Effects of Electric Cortical Stimulation (ECS) and Transcranial Direct Current Stimulation (tDCS) on Rats With a Traumatic Brain Injury.

OBJECTIVE: To evaluate the effects of electric cortical stimulation (ECS) and transcranial direct current stimulation (tDCS) on motor and cognitive function recovery and brain plasticity in focal traumatic brain injury (TBI) of rats model. METHODS: Forty rats were pre-trained to perform a single pellet reaching task (SPRT), rotarod test (RRT), and Y-maze test for 14 days, then a focal TBI was induced by a weight drop model on the motor cortex. All rats were randomly assigned to one of the three groups: anodal ECS (50 Hz and 194 µs) (ECS group), tDCS (0.1 mA, 50 Hz and 200 µs) (tDCS group), and no stimulation as a control group. Four-week stimulation, including rehabilitation, was started 3 days after the operation. SPRT, RRT, and Y-maze were measured from day 1 to day 28 after the TBI was induced. Histopathological and immunohistochemistry staining evaluations were performed at 4 weeks. RESULTS: SPRT was improved from day 7 to day 26 in ECS, and from day 8 to day 26 in tDCS compared to the control group (p<0.05). SPRT of ECS group was significantly improved on days 3, 8, 9, and 17 compared to the tDCS group. Y-maze was improved from day 8 to day 16 in ECS, and on days 6, 12, and 16 in the tDCS group compared to the control group (p<0.05). Y-maze of the ECS group was significantly improved on day 9 to day 15 compared to the tDCS group. The c-Fos protein expression was better in the ECS group and the tDCS group compared to the control group. CONCLUSION: Electric stimulation in rats modified with a focal TBI is effective for motor recovery and brain plasticity. ECS induced faster behavioral and cognitive improvements compared to tDCS during the recovery period of rats with a focal TBI.

A New Instrument for Measuring Tibial Torsion in Pediatric Patients.

OBJECTIVE: To develop and test the validity and reliability of a new instrument for measuring the thigh-foot angle (TFA) for the patients with in-toeing and out-toeing gait. METHODS: The new instrument (Thigh-Foot Supporter [TFS]) was developed by measuring the TFA during regular examination of the tibial torsional status. The study included 40 children who presented with in-toeing and out-toeing gaits. We took a picture of each case to measure photographic-TFA (P-TFA) in the proper position and to establish a criterion. Study participants were examined by three independent physicians (A, B, and C) who had one, three and ten years of experience in the field, respectively. Each examiner conducted a separate classical physical examination (CPE) of every participant using a gait goniometer followed by a TFA assessment of each pediatric patient with or without the TFS. Thirty minutes later, repeated in the same way was measured. RESULTS: Less experienced examiner A showed significant differences between the TFA values depending on whether TFS used (left p=0.003 and right p=0.008). However, experienced examiners B and C did not show significant differences. Using TFS, less experienced examiner A showed a high validity and all examiner's inter-test and the inter-personal reliabilities increased. CONCLUSION: TFS may increase validity and reliability in measuring tibial torsion in patients who has a rotational problem in lower extremities. It would be more useful in less experienced examiners.

The Accessory Sacroiliac Joint Diagnosed With Bone SPECT/CT.

The accessory sacroiliac (SI) joint is not rare and can be one of the causes of lower back pain. We present a case of a 35-year-old woman with chronic lower back pain. Conventional radiography was equivocal, and bone scintigraphy showed a focus of mildly increased uptake in left SI joint region. SPECT/CT revealed increased uptakes in the accessory articulations between both sacral alae and iliac bones, and confirmed the diagnosis of accessory SI joint. This case illustrates the SPECT/CT findings of the accessory SI joint.

Relationship Between HbA1c and Complex Regional Pain Syndrome in Stroke Patients With Type 2 Diabetes Mellitus.

OBJECTIVE: To investigate the relationship between glycosylated hemoglobin A (HbA1c) and complex regional pain syndrome (CRPS) in stroke patients with type 2 diabetes mellitus (T2DM). METHODS: A retrospective chart review was performed of stroke patients from January 2012 to December 2013. We reviewed 331 patients and included 200 in the analysis. We divided them into CRPS and non-CRPS groups and compared them by age, gender, stroke lesion, cause of stroke, duration of T2DM, HbA1c (%), National Institutes of Health Stroke Scale score, affected shoulder flexor muscle strength, Fugl-Meyer Assessment score, motricity index, Functional Independence Measure, Korean version of Modified Barthel Index, blood glucose level on admission day, duration from stroke onset to HbA1c check, and duration from stroke onset to three-phase bone scan for CRPS diagnosis. Thereafter, we classified the patients into five groups by HbA1c level (group 1, 5.0%-5.9%; group 2, 6.0%-6.9%; group 3, 7.0%-7.9%; group 4, 8.0%-8.9%; and group 5, 9.0%-9.9%) and we investigated the difference in CRPS prevalence between the two groups. RESULTS: Of the 200 patients, 108 were in the CRPS group and 92 were in the non-CRPS group. There were significant differences in HbA1c (p<0.05) between the two groups but no significant differences in any other factors. Across the five HbA1c groups, there were significant differences in CRPS prevalence (p<0.01); specifically, it increased as HbA1c increased. CONCLUSION: This study suggests that higher HbA1c relates to higher CRPS prevalence and thus that uncontrolled blood glucose can affect CRPS occurrence in stroke patients with diabetes.

The Effect of Electrical Stimulation Combined with Foam Dressing on Ulcer Healing in Rats with Spinal Cord Injury.

OBJECTIVE: To evaluate the effect of electrical stimulation (ES) combined with foam dressing on wound healing in rats with spinal cord injury. METHODS: Complete spinal cord injury was induced in 49 male Sprague-Dawley rats at the T11-L1 level, after which a pressure ulcer was induced on the left thigh. The newly invented surface electrode, which was fitted with foam inside, was applied to the ulcers. Rats were divided into 2 groups as follows: the ES group, which received foam dressings and ES (2 Hz and 200-microsecond duration, 15 mA) for 4 times a day, 30 minutes each, for 3 weeks; and the control group, which received the foam dressings without ES. The ulcer area was measured by taking a photograph daily from day 0 to day 21. Histopathologic and immune-histochemical evaluations were performed on day 1 and days 7, 14, and 21. RESULTS: The area of the ulcers of the ES group was smaller than that of the control group after day 14 (P < .05). In the ES group, the vascularity was significantly greater on day 14 and more decreased on day 21 compared with day 7 than that in the control group (P < .05). In the ES group, the area of positive reaction to anti-α-SMA antibody was increased compared with the control group on days 7 and 14 and decreased on day 21 (P > .05). CONCLUSION: Electrical stimulation combined with foam dressing by means of newly invented surface electrodes facilitates and accelerates the wound-healing process.

Balloon dilatation for an esophageal stricture by long-term use of a nasogastric tube: a case report.

In the present report, we describe a case of long-term follow-up esophageal stricture occurring in a patient with nasogastric tube use. A 63-year-old man who had experienced dislocation of the 6th and 7th cervical vertebrae as the result of an external injury received treatment at another hospital and was admitted to the rehabilitation department of our hospital. After he exhibited normal swallowing in a videofluoroscopic swallowing test, the nasogastric tube was removed and oral feeding with a dysphagia diet was initiated. However, during oral feeding, the patient complained of swallowing difficulties in his lower throat. An esophagogastroduodenoscopy was performed to examine the lesions below the pharynx and a 2-mm stricture was observed. A balloon dilatation was performed for a total of 9 times to extend the stricture. After the procedure, the patient was able to easily swallow a normal diet through the esophagus and the vomiting symptoms disappeared. An esophagography showed that the diameter of the esophageal stricture was 11 mm.

The effect of electric cortical stimulation after focal traumatic brain injury in rats.

OBJECTIVE: To evaluate the effects of electric cortical stimulation in the experimentally induced focal traumatic brain injury (TBI) rat model on motor recovery and plasticity of the injured brain. METHOD: Twenty male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT) and on a Rotarod task (RRT) for 14 days. Then, the TBI model was induced by a weight drop device (40 g in weight, 25 cm in height) on the dominant motor cortex, and the electrode was implanted over the perilesional cortical surface. All rats were divided into two groups as follows: Electrical stimulation (ES) group with anodal continuous stimulation (50 Hz and 194 µs duration) or Sham-operated control (SOC) group with no electrical stimulation. The rats were trained SPRT and RRT for 14 days for rehabilitation and measured Garcia's neurologic examination. Histopathological and immunostaining evaluations were performed after the experiment. RESULTS: There were no differences in the slice number in the histological analysis. Garcia's neurologic scores & SPRT were significantly increased in the ES group (p<0.05), yet, there was no difference in RRT in both groups. The ES group showed more expression of c-Fos around the brain injured area than the SOC group. CONCLUSION: Electric cortical stimulation with rehabilitation is considered to be one of the trial methods for motor recovery in TBI. However, more studies should be conducted for the TBI model in order to establish better stimulation methods.

Development and application of a newly designed massage instrument for deep cross-friction massage in chronic non-specific low back pain.

OBJECTIVE: To introduce a newly designed massage instrument, the Hand Grip T-bar (HT-bar) and use it to relieve chronic non-specific low back pain (nLBP) through deep cross-friction massage (roptrotherapy). METHOD: 22 subjects (9 males and 13 females, aged 51.6±6.7) with chronic nLBP were allocated randomly to a Roptrotherapy group (n=12) and a Transcutaneous Electrical Nerve Stimulation (TENS) group (n=10). The Roptrotherapy group received deep cross-friction massage with the HT-bar, which was made of metal and had a cylinder for increasing weight and grooves for an easy grip. It was applied across the middle and lower back for 20 minutes a day, 3 days a week for 2 weeks. The TENS group received TENS for 20 minutes a day, 5 days a week for 2 weeks. The outcome was measured on the pain numeric rating scale (PNRS), by the Oswestry disability index (ODI), and by the Roland & Morris Disability Questionnaire (RMDQ) at pre-treatment, at immediate post-treatment and 2 weeks later. The application of the HT-bar was assessed by a questionnaire to 19 therapists. RESULTS: At post-treatment, immediately and 2 weeks later, both groups showed significant improvement in PNRS, ODI and RMDQ. During the two weeks after post-treatment, however, the Roptrotherapy group improved in PNRS, ODI and RMDQ, but the TENS group did not. Over 80% of the therapists responded that the HT-bar was useful and comfortable. CONCLUSION: This study suggests that deep cross-friction massage can be a beneficial therapeutic technique and that the HT-bar can be a useful instrument in deep cross-friction massage for chronic nLBP patients.