0.77; and satisfaction, 4.41±0.25. @*Conclusion@#Thus, the GTR-A is a feasible and safe robotic device for patients with gait impairment after stroke, resulting in improvement of ambulatory function and performance of activities of daily living with endurance training. Further research including various diseases and larger sample groups is necessary to verify the utility of this device.

The Effect of Cervical Stellate Ganglion Block Using Botulinum Toxin Type A in Intractable Cancer-related Pain: Case Report

OBJECTIVE: For patients who do not relieve with pharmacological intervention, interventional treatment including neurolytic blocks may have a specific role in palliative cancer management.METHOD: We performed cervical stellate ganglion block for the second time with Botulinum toxin type A mixed with 4 ml of normal saline, total 75 IU of Botulinum toxin type A, minimal effective dosage was measured to minimize the possible side effects.RESULTS: About 3 days later, the patient reported that her continuous pain intensity had decreased from 8/10 to 4/10 on the visual analogue scale score. The frequency of the pain attack that required additional morphine injections was also decreased. As a result, her maximum morphine requirement dose per day was significantly reduced.CONCLUSION: In this case, cervical stellate ganglion block with Botulinum toxin hadlonger lasting effect in the continuous pain intensity and resulted in less frequent pain attack. Botulinum toxin can be a possibleintervention material in intractable neuropathic pain related to cancer.

Lipoma Compressing the Sciatic Nerve in a Patient With Suspicious Central Post-stroke Pain

Lipomas are mostly located in the subcutaneous tissues and rarely cause symptoms. Occasionally, peripheral nerve compression by lipomas is reported. We describe a case of a 59-year-old man with a left-middle cerebral artery infarction who was newly diagnosed as right basal ganglia and thalamic intracranial hemorrhage. He had neuropathic pain in the left arm and leg that was suspected to be central post-stroke pain. The administration of pain medication brought only temporary symptom relief. Nerve conduction and electromyography studies revealed left L5 radiculopathy and he showed a positive ‘sign of the buttock’ in the left hip. Left-hip magnetic resonance imaging revealed an intermuscular lipoma compressing the sciatic nerve. After surgery, the range of motion in the left hip joint was significantly increased, and the patient's pain was relieved.

An Deletion/Insertion Polymorphism of the Angiotensin Converting Enzyme Gene in Ischemic Stroke Patients

BACKGROUND: A deletion (D)/insertion (I) polymorphism of the angiotensin-converting enzyme (ACE) gene is known to be associated with hypertension, left ventricular hypertrophy, myocardial infarction. Cardiac diseases, such as atrial fibrillation, valvular heart disease, myocardiac infarction and coronary artery disease have been clearly associated with increasing the risk of ischemic stroke. We investigated the relationship between ACE gene deletion/insertion (D/I) polymorphism and the pattern of ischemic stroke. METHODS: The pattern of ACE genotypes in 59 stroke patients including symptomatic carotid artery territory cerebral ischemia were compared with 101 age-matched control subjects. In the stroke patients, the degrees of stenosis of bilateral cervical carotid arteries and their major intracranial tributaries were recorded according to duplex neck sonography and magnetic resonance angiography. DNA was extracted from peripheral blood and ACE I/D polymorphism is confirmed by PCR method. RESULTS: In the stroke patients, 25.4% showed the I I genotypes, 8.5% the ID genotypes and 66.1% the DD genotypes. In the control group, the frequencies of each genotype were 20.8%, 55.4% and 23.8%, respectively. The DD genotypes were more common in patients with ischemic stroke compared with the controls, but there was no significant association between ACE genotypes and sub-types of cerebrovascular disease. CONCLUSIONS: The deletion polymorphism in the angiotensin-converting enzyme gene may play a role in development of ischemic stroke.