OBJECTIVE: To evaluate the immediate and short term effects of extracorporeal shock wave therapy (ESWT) on elbow flexor spasticity after stroke, to compare the treatment effects according to the ESWT applied site (muscle group and musculotendinous junction group) and to assess the factors affecting the treatment effect. METHOD: A total of 32 stroke patients were enrolled, 23 of them were ESWT group and 9 were control group. ESWT was applied 1 session/week, total 3 sessions and 12 patients were applied at biceps muscle belly and 11 patients were applied at biceps musculotendinosus junction. Patients were evaluated using modified Ashworth scale (MAS), modified Tardieu scale (MTS), Korean-modified Barthel index (K-MBI) at baseline, immediately, 1 week and 4 weeks after ESWT. RESULTS: MAS and MTS were significantly improved immediately after ESWT, but were not significantly changed at 1 week, 4 weeks in ESWT group. The scores of K-MBI improved but were not different between ESWT group and control group. The treatment effect was greater in musculotendinous junction group than muscle belly group in MTS and MAS immediately after ESWT. We could not find out any significant factors affecting the effects of ESWT. CONCLUSION: Spasticity after chronic stroke improved immediately after ESWT, but was not changed significantly at 1 week and 4 weeks after ESWT. Further studies about ESWT parameters for spasticity and factors affecting treatment effect are needed.
Elbow ; Humans ; Muscle Spasticity ; Muscles ; Shock ; Stroke

OBJECTIVE: To test the hypothesis that a transient non-lethal ischemia (ie. ischemic preconditioning(IPC)) would protect against subsequent traumatic brain injury (TBI) using 1H-magnetic resonance spectroscopy (MRS). METHOD: Sprague-Dawley rats were randomized to sham ischemia procedures followed by TBI, IPC followed by TBI, and IPC followed by sham TBI. IPC was induced by 20 min of right common carotid artery occlusion 24 hour prior to TBI, and experimental injury was induced using lateral fluid percussion model of moderate severity. We measured metabolic changes with 1H-MRS and conducted motor function and 4 arm maze tests to identify neurobehavioral deficits and cognitive deficits, respectively, at 1 day to 4 weeks post-injury. RESULTS: The NAA/Cr ratios in the affected hemisphere were significantly lower in TBI than in IPC-TBI group at 2 (p=0.006) and 4 (p=0.012) weeks and in the unaffected hemisphere at 4 weeks (p=0.030). TBI group also showed a trend towards reduction in NAA/Cho ratio in the affected hemisphere at 4 weeks (p=0.054). CONCLUSION: Brief IPC 24 hours before moderate lateral fluid percussion brain injury increases the resistance to brain damage and that is associated with changes in brain metabolites. These findings indicate that IPC induces neuroprotection against TBI in rat brains.
Animals ; Arm ; Brain ; Brain Injuries ; Carotid Artery, Common ; Ischemia ; Ischemic Preconditioning ; Neuroprotective Agents ; Percussion ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Spectrum Analysis

OBJECTIVE: To investigate the mode of the development of osteoporosis in hemiplegic stroke patients and to study the change in bone mineral density (BMD) in relation to stroke duration and affected sides. METHOD: The subjects were 79 hemiplegic stroke patients (39 males, 40 felames, mean age 61.9 years). We measured the BMD of the subjects, compared the BMD of affected sides with that of unaffected sides, and evaluate the BMD in connection with stroke duration and affected sides. RESULTS: The reduction of the BMD in affected sides was highly correlated with the duration of hemiplegia, but the correlation was not shown in the case of those in unaffected sides. In addition, the difference of BMD in affected sides between those in unaffected sides had an obvious negative correlation with the stroke duration of left hemiplegia, but not with that of right hemiplegia. CONCLUSION: Stroke patients have a high prevalence of osteoporosis and this findings were particularly prominent in people who suffer from left hemiplegia. Early rehabilitative care, including weight-bearing exercise and outdoor ambulation, is essential for left side hemiplegic patients in order to prevent possible complications.
Bone Density ; Hemiplegia ; Humans ; Male ; Osteoporosis ; Prevalence ; Stroke ; Walking ; Weight-Bearing

OBJECTIVE: To explore the factors affecting rehabilitation outcome of congenital muscular torticollis (CMT) patients and suggest the onset time, method and the duration of the rehabilitation treatment. METHOD: 112 patients diagnosed as CMT were enrolled and we reviewed the patients' charts and radiologic findings, retrospectively. We reviewed the sex, gestational age, birth weight, mode of delivery, age at diagnosis, mass thickness, ratio of mass thickness, mass site, plagiocephaly, clavicle fracture, the frequency of rehabilitation treatment. RESULTS: The patients with a plagiocephaly or a clavicle fracture had been needed significantly longer rehabilitation and ratio of mass thickness and rehabilitative duration had a positive linear relationship and diagnostic time and the duration of rehabilitative treatment showed a positive correlation. However, rehabilitation frequency did not equate to a shorter rehabilitation period and mass site did not correlate with the duration of rehabilitation treatment. Also, the group treated with manipulation with additional ultrasound treatment showed no significant difference to the group treated with only manipulation. In this study, 2 patients received surgical treatment, which was SCM tenotomy of the affected side in conjunction with rehabilitation therapy. CONCLUSION: This study showed that plagiocephaly, clavicle fracture, mass ratio, and diagnosis time are clinically significant in determining rehabilitative treatment. So, it is imperative to make a timely diagnosis and objectively evaluate the tilting of the head and neck, as well as checking the mass ratio and identifying the presence of clavicle fractures.
Birth Weight ; Clavicle ; Gestational Age ; Head ; Humans ; Neck ; Plagiocephaly ; Retrospective Studies ; Tenotomy ; Torticollis ; Treatment Outcome

OBJECTIVE: To investigate the effect of obturator nerve block with 5% phenol under sevoflurane mask inhalation general anesthesia and its influence on vital signs in spastic cerebral palsy children during the procedure. METHOD: 26 cerebral palsy children with spastic hip adductor muscles went under inhalation general anesthesia by anesthesiologist for phenol block of obturator nerve. After induction with thiopental sodium and sustained with sevoflurane by face mask without the use of muscle relaxant, the vital signs including heart rate, blood pressure and oxygen saturation were closely monitored throughout the procedure. The obturator nerve block was carried out with 5% phenol using a stimulator. Modified Ashworth scale (MAS) and range of motion of hip were measured before and after the procedure to compare the effects of nerve block. RESULTS: No significant differences were observed from the vital signs before, during and after the procedure. The MAS score improved from average 2.50+/-0.71 to 1.12+/-0.32. The range of motion increased from 24.31+/-12.32degrees and 25.88+/-12.28degrees right and left relatively to 39.62+/-10.10degrees and 40.96+/-11.14degrees. CONCLUSION: Both spasticity and range of motion of hip adductor muscles improved significantly after obturator nerve block with 5% phenol under inhalation general anesthesia in the operating room with face mask, and no adverse effects or complications were seen in all 26 cerebral palsy children. Therefore phenol nerve block under inhalation general anesthesia in operation room for cerebral palsy children with poor cooperation or positioning difficulty due to spasticity should be considered as a useful method.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Cerebral Palsy ; Child ; Heart Rate ; Hip ; Humans ; Inhalation ; Masks ; Methyl Ethers ; Muscle Spasticity ; Muscles ; Nerve Block ; Obturator Nerve ; Operating Rooms ; Oxygen ; Phenol ; Range of Motion, Articular ; Thiopental ; Vital Signs

OBJECTIVE: To investigate the non-speech mechanism function in relation with functional status and find out the relationship between nutritional status and non-speech mechanism function in children with cerebral palsy (CP). METHOD: Eighty four children with CP were participated in this study. Non-speech mechanism function was investigated with a simple scale of oral motor status (OMS) and a feeding-swallowing evaluaton protocol for children (FEP-C). Higher score represents more severe in dysfunction in both tests. As well, Gross motor function classification system (GMFCS), the nutritional status based on body mass index were assessed in these subjects. GMFCS level I to III were grouped into high functioning group while GMFCS level IV and V were grouped into low functioning group. RESULTS: Fifty seven (67.9%) individuals with CP showed dysphagia symptoms (OMS sore > or =1). The mean scores of non-speech mechanism function in low functioning group were higher than in high functioning group (p<0.05). The mean scores of both OMS and FEP-C were higher in individuals with underweight (p<0.05). Compared to high functioning individuals with CP, underweight was more prevalent along with higher scores in oral motor function in low functioning group. OMS scores were significantly correlated with the mean scores of non-speech mechanism in all subareas (p<0.05). CONCLUSION: Non-speech mechanism function was closely related with GMFCS level. As well, this study revealed that the oromotor function and nutritional status in these individuals with CP related with non-speech mechanism function.
Body Mass Index ; Cerebral Palsy ; Child ; Deglutition Disorders ; Humans ; Nutritional Status ; Thinness

OBJECTIVE: To evaluate the effect of weight-bearing exercise on the bone mineral density (BMD) in children with spastic quadriplegic cerebral palsy (CP). METHOD: A heterogeneous group of 18 prepubertal children with CP (age, 8.9+/-2.9 years; GMFCS level, IV and V) participated. Patients underwent a dual-energy X-ray absorptiometry scan of the lumbar spine (L1-L4) and proximal femur, and the Z scores were calculated by using data obtained from the control group who were normal children (age, 8.8+/-2.9 years). We divided the patients into 2 groups: group A standing for 2 hours a day, 5 days a week; group B standing for 30 minutes a day, 1 or 2 days a week. We measured BMD after 1 year and compared it to baseline measurements. RESULTS: BMD was significantly higher on L2-L4 vertebrae, femoral neck and trochanter area after exercise in group A (p<0.05). There was no significant difference in BMI after exercise in the group B (p>0.05). BMD according to static weight-bearing exercise for 1 year were significantly different between groups A and B on the L1, L4 vertebrae, femoral neck and trochanter area (p<0.05). CONCLUSION: This study suggests that weight-bearing exercise may be an important part of a rehabilitation protocol to maintain and improve BMD in children with spastic quadriplegic CP.
Absorptiometry, Photon ; Bone Density ; Cerebral Palsy ; Child ; Femur ; Femur Neck ; Humans ; Muscle Spasticity ; Spine ; Weight-Bearing

OBJECTIVE: To assess the effect of electrical stimulation and weight-supported treadmill gait simulation on apoptosis in the muscles of rats with spinal cord injury. METHOD: Twenty seven rats with a model of complete spinal cord injury were assigned to one of the following groups: control (n=9), electrical stimulation (n=10), and exercise (n=8) groups. After a 2-week intervention period, they were sacrificed, and the pattern of apoptosis was analyzed by in situ DNA nick-end labeling (TUNEL), by DNA fragmentation assay, and by Western blot for Bax and Bcl-2 using specimens from the right hamstring muscles for all groups. RESULTS: The electrical stimulation group had increased apoptosis compared to the control group possibly due to overwork weakness, but there was no statistical significance between the groups. Apoptosis decreased in the exercise group compared with in the electrical stimulation and control group. The expression of Bcl-2 was most prominent in the exercise group, and it was significantly reduced in the electrical stimulation and control group. CONCLUSION: These findings suggest that exercise could play an important role in decreasing apoptosis by the up-regulation of Bcl-2 protein expression and that electrical stimulation might cause overwork weakness in rat models of spinal cord injury.
Animals ; Apoptosis ; Blotting, Western ; DNA ; DNA Fragmentation ; Electric Stimulation ; Gait ; Muscles ; Rats ; Spinal Cord ; Spinal Cord Injuries ; Up-Regulation

The causes of leg length discrepancy in childhood include neurologic, musculoskeletal, tumor and vascular diseases. It may contribute secondary complications such as gait disturbance, scoliosis, hip joint arthritis or cosmetic problem etc. Acquired arteriovenous fistula is a rare cause of leg length discrepancy. Multiple vascular punctures in the neonates, especially in prematures, can result in iatrogenic arteriovenous fistula formation. We report two cases of arteriovenous fistula secondary to vascular punctures, diagnosed by color doppler ultrasonography and CT angiography. The lesions were explored and treated surgically.
Angiography ; Arteriovenous Fistula ; Arthritis ; Cosmetics ; Fistula ; Gait ; Hip Joint ; Humans ; Infant, Newborn ; Leg ; Punctures ; Scoliosis ; Ultrasonography, Doppler, Color ; Vascular Diseases

Achalasia is rare disorder with an estimated prevalence of 0.5~1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma.
Deglutition ; Electromyography ; Esophageal Achalasia ; Hoarseness ; Humans ; Male ; Prevalence ; Thorax ; Vagus Nerve ; Vagus Nerve Injuries