A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors.

OBJECTIVE Despite the widespread use of deep brain stimulation (DBS) for movement disorders such as Parkinson's disease (PD), the exact anatomical target responsible for the therapeutic effect is still a subject of research. Intraoperative stimulation tests by experts consist of performing passive movements of the patient's arm or wrist while the amplitude of the stimulation current is increased. At each position, the amplitude that best alleviates rigidity is identified. Intrarater and interrater variations due to the subjective and semiquantitative nature of such evaluations have been reported. The aim of the present study was to evaluate the use of an acceleration sensor attached to the evaluator's wrist to assess the change in rigidity, hypothesizing that such a change will alter the speed of the passive movements. Furthermore, the combined analysis of such quantitative results with anatomy would generate a more reproducible description of the most effective stimulation sites. METHODS To test the reliability of the method, it was applied during postoperative follow-up examinations of 3 patients. To study the feasibility of intraoperative use, it was used during 9 bilateral DBS operations in patients suffering from PD. Changes in rigidity were calculated by extracting relevant outcome measures from the accelerometer data. These values were used to identify rigidity-suppressing stimulation current amplitudes, which were statistically compared with the amplitudes identified by the neurologist. Positions for the chronic DBS lead implantation that would have been chosen based on the acceleration data were compared with clinical choices. The data were also analyzed with respect to the anatomical location of the stimulating electrode. RESULTS Outcome measures extracted from the accelerometer data were reproducible for the same evaluator, thus providing a reliable assessment of rigidity changes during intraoperative stimulation tests. Of the 188 stimulation sites analyzed, the number of sites where rigidity-suppressing amplitudes were found increased from 144 to 170 when the accelerometer evaluations were considered. In general, rigidity release could be observed at significantly lower amplitudes with accelerometer evaluation (mean 0.9 ± 0.6 mA) than with subjective evaluation (mean 1.4 ± 0.6 mA) (p < 0.001). Of 14 choices for the implant location of the DBS lead, only 2 were the same for acceleration-based and subjective evaluations. The comparison across anatomical locations showed that stimulation in the fields of Forel ameliorates rigidity at similar amplitudes as stimulation in the subthalamic nucleus, but with fewer side effects. CONCLUSIONS This article describes and validates a new assistive method for assessing rigidity with acceleration sensors during intraoperative stimulation tests in DBS procedures. The initial results indicate that the proposed method may be a clinically useful aid for optimal DBS lead placement as well as a new tool in the ongoing scientific search for the optimal DBS target for PD.

Test of Validity and Reliability of the Adolescent Mental Problem Questionnaire for Korean High School Students

PURPOSE: This study was done to test the validity and reliability of the Adolescent Mental Problem Questionnaire (AMPQ) for Korean high school students. METHODS: The AMPQ was designed to assess adolescents' mental health status and problem behavior (Ahn, 2006). A methodological study design was used with exploratory factor analysis, Pearson's correlation coefficients, and a fitness of the modified model for validity. Also, Cronbach's alpha coefficients and alternative-form method for reliability were used. AMPQ was tested with a sample of 36,313 high school students. The participants consisted of 18,701 males and 17,612 females. RESULTS: Seven factors were extracted through factor analysis: 'Psychiatric problems', 'Delinquency', 'Academic troubles', 'Family problems', 'Hazardous behavior', 'Harmful circumstance', 'Eating problems'. These factors explained 51.1% of the total variance. The fitness of the modified model was good (chi-square=38,413.76, Goodness of Fit Index [GFI]=.94, Adjusted Goodness of Fit Index [AGFI]=.93, Comparative Fit Index [CFI]=.95, Root Mean Square Error of Approximation [RMSEA]=.05), and concurrent validity with Korea-Youth Self-Report [K-YSR] was .63. Cronbach's alpha coefficient of the 31 items was .85. CONCLUSION: The results of present study suggest that the modified AMPQ instrument may be useful for efficiently assessing mental health status and problem behavior in late adolescent, high school students.

Development of Screening Test for Adolescent Mental Health and Problem Behavior / 신경정신의학

OBJECTIVES: This study was conducted to develop the screening questionnaire (Adolescent Mental Health and Problem Behavior Questionnaire, AMPQ) for detecting mental health problems and various problem behaviors in adolescents. METHODS: First, six main domains of questionnaire were defined and preliminary sub-items were collected through literature study, consultation data from field mental health experts, and preliminary survey study. Next, with these 52 preliminary items, we conducted nationwide survey on 1,267 middle and high school students of five districts of Korea. RESULTS: Through reliability test and factor analysis 34 items were finally filtered out. The Cronbach's alpha of these 34 items was .88. And correlation with K-YSR and K-CBCL were .34 (p<.01) and .68 (p<.01). CONCLUSION: AMPQ, which is comprised of relatively short list of items and at the same time covers overall mental health and problem behaviors in adolescents can be used by non-professionals as a screening questionnaire in school settings or mental health centers.