No abstract available.
Humans ; Stroke* ; Walking*

Driver rehabilitation is a component of rehabilitation medicine that specifically focuses on the evaluation and retraining of drivers who have medical conditions that may affect driving capacity. Automobile driving is an instrumental activity of daily living and driver rehabilitation needs a comprehensive approach guided by rehabilitation specialist. Drivers who need evaluation include brain damaged drivers, such as stroke and traumatic brain injury; older drivers, especially those who are suspicious as having dementia; and drivers with psychiatric illnesses. Driver evaluation is constituted of pre-driving (in-clinic) evaluation and behind-the-wheel evaluation. In-clinic evaluation includes history taking and physical examination that focuses on visual, motor and cognitive function. Details of in-clinic evaluation are discussed. Driving performance can be evaluated during simulated or on-road driving or both. Driver retraining can also be done using driving simulator or real automobile equipped with adaptive devices. It is predicted that increasing aged population raises the need for driver evaluation and rehabilitation in the near future. Concerns and participation for rehabilitation specialists in driver rehabilitation is requested.
Aged ; Automobile Driving ; Automobiles ; Brain ; Humans ; Physical Examination ; Specialization ; Stroke

Recent emphasis on motor learning approach and advances in rehabilitation engineering facilitated new development of therapeutic systems in neurorehabilitation. Virtual reality and robotic technology has been applied to provide stimulating and challenging environment in which participants can practice tasks repetitively, to augment feedback of performance, and to guide precise and repetitive movement. Virtual reality is a computer-based technology that provide real-time interactive and multisensory simulated environment. It has been adopted in upper limb rehabilitation, gait training, and driver retraining. Virtual reality can be either immersive or nonimmersive depending on the components used in the system, and immersive environment seems to be more effective in rehabilitation. By providing enhanced feedback, environments offering motivation and tasks meaningful to participants, virtual reality can facilitate motor learning. Robotic systems can be classified into 2 types: exoskeleton and end-effector. A lot of robotic systems have been developed and used for upper limb exercise and gait training. Studies revealed those systems are beneficial to enhance arm motor function and walking ability. Application of robotics in rehabilitation has several advantages: enabling massed practice by increasing therapy intensity and amount; provision of force feedback; possibility of automating therapy sessions; setup of therapy specific to individuals; precise, objective and reliable assessment of motor function. Combination of virtual reality and robotics would make it possible to develop better rehabilitation systems that could enhance motor learning in more effective way.

OBJECTIVE: We conducted a retrospective data analysis to review the results of robot-assisted arm rehabilitation in post stroke patients during past 2 years and find out positive influences of the outcomes. METHOD: We measured improvements of arm function longitudinally in a group of sixty-four stroke patients, who participated in the robot-assisted arm therapy from January 2012 to December 2013. Treatment session lasted 30 to 40 minutes, 2 to 5 times a week. For at least more than one month, we used the InMotion2.0 (Interactive Motion Technologies, Watertown, MA, USA) and measured outcomes with the Fugl-Meyer assessment-upper extremity (FMA-UE), Korea-modified Barthel index (K-MBI) and InMotion robot arm evaluation index. Also, analysis on the subgroup was carried out. RESULTS: Following the robot-assisted arm rehabilitation, FMA-UE, K-MBI and InMotion robot arm evaluation index were significantly improved compared to baseline. Mean FMA-UE and K-MBI gain were 4.22 +/- 0.76, 7.63 +/- 1.18 in each. However, in the subgroup analysis, the group with less intensity treatment (640 repetition) did not show any significant improvement. CONCLUSION: This is an observational study showing improvements in arm function following robot-assisted arm rehabilitation compared to baseline, which was significant only in the subgroup who received the intervention longer and more intensity.
Arm* ; Extremities ; Humans ; Observational Study ; Rehabilitation* ; Retrospective Studies ; Statistics as Topic ; Stroke* ; Upper Extremity

OBJECTIVE: We used music as a rhythmic cue in gait training of patients with hemiplegia and analysed its effect on gait parameters. METHOD: Twenty hemiplegic patients were included in the study. Gait cycle, foot contact area, and center of pressure pathway were measured by F-scan with and without music. Four subjects were followed after 3 weeks of gait training using rhythmic cue with music. RESULTS: 1) In involved limb, stance phase was slightly increased from 65.8+/-9.9% to 67.8+/-7.9%, and single limb support was changed from 17.1+/-6.3% to 17.2+/-6.2%, without statistical significance. 2) Stance and swing symmetry was slightly increased from 0.77+/-0.13 and 0.52+/-0.21 to 0.83+/-0.09 and 0.54+/-0.16 respectively, without statistical significance. 3) Foot contact area and anteroposterior distance of center of pressure were not changed significantly. 4) All 4 subjects who were followed after 3 weeks showed increased single limb support of involved limb (from 14.5% to 18.8%) and swing symmetry (from 0.47 to 0.67). CONCLUSION: Though it was not proved to be effective for every hemiplegics, use of rhythmic cue with music in gait training may be helpful in some patients. Further study is needed to confirm these results.
Cues ; Extremities ; Foot ; Gait ; Gait Disorders, Neurologic* ; Hemiplegia ; Humans ; Music Therapy ; Music* ; Rehabilitation

No abstract available.
Trigger Points*

Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. the SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admired in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED doing the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%). 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3+/-16 years. 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture offhand 6 cases(6.5%), and others 19 cases(20.6%). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admired to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65+/-9.6 to 7.52+/-5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admixed patients waiting in the ED.
Contusions ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Extremities ; Female ; Gastroenteritis ; Humans ; Lacerations ; Length of Stay ; Male ; Retrospective Studies ; Rupture ; Sex Ratio ; Tendons

OBJECTIVE: To evaluate the utility of Cognitive Perceptual Assessment for Driving (CPAD) through the on-road test in predicting the actual road driving skills in brain injured patients. METHOD: 25 brain injured patients with actual driving experience before the occurrence of diseases participated in the handicapped driving adaptation training program of our hospital as the subjects of the study, and one round of CPAD and on-road test were performed. CPAD evaluations and on-road tests for all patients were evaluated by the same therapist. RESULTS: 11 patients passed the CPAD and all of them passed the on-road test. 3 patients failed from CPAD and they turned out to be failed at the on-road test. The mean CPAD score of the on-road test passed group was 53.6 which was significantly different from the mean 43.6 CPAD score acquired by the on-road test failed group by showing a significant difference between two groups (p<0.05). Among the 11 patients who received the borderline CPAD score, 9 patients passed the on-road test. CONCLUSION: CPAD is considered to be useful in predicting the actual road driving skills of brain injured patients who previously had driving experiences before the occurrence of the diseases.
Brain ; Disabled Persons ; Humans

BACKGROUND: An endothelium derived vasoconstrictor peptide, endothelin, has been shown to be a potent coronary vascular constrictor. In the clinical settings of angina or myocardial ischemia, the endothelial injury of coronary artery can stimulate the endothelin production. In this study, the authors assessed the response to endothelin of the coronary artery in isolated rat heart and compared the relative effects of three vasodilators (nifedipine, adenosine, nitroprusside) on coronary vasospasm which was induced by endothelin. METHODS: The isolated rat heart preparations (Langendorff model) were obtained from fourty male Sprague-Dawley rats (350-400 gm). Preparations were perfusated with Krebs-Hanseleit solution of (mM): NaCl 115, NaHCO3 25, KCl 4.7, CaCl2 2H2O 2.5, MgCl2 6H2O 1.2, KH2PO4 1.2, glucose 10. The perfusate was maintained at 37oC and aerated with carbogen (oxygen 95% and carbon dioxide 5%). The coronary perfusion was maintained at 80 cmH20 pressure and Latex balloon was positioned in left ventricle. After the preparations were stabilized, endothelin (10(-9) M) was added to perfusate for 5 minutes and followed the perfusion without vasodilators (control, n = 10) or with vasodilators (nifedipine, adenosine and nitroprusside 10(-7) M to 10(-6) M, n = 10 each) for 45 minutes. The left ventricular developed pressure (LDP) and heart rate (HR) was recorded and the coronary effluent (VOL) was collected to measure the unit volume and the CPK isoenzyme (CK-MB). Effects of the interventions were assessed using analysis of variance. All values are presented as means +/- SE. RESULTS: VOL, HR and VDP were significantly reduced after infusion of 10(-9) M endothelin in 3 and 5 minutes. VOL was recovered efficiently after infusion of three vasodilators. Adenosine and nitroprusside groups showed superior recovery in the changes of rate pressure product (RPP) than in nifedipine group, which was significant reduced in VDP. CONCLUSIONS: These results suggest that in the situation of endothelin induced severe coronary vasospasm, adenosine and nitroprusside effectively reversed the coronary vasospasm without severe myocardial depression.
Adenosine ; Animals ; Carbon Dioxide ; Coronary Vasospasm* ; Coronary Vessels ; Depression ; Endothelins* ; Endothelium ; Glucose ; Heart Rate ; Heart Ventricles ; Heart* ; Humans ; Latex ; Magnesium Chloride ; Male ; Myocardial Ischemia ; Nifedipine ; Nitroprusside ; Perfusion ; Rats* ; Rats, Sprague-Dawley ; Vasodilator Agents*

Locked-in Syndrome is a severe pontine stroke causing quadriplegia, lower cranial nerve paralysis, and mutism with preservation of only vertical gaze and upper eyelid movement in a conscious patient. We present a case of a Locked-in Syndrome patient who received communication training with augmentative and alternative communication equipment by using eye blinks. After 3 weeks of training, the patient was able to make an attempt to interact with other people, and associate a new word by Korean alphabet selection. Augmentative and alternative communication equipment which uses eye blinks might be considered to be beneficial in improving the communication skills of locked-in syndrome patients.
Communication Aids for Disabled ; Cranial Nerves ; Eye ; Eyelids ; Humans ; Mutism ; Paralysis ; Quadriplegia ; Stroke