This paper was written to provide informations on the functional assessment system in developing public long-term care scheme for frail older persons. Until now in Korea long-term care services tend to be provided to older persons disqualified, because there is no a formal instrument to assess. Fundamentally the scope of function covered by particular measures is composed of four domains:self-care functioning, domestic functioning, cognitive function and challenging behaviour. As a result of review of literatures and each nation's system, assessment indices were suggested 41 items. That is to say, the self-care functioning and domestic functioning are consisted of 22 items, cognitive function and challenging behaviour being 9 items. Besides, it is suggested that 10 items of nursing and rehabilitative needs should be assessed. It is desirable that assessedment should be practised by medical manpowers, for example, medical doctor or nurse and in assessment process firstly visiting examiner make an investigation of physical and cognitive function with a constructed questionnaire and secondly assessment team such as ACAT in Australia decide the level of functional severity.
Australia ; Humans ; Korea ; Long-Term Care* ; Nursing ; Surveys and Questionnaires ; Self Care

BACKGROUNDS: Though K-ADL was developed and validated, weighting each item of K-ADL is needed to evaluate the severity of functional disability as a whole. METHODS: Nominal group technique was used to weight individual items of K-ADL. Relevant experts were recruited; one specialist in geriatrics, one expert in elderly health service, one doctor expert in questionnarie, one nurse and two social welfare workers and one caregiver who work in nursing home for elderly, one nurse working at dementia care center. At the first round, each expert assigned the weights of each item. At the second round, those experts met, discussed, and re-evaluated each weighting. Using the newly developed weighted score, we measured its validity compared to brain-disability grade and three experts' decision of severe dysfunction. RESULTS: For inability to perform task, 7 points were given to 'dressing'and 'washing face', 6 points to 'bathing', 9 points to 'feeding', 8 points to 'transfer and toileting'. If any assistance is needed, 7 points were scored to 'dressing', 4 points were scored to 'washing face', 'feeding', 'transfer' and 'toileting', 2 points were scored to 'dressing'. Correlation coefficient between weighted K-ADL sum and brain-disability grade was -0.665(p=0.000). CONCLUSIONS: We assigned differential weighting to each of K-ADL and found that summing weighted K-ADL was excellent in some validity test.
Aged ; Caregivers ; Dementia ; Geriatrics ; Health Services ; Humans ; Nursing Homes ; Social Welfare ; Specialization ; Weights and Measures

Painful ophthalmoplegia is not common and may be due to variety of causes, of which distant metastsis of malignant lymphoma is rare. This is a case of painful ophthalmoplegia who has looked like Tolosa-Hunt syndrome at first showing normal CSF findings, increased erythrocyte sedimentation rate and some response to steroid. About 2 months later, however, pelvic malignant lymphoma (diffuse undifferentiated according to Rappaport classification) was found, followed by lymphomatous meningitis. The symptoms of pain and ophthalmoplegia were markedly improved after systemic and intrathecal chemotherapy and radiotherapy of whole brain for the metastatic malignant lymphoma.
Blood Sedimentation ; Brain ; Drug Therapy ; Lymphoma* ; Meningitis ; Ophthalmoplegia* ; Radiotherapy ; Tolosa-Hunt Syndrome

BACKGROUND: Korean Instrumental Activities of Daily Living(K-IADL) scale was developed to measure the elderly function. The aim of the present study was to establish the validity and reliability of K-IADL scale. METHODS: Clinical validity and convergent validity was tested. Reliability was tested by internal consistency(Cronbach`s alpha), two weeks test-retest method, and interrator correlation. RESULTS: Cronbach`s alpha was 0.938. 2 weeks test-retest correlations in all 10 items were higher than 0.674. Interrator agreements were high in all 10 items(H=0.808~0.947). Normal control group had lower scores than patients group in all 10 items(p=0.000). Correlation coefficient between K-IADL score and brain-disability grade was between -0.336(laundry) and -0.663(using transportation)(p=0.000). CONCLUSIONS: Korean Instrumental Activities of Daily Living(K-IADL) scale is a valid and reliable instrument. In the future, the studies showing an association between K-IADL and mortality, prognosis are needed.
Aged ; Humans ; Mortality ; Prognosis ; Reproducibility of Results*

Vincristine has been extensively need in chemotherapy to treat leukemia, lymphoma, and a variety of solid tumor. The major antitumor effect has been known to be associated with its high affinity binding to the basic protein sub unit of microtubule, tubulin, which causes disruption of the mitotic spindle apparatus and arrest of calls in metaphase. The principal side effect that has commonly limited the use of this agent is peripheral sensori-motor neuropathy, a feature probably related to the disruption of microtubule in neural tissues. There has been a need for animal experimental models w study the peripheral neuropathy induced by vincristine. However, it was not easy to develop an adequate model due to reported interspecies difference of susceptibility to vincristine. In addition, electrophysiologic test methods to confirm peripheral neuropathy in small experimental animals has not been properly addressed. The purpose of this experiment is to find out whether rat can be used as an animal experimental model of vincristine neuropathy. The authors also incorporated serial noninvasive electrophysiololgic tests, in attempt to correlate morphologic alterations induced by vincristine and functional status of peripheral nerve and muscle. Experiment Group 1 of 14 rats were given 0. 2mg/kg vincristine sulfate once a week, Group 2 of 14 rats were given same does twice a week and Group 3 of 14 rats were given 0. 4mg/kg intravenously, through tail veins for 6 weeks, to delineate the possible different effects from dosage and frequency of injections. The 14 rats for control were given only normal saline with the same methods. The electrophysiologic tests including motor nerve conduction study, sensory nerve conduction study and cervical somatosensory evoked potential were per formed 2 weeks interval. The morphologic examinations of posterior tibial nerves using light microscope and electron microscope were done 4 weeks interval up to 16 weeks. The H&E, modified Gomori-trichrome and histochemical stain(ATPase & NADH) 1. Vincristine induced peripheral neuropathy was successfully established in rat.. This was confirmed not only by morphologic measurements but also by noninvasive serial electrophysiologic examinations of peripheral nerves. 2. The vincristine neuropathy in rats was sensori-motor type similar to those in human. 3. The motor and sensory conduction velocity of posterior tibial nerve in rats fell significantly at ter 2-4 weeks in the vincristine injected groups A tendency of recovery was noted, but the conduction velocity failed to return to normal level up to 16 weeks follow up study. However, the amplitude of compound muscle action potentials as well as compound nerve action potentials showed a great deal of fluctuation during the genesis of neuropathy. Therefore, these electrophysiologic parameters were not optimal predictors in assessment of functional integrity of given nerves with the electrophysiologic test methods used in this experiments. 4, Morphologic examinations revealed that vincristine neuropathy I rats are clearly these of axonal degeneration, compatible to the findings of electrophysiologic examination. 5. The higher dose of vincristine induced the more damage to the peripheral nerves but it also resulted in high mortality rate. Administration of 0.2mg/kg/week would be adequate in generation of experimental neuropathy. 6. The examinations of gastrocnemius and soleus muscle showed same evidence of mild degree of myopathy but it was felt to be direct toxic effect, rather than secondary changes due to the neuropathy.
Action Potentials ; Animal Experimentation ; Animals ; Axons ; Drug Therapy ; Evoked Potentials, Somatosensory ; Follow-Up Studies ; Humans ; Leukemia ; Lymphoma ; Metaphase ; Microtubules ; Mortality ; Muscle, Skeletal ; Muscular Diseases ; Neural Conduction ; Peripheral Nerves* ; Peripheral Nervous System Diseases ; Rats* ; Spindle Apparatus ; Tibial Nerve ; Tubulin ; Veins ; Vincristine*

High dose intravenous methyl prednisolone was administered to patients with multiple sclerosis (4), transverse myelitis (6), and arachnoiditis (I). Almost complete remission was noted in 5 cases (4 with transverse myelitis and one with multiple sclerosis) and partial improvement in 3 patients (2 with multiple sclerosis and I with arachnoiditis ) within 3 days after therapy. The benefits of this therapy, however, was not that dramatic when started late after the onset of neurologic deficits.
Arachnoid ; Arachnoiditis ; Humans ; Multiple Sclerosis ; Myelitis, Transverse ; Neurologic Manifestations ; Prednisolone

In one case of cancer-associated Lambert-Eaton myasthenic syndrome (LEMS), treatment with cytotoxic chemotherapy and radiotherapy resulted in remission of both cancer and neuromuscular disorder. Serial repetitive nerve stimulation (RNS) findings showed that the typical RNS features of LEMS returned to normal in the orders of dramatic postexercise facilitation, an incremental response in high rate stimulation, and a decremental response in low rate stimulation with clinical improvement.
Drug Therapy* ; Lambert-Eaton Myasthenic Syndrome* ; Radiotherapy* ; Small Cell Lung Carcinoma*

This is the first report of motor neuron disease associated with feminization in Korea. The case in this report is a 26 year old male patient wlth hypogonadotropic hypogonadism who developed progressive lower motor neuron dysfunctions started from the lower extremities and later spreaded to the entire body including bulbar muscles. At first glance, wve thought that this is very similar to well known Kennedy-Alter-Sung syndrome but after thorough evaluation and follow up of the partient for 4 years until his death we concluded that this case is somewhat different from Kennedy-Alter-Sung syndrome in several aspects even though it is similar and may be a variant of that syndrome or a new unique syndrome associated with hypogonadotropic hypogonadism.
Adult ; Feminization ; Follow-Up Studies ; Humans ; Hypogonadism ; Korea ; Lower Extremity ; Male ; Motor Neuron Disease* ; Motor Neurons* ; Muscles

Mobius syndrome is a rare congenital disorder characterlzed by facial diplegia and bilateral abducens palsy, which occasionally combinds with other cranial nerve dysfunction, cardiac anomalies, endocrinopathy. Myopathy, peripheral neuropathy and skeletal abnormalities. We report 2 cases of Mobius syndrome; A 6 year old boy showing delayed development, musculo-skeletal anomaly, hypoglossal dysfunction, carpal tunnel syndrome and mild endocrinologic dysfunction, and a 23 year-old lady with only questionable endocrine dysfunction. MRI scans of brain and brainstem are normal and there is no definite electrophysiological evidence of dysfunctions in brainstem on evoked potential blink reflex study. Mental functions look normal in both cases.
Blinking ; Brain ; Brain Stem ; Carpal Tunnel Syndrome ; Child ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Cranial Nerves ; Evoked Potentials ; Humans ; Magnetic Resonance Imaging ; Male ; Mobius Syndrome* ; Muscular Diseases ; Paralysis ; Peripheral Nervous System Diseases ; Young Adult

Twenty patients with clinically definite multiple sclerosis were seen at the Department of Neurology, Severance Hospital between 1984 and 1991 and their clinical features ar.d multimodality evoked potential findings were analyzed. We could not find any significant differences in sex ratio, age of onset, and clinical courses from the study results of Japanese and Western groups. However, visual disturbances at the onset and optic-spinal or optic-spinal-brainstem involvements, which are known to be characteristic features of oriental patients, were also noted to be the most common features in our study. Multimodality evoked potential studies were performed and abnorrnal recordings by at least one of the examinations were found in all but one patient. VEP yielded most frequent abnormalities Diagnostic yield of BAEP increased from overall 43% to 83% in cases having brainstem samploms or sings and the increase was much higher than those seen in VEP of SSEP. Increase or increase in latency as occasionall noticed during follow up but majority of patients did not show significant changes in EP {indings. In one patient however. EP abnorrnalities showed improvement in 2 follow up exarninations during 4 years and 7 months despit the evident aggravation in clinical features. Evoked potentials can give valuable information in the diagnosis of multiple scierosis but further studies are necessary to evaluate their usefulness in the follow up examination.
Age of Onset ; Asian Continental Ancestry Group ; Brain Stem ; Diagnosis ; Evoked Potentials* ; Follow-Up Studies ; Humans ; Multiple Sclerosis* ; Neurology ; Sex Ratio