Anterior Displacement of Humeral Head in Hemiplegic Shoulder Subluxation

OBJECTIVE: To measure anterior displacement of the humeral head and to observe its relationship with clinical findings in the subluxed hemiplegic shoulders. METHOD: Seventeen hemiplegic patients, having the subluxed shoulder over one finger breadth were subjected. We measured shoulder pain, muscle power of the shoulder abductors, Brunnstrom stage and spasticity in the affected upper extremity. To measure the humeral displacement of the shoulder subluxation, the AP and transthoracic lateral views of simple radiologic picture were taken on both affected and unaffected shoulders, and repeated after donning three kinds of arm slings. RESULTS: Its anterior displacement as well as the inferior displacement occured in all subjects, and was significantly related with the value of shoulder pain and spasticity, and the inferior displacement with Brunnstrom stage and muscle power of the shoulder abductors in the subluxed hemiplegic shoulder (p<0.05). Correction of the humeral displacement occured significantly in anterior direction as well as inferior by use of all tested arm slings. CONCLUSION: Clinical implications of the shoulder subluxation were different according to direction of the humeral displacement, and anterior displacement will be considered for its symptom in hemiplegic shoulder.

Multiple System Atrophy Overlaps Stroke: A case report

Multiple system atrophy (MSA) is an idiopathic neurodegenerative disorder involving many neuronal structures. It is a heterogeneous system disorder affecting extrapyramidal, cerebellar and autonomic nervous system. Only a minority of MSA patients are diagnosed before reaching the full blown stage. Its autonomic features like orthostatic hypotension, vocal cord paralysis are directly related to mortality. Up to now, rehabilitation of MSA patients had been rarely reported. Early, proper diagnosis and comprehensive rehabilitation for their heterogeneous clinical features are important. We experienced 54 year old hemiplegic paient who overlaps MSA. He showed some improvement in ADL and cerebellar symptoms after comprehensive rehabilitation programs.

Organophosphate Induced Peripheral Polyneuropathy with Delayed Myelopathy: A case report

Organophosphate is known to damage both the peripheral and central nervous system. We report a case of organophosphate-induced peripheral polyneuropathy with myelopathy. A 46 years old woman who had ingested a large amount of insecticide (organophosphate) was transported to our hospital. Following medical treatment, she was transferred to the Department of Rehabilitation Medicine 1 month later. Upon admission to rehabilitation medicine, the patient was quadriplegic with markedly decreased muscle tone and strength. Electrodiagnostic examination revealed low amplitude of sensory nerve action potential (SNAP), unevokable compound muscle action potential in distal muscles and abnormal spontaneous activities with needle electromyography, which were compatible with peripheral polyneuropathy. Three months later, motor and sensory function of upper extremities were normalized. The muscle tone of lower extremity increased to Ashworth grade II. Follow-up electrodiagnostic examination revealed normalization of SNAP and disappearance of spontaneous activities, but somatosensory evoked potential which were initially normal, revealed prolonged P40 latencies in the lower extremities. These electrophysiological findings were thought to result from the spinal cord lesion and correlated with clinical findings. We diagnosed the patient as peripheral polyneuropathy with delayed myelopathy induced by organophosphate.

The Neurophysiologic Response of Anterior Horn Cell Activity to Paraspinal Electrical Stimulation

OBJECTIVE: This study was proposed to evaluate the electrophysiologic changes in central motor conduction and in silent period (SP) after paraspinal transcutaneous electrical stimulation near caudal area of the spinal cord. METHOD: Conditioning stimulation was applied to T12 paraspinal area for 20 minutes using interferential current therapy (80~100 Hz) in 11 healthy subjects. The amplitude and latency of central motor conduction and duration of SP were measured in motor evoked potential (MEPs) by using magnetic stimulator, before and after the conditioning stimulation. These variables were recorded in both tibialis anterior muscle, innervated from stimulated spinal area, and both abductor pollicis brevis, innervated from cervical cord not directly stimulated by electrical stimulation. RESULTS: After conditioning stimulation, the amplitudes of central motor conduction decreased (p<0.01), and the latencies did not change in both cervical and lumbar muscles in transcranial and spinal MEP studies, and the duration of SP was decreased in same manner (p<0.01). CONCLUSION: These results mean that the excitability of anterior horn cells decreases and the supraspinal inhibitory mechanism of the central motor conduction is suppressed by a certain conditioned electrical cutaneous stimulation in entire spinal cord.

Motor Unit Numbers Estimation in Abductor Pollicis Brevis Muscle of Normal Adult

OBJECTIVE: To estimate the motor unit numbers in normal adult hand muscles using manual incremental technique and F-wave technique. METHOD: We estimated the motor unit numbers in abductor pollicis brevis muscles of twenty normal adults. In manual incremental technique, we estimated the motor unit numbers using motor unit count program setted in electrodiagnostic equipment (Dantec, Keypoint). In F-wave technique, we estimated the motor unit numbers dividing maximal M-potential amplitude by mean amplitude of surface motor unit action potential. RESULTS: There was no significant difference of motor unit numbers between right and left abductor pollicis brevis in both manual incremental and F-wave technique. Motor unit numbers using F-wave technique were significantly greater than motor unit numbers using manual incremental technique. CONCLUSION: The difference of motor unit numbers using manual incremental technique and F-wave technique was considered as a difference of functional electrical stimulation. F-wave technique was more physiologic and functional method of motor unit numbers estimation than manual incremental technique.