Executive dysfunction is related with decreased frontal lobe blood flow in patients with subarachnoid haemorrhage.

OBJECTIVE: This study evaluated executive dysfunction in patients with subarachnoid haemorrhage (SAH) using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and correlated the occurrence of executive dysfunction with cerebral blood flow (CBF) reduction in the frontal lobe as assessed by single photon emission computed tomography (SPECT). DESIGN: Correlational study. SUBJECTS: Twenty-two patients who underwent microsurgical clipping at least 3 months after SAH. METHODS: This study evaluated the BADS and the Wechsler Adult Intelligence Scale-III (WAIS-III). In addition, it assessed activities of daily living (ADL). CBF was evaluated using SPECT. The patients were divided into the following groups according to the results of SPECT: (1) those with reduced CBF in the frontal lobe (reduced CBF group, n = 8) and (2) those with intact CBF (intact CBF group, n = 14). RESULTS: The BADS score was significantly lower in the reduced CBF group compared with that of the intact CBF group, while there was no significant difference in the WAIS-III scores and ADL scale between the two groups. CONCLUSION: Although this result was conducted with a small sample size, executive dysfunction correlates with reduced CBF in the frontal lobes of SAH patients. A detailed evaluation of executive function is suggested in SAH patients, even if the patient's intelligence test and ADL scale reveal no abnormalities.

Asymmetric skull deformity in children with cerebral palsy: frequency and correlation with postural abnormalities and deformities.

OBJECTIVE: Asymmetrical skull deformity is frequently seen in children with cerebral palsy, and may contribute to postural abnormalities and deformities. The aim of this cross-sectional- survey was to determine the frequency of asymmetrical skull deformity and its correlation with clinical parameters. METHODS: A 10-item checklist for asymmetrical skull deformity, postural abnormalities, and deformities was developed, and its inter-rater reliability was tested. A total of 110 participants aged 1-18 years (mean age 9.3 years (standard deviation 4.7)) was assessed using the checklist. The frequency of asymmetrical skull deformity was analysed and related to the Gross Motor Function Classification System (GMFCS), postural abnormalities, and deformities. RESULTS: The reliability of the checklist was satisfactory (κ > 0.8). Asymmetrical skull deformity was observed in 44 children, 24 showing right and 20 showing left flat occipital deformity. Its frequency was significantly related to GMFCS and with the patterns of asymmetrical posture and deformities (p < 0.05). Children with right flat occipital asymmetrical skull deformity showed predominantly rightward facial direction and right-side-dominant asymmetrical tonic neck reflex, left convex scoliosis, right-side-elevated pelvic obliquity, and left-sided hip dislocation. Those with left flat occipital asymmetrical skull deformity demonstrated the reverse tendency. CONCLUSION: Asymmetrical skull deformity is frequent in cerebral palsy and closely related to asymmetrical posture and deformities. This information will be useful to manage these problems.

Activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy, including adults.

OBJECTIVE: To study the activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy (DMD). DESIGN: Cross-sectional survey. SUBJECTS: Seventy-two patients with DMD (mean [SD] age, 17.2 [8.1] years), recruited in 160-bed regional center for neuromuscular disease. methods: We assessed 72 participants with the Functional Independence Measure (FIM SM), and determined the difficulty order of the FIM SM items with the percentage of patients who were independent (6 or 7) for each FIM item (% independence). RESULTS: The ADL of patients with DMD had an order in terms of difficulty. For the motor subscale, the most difficult item was stairs, and the easiest item was locomotion. On the cognitive subscale, problem solving was the most difficult item. When we compared item difficulty between patients <15 years of age and those > or =15 years, the % independence was lower in the older age group for all motor items. The decrease in the % independence of the eating item with age was significant; however bladder management was well maintained. CONCLUSIONS: ADL of patients with DMD has a specific difficulty order. The order of difficulty is based on the relative level of independence/dependence. The difficulty order was maintained, although the structure of ADL changed with age.

Strenuous exercise-induced alterations of muscle fiber cross-sectional area and fiber-type distribution in steroid myopathy rats.

OBJECTIVE: To investigate the effect of exercise intensity on the muscle histopathology in steroid myopathy rats. DESIGN: Eight-week-old male Wistar rats (n=40) were divided into four groups: a control group (n=4), steroid-only group (n=12), moderate exercise + steroid group (n=12), and a high-intensity exercise + steroid group (n=12). Five weeks after triamcinolone injection, the soleus muscle (SOL) and extensor digitorum longus muscle (EDL) were removed and stained for adenosine triphosphatase (ATPase). The muscle fiber area and fiber type distribution of each fiber type were measured. RESULTS: In the high-intensity exercise group, the type I fibers in the SOL and the type IIb fibers in the EDL showed significant atrophy. In the fiber distribution of the SOL, type I fibers decreased in the steroid-only group and high-intensity exercise group as compared with the control, whereas there was a significant increase in the moderate exercise group vs. the steroid-only group. In the EDL, type I fibers were significantly greater in the moderate- and high-intensity exercise groups, whereas type IIb fibers significantly decreased in the moderate-exercise group as compared with the steroid-only group. CONCLUSIONS: In rats with steroid myopathy, high-intensity exercise caused changes such as muscle atrophy. The fiber type distribution of the SOL changed from type II fibers to type I fibers in the moderate exercise group. Intensive exercise, however, resulted in transformation from type I to type II in the fiber type distribution. For the EDL, no significant fiber type changes were observed with high-intensity exercise when compared with moderate exercise.

A washing toilet seat with a CCD camera monitor to stimulate bowel movement in patients with spinal cord injury.

OBJECTIVE: The objective was to study the effectiveness of a modified washing toilet seat equipped with a CCD camera monitor and an electronic bidet to facilitate precise hitting of the anal area with water streams to stimulate bowel movement in patients with spinal cord injury (SCI). DESIGN: There were 20 subjects, all of whom had traumatic SCI, were at least 5 mos post acute injury, and could change their position on the toilet seat while watching the monitor. Stimulation of bowel movement with the modified toilet seat was provided for a maximum of 30 mins. Success or failure to induce bowel movement was evaluated as related to injury level, ASIA impairment scale, and ability to voluntarily increase anorectal pressure, measured with a manometory. RESULTS: Bowel movement was successfully induced in 15 of the 20 patients (75%). Success was not related significantly to injury level, ASIA impairment scale, or ability to voluntarily squeeze. Compared with their usual manner of bowel management, for which they spent more than 30 mins, time needed for successful bowel movement was shortened in 11 of 13 patients. No complications were observed. CONCLUSIONS: This preliminary study suggests that our newly modified washing toilet seat with a monitoring system could be a useful alternative for bowel management in patients with SCI.

Functional status and muscle strength in people with Duchenne muscular dystrophy living in the community.

OBJECTIVE: To describe activity limitation of people with Duchenne muscular dystrophy who are living in the community and to correlate it with age and muscle strength. DESIGN: Descriptive, correlational. SUBJECTS: Twenty-seven children with Duchenne muscular dystrophy aged 7-14 years who are living in the community. METHODS: The subjects' activity limitation was evaluated using the Functional Independence Measure and the muscle strength of their major upper and lower limb muscles was evaluated with manual muscle testing. The Functional Independence Measure was correlated with age and manual muscle testing, and the pattern of activities of daily living limitations and factors related to it were analysed. RESULTS: There were significant correlations between age and averaged MMT score (Spearman's rho = -0.63, p < 0.01), age and Functional Independence Measure motor score (rho = -0.52, p < 0.01), and Functional Independence Measure motor score and averaged manual muscle testing (rho = 0.77, p < 0.01). At similar manual muscle testing level, children with good cognitive function (Functional Independence Measure cognitive score > or = 26) showed significantly higher Functional Independence Measure motor scores than those with poor cognitive function (Mann-Whitney U test, p < 0.01). For individual Functional Independence Measure items, eating and bowel management were the easier, whereas transfer and stair climbing were the more difficult. Patients with mean muscle strength > or = grade 3 were rated as relatively independent, while those with a mean muscle strength < grade 3 were rated as maximal or total assistance (Mann-Whitney U test, p < 0.05). CONCLUSION: Activities of daily living in patients with Duchenne muscular dystrophy are related to age and muscle strength, and manual muscle testing grade 3 is an important cut-off point to predict their disability.