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Obturator Nerve Block Using Ultrasound-guided Intraneural Alcohol Injection in Patient with Hip Adductor Spasticity.

Seung Deuk BYUN ; Dong Hwi PARK ; Won Duck CHOI ; Yong Ho HONG ; Zee Ihn LEE ; Chul Hyun KIM

Brain & Neurorehabilitation.2012;5(2):82-86. doi:10.12786/bn.2012.5.2.82

OBJECTIVE: To investigate the effects of obturator nerve blocks with ultrasound guided intraneural alcohol injection. METHOD: Nine quadriplegic patients suffering hip adductor spasticity were included in this study. The obturator nerve was identified at just below inguinal ligament area on anteromedial surface of upper leg at supine position. An 23 G needle was inserted into anterior branch of obturator nerve under real time ultrasonography. The 50% alcohol solution was injected 3~5 ml at a time within the epineurium of the anterior branch of obturator nerve until the expanding nerve was visualized. We examed modified Ashworth scale (MAS) of hip adductor and passive range of movement of hip abduction at supine position at study entry, 1, 4, and 12 weeks after ultrasound guided intraneural injection. RESULTS: There were statistically significant improvement was seen in MAS of hip adductors and hip abduction angle at 1, 4, and 12 weeks after ultrasound guided intraneural injection, compared with parameters measured at previous injection (p<0.05). CONCLUSION: Ultrasound guided intraneural alcohol injection into anterior branch of obturator nerve for treatment of hip adductor spasticity in patients with quadriplegia is an effective and safe procedure for relieving localized spasticity of the hip adductors.
Hip ; Humans ; Leg ; Ligaments ; Muscle Spasticity ; Needles ; Obturator Nerve ; Peripheral Nerves ; Quadriplegia ; Stress, Psychological ; Supine Position

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Efficacy and Safety of Solifenacin Succinate for Urinary Difficulty in Brain Lesion: Multicenter Prospective Study.

Soo Kyung BOK ; Jun Ho LIM ; Kang Hee CHO ; Eun Seok CHOI ; Sang Soo KIM ; Young Jin LEE ; Noh Kyung PARK

Brain & Neurorehabilitation.2012;5(2):75-81. doi:10.12786/bn.2012.5.2.75

OBJECTIVE: We studied the efficacy and safety of solifenacin for urinary difficulty in brain lesion from multicenter prospective study. METHOD: Eighty patients with brain lesion who visited from 5 multicenter department of rehabilitation medicine from May 2009 to June 2010 were included. Patients were treated with solifenacin 5 mg to 10 mg for 12 weeks. The outcome measure was mean change in daily micturation frequency, daily frequency of incontinence, urgency episodes, and nocturia episodes from baseline to week 12. Patient's attitude to drug was assessed using the BSW Questionnaire (Benefit, Satisfaction and Willingness to Continue Questions). RESULTS: Sixty-one of 80 were evaluated for effect. All voiding parameters showed significant improvement after 12 weeks of treatment (p<0.05). There was no significant difference in efficacy of solifenacin between ischemic and hemorrhagic stroke. A twenty-two patients experienced 27 adverse events (AE). The most frequent AE were dry mouth (12.5%) and constipation (6.3%). Treatment related adverse events with solifenacin were mainly mild in severity, and only led to discontinuation in 6.3% of patients. CONCLUSION: Solifenacin succinate improve urinary difficulty symptoms with acceptable efficacy and safety in patient with brain lesion.
Brain ; Brain Injuries ; Constipation ; Humans ; Mouth ; Nocturia ; Outcome Assessment (Health Care) ; Prospective Studies ; Quinuclidines ; Stroke ; Succinic Acid ; Tetrahydroisoquinolines ; Solifenacin Succinate ; Surveys and Questionnaires

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Survey on Clinical Application of 'Neurodevelopmental Treatment'.

Minyoung KIM ; Ju Seok RYU ; Myeong Ok KIM ; Dong Hwan YUN ; Seong Eun KOH ; Geun Young PARK ; Sung Bom PYUN ; Eun Joo KIM ; Han Young JUNG

Brain & Neurorehabilitation.2012;5(2):68-74. doi:10.12786/bn.2012.5.2.68

OBJECTIVE: To investigate the recognition about clinical application of "neurodevelopmental treatment (NDT)". METHOD: We surveyed on the recognition for Bobath and NDT concepts and its training programs provided by Korean Academy of Rehabilitation Medicine from Jan 2009 to Feb 2009. The survey was made for physiatrists and physical therapists (PTs), separately. One hundred twelve physiatrists and 322 PTs have participated. RESULTS: In physiatrist, interest in NDT was very high (98%), and the need for further knowledge of NDT was also high (95%). Though the NDT was mainly used techniques in neuro-rehabilitation setting, the expectation about effectiveness of it was moderate (56%) and the requirement of changing concepts of the NDT was very high (93%). PTs have carried out NDT most frequently with Bobath's concepts, but they also did not regard NDT as the best procedure. PTs emphasized the importance of their handling technique in NDT practices and also had high interest in the other maneuvers beside Bobath's. CONCLUSION: Physiatrists and PTs regard NDT as one of the most important treating method for patients with brain lesions, but it is not approved as the most effective method yet. Nowadays NDT is changing or adapting, with discarding some of the old Bobath's concepts and adding new modern scientific knowledge. Therefore we suggest that physiatrists to give PTs the revised NDT concepts and evidence based the other therapeutic methods. And the NDT needs to be verified its therapeutic efficacy with evidence based view points through proper studies.
Brain ; Handling (Psychology) ; Humans ; Physical Therapists

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Complications of Traumatic Brain Injury: Post-traumatic Headache and Epilepsy.

Jae Hyeok CHANG

Brain & Neurorehabilitation.2012;5(2):62-67. doi:10.12786/bn.2012.5.2.62

Posttraumatic headache (PTH) is one of several complications of traumatic brain injury (TBI). PTH usually resolving within the first 3 months, although a minority develop chronic headaches. PTH remains among the most controversial headache topics to its propensity for chronicity and often associated additional cognitive, behavioral, and somatic problems. Sufficient psychological or neurobiological markers for PTH do no exist, thus treatment can be very challenging and should always be multidisciplinary to make every reasonable effort in preventing the development of chronic pain. Posttraumatic seizure or epilepsy (PTE) is defined as a recurrent seizure disorder due to traumatic brain injury. PTE can be divided into three groups: immediate, early and late seizures. Immediate and early seizures are provoked seizures, whereas late seizure is unprovoked seizure. The effects of antiepileptic drugs (AED) in patients with TBI must be assessed separately in terms of prevention and control of provoked seizures and prevention of subsequent unprovoked seizures. Routine preventive AEDs are not indicated for patients with TBI and the effects are controversy.
Anticonvulsants ; Brain ; Brain Injuries ; Chronic Pain ; Epilepsy ; Headache ; Headache Disorders ; Humans ; Post-Traumatic Headache ; Seizures

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Autonomic Dysfunction after Traumatic Brain Injury.

Soo Kyung BOK

Brain & Neurorehabilitation.2012;5(2):58-61. doi:10.12786/bn.2012.5.2.58

Patients following traumatic brain injury (TBI) sometimes display paroxysmal autonomic and muscle overactivity, which is suspicious to self-limiting or permanent disability. There are still no standard definition and diagnostic tools for autonomic dysfunction after TBI. Dysautonomia has been used as the most dominant term by authors of papers, was defined as simultaneous paroxysmal increases in at least five out of the seven features (heart rate, respiratory rate, blood pressure, temperature, posturing, dystonia and sweating) with episodes persisting for at least 2 weeks after injury. Heart rate variability (HRV) may be helpful to diagnosis the dysautonomia. The available evidence for managing of dysautonomia was intravenous morphine, Gabapentin, Bromocriptine and intrathecal baclofen infusion. Therefore, future efforts should be targeted at multicenter, large sample studies to make the diagnostic criteria and to evaluate the incidence, natural history and management of autonomic dysfunction after TBI.
Amines ; Baclofen ; Blood Pressure ; Brain Injuries ; Bromocriptine ; Cyclohexanecarboxylic Acids ; Dystonia ; gamma-Aminobutyric Acid ; Heart Rate ; Humans ; Incidence ; Morphine ; Muscles ; Natural History ; Primary Dysautonomias ; Respiratory Rate

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Endocrinologic Complications after Traumatic Brain Injury.

Jaewon BEOM ; Byung Mo OH

Brain & Neurorehabilitation.2012;5(2):52-57. doi:10.12786/bn.2012.5.2.52

The endocrinologic complications such as adrenal insufficiency and hypopituitarism are common after traumatic brain injury (TBI) portending poor rehabilitation outcome. Anterior pituitary dysfunction presents as hypothyroidism, hypogonadism, growth hormone deficiency, adrenal insufficiency and hyperprolactinemia, whereas posterior pituitary dysfunction includes syndrome of inappropriate antidiuretic hormone and central diabetes insipidus. Careful history taking and physical examination are essential to detect these abnormalities early. Laboratory tests such as serum/urine sodium and osmolality, thyroid hormone, testosterone, estradiol, cortisol, prolactin, growth hormone or IGF-1 are also necessary. Screening of endocrinologic functions is recommended especially in patients with moderate or severe TBI, skull base fracture or diffuse axonal injury 3 to 6 months after injury. Further studies are needed to reveal the effect of early correction of endocrinologic abnormality on long-term functional outcome.
Adrenal Insufficiency ; Brain Injuries ; Diabetes Insipidus, Neurogenic ; Diffuse Axonal Injury ; Endocrine System Diseases ; Estradiol ; Growth Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Hypogonadism ; Hypopituitarism ; Hypothyroidism ; Insulin-Like Growth Factor I ; Mass Screening ; Osmolar Concentration ; Physical Examination ; Prolactin ; Skull Base ; Sodium ; Testosterone ; Thyroid Gland ; Treatment Outcome

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Movement Disorders after Traumatic Brain Injury.

Yong Wook KIM ; June Yop KIM ; Dong Jin KOH

Brain & Neurorehabilitation.2012;5(2):47-51. doi:10.12786/bn.2012.5.2.47

Traumatic brain injury can cause movement disorders such as tremor, dystonia, myoclonus, parkinsonism and chorea. After the severe traumatic brain injury, movement disorders have been reported in 13 to 66% of patients and 20% of cases combined with weakness, spasticity, cognitive impairment and ataxia. Postural/kinetic tremor, which is the most common type of movement disorder after traumatic brain injury, may be transient or persistent however the other syndromes tend to persist and produce significant impairment in activity of daily living. The symptomatic relief can generally be achieved with medical treatment and some cases with neurosurgical intervention such as functional stereotactic surgery or deep brain stimulation. This article reviews the epidemiology, underlying mechanism, the type and treatment of movement disorders follow traumatic brain injury.
Ataxia ; Brain Injuries ; Chorea ; Deep Brain Stimulation ; Dystonia ; Humans ; Movement Disorders ; Muscle Spasticity ; Myoclonus ; Parkinsonian Disorders ; Tremor

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Cognitive Assessment in Traumatic Brain Injury.

Seong Hye CHOI

Brain & Neurorehabilitation.2008;1(2):148-154. doi:10.12786/bn.2008.1.2.148

Neurobehavioral deficits, especially in cognition, are often the cause of significant disability after traumatic brain injury (TBI). A thorough evaluation of cognitive function is needed before an effective cognitive rehabilitation. Common cognitive changes that follow TBI include impaired attention, psychomotor slowing, executive dysfunction, and impairment in working memory. The Seoul Neuropsychological Screening Battery (SNSB), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog) can be used to evaluate the multiple cognitive domains in TBI. Wisconsin Card Sorting Test, Frontal Assessment Battery, Trail making test, Digit-symbol test and symbol-digit test are useful to detect mild cognitive impairment in the TBI patients who have subjective cognitive impairment and no abnormality on routine neuropsychological tests. Tests of psychomotor speed and executive function are sensitive to TBI. Computerized neurocognitive testing can be administered to measure relatively mild degrees of neurocognitive impairment in TBI.

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Emerging Therapies in Vegetative and Minimally Conscious State after Brain Injury.

Yong Il SHIN ; Jin Ho CHO

Brain & Neurorehabilitation.2008;1(2):143-147. doi:10.12786/bn.2008.1.2.143

The practice of coma arousal and brain stimulation in vegetative state or minimally conscious state is becoming the focus of heated debate. There is no definite theory on which patients may benefit, at what time in their recovery, or how the 'arousal' or 'stimulation' procedures should be applied. In this review, old and new therapeutic methods for recovery of vegetative state or minimally conscious state will discussed. And we consider some of the information processing mechanisms that are important mediators of arousal and awareness in current practices.

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Controversies in Acute Care of Patients with Severe Traumatic Brain Injury.

Jeong Eun KIM ; Jung Cheol PARK ; Hyun Seung KANG ; Chang Wan OH

Brain & Neurorehabilitation.2008;1(2):136-142. doi:10.12786/bn.2008.1.2.136

Traumatic brain injury (TBI) can be pathophysiologically classified into either primary or secondary injury. It is an important resuscitation to prevent the secondary injury which includes hypoxia, hypotension, cerebral ischemia, and intracranial hypertension, in the acute management of patients with severe TBI. However, many aspects of the proper management are controversial. The authors focused on the management of the secondary brain injury after TBI and categorized the acute care of the patients with severe TBI as generalized management and management of the intracranial hypertension. They reviewed the pertinent literatures using evidence-based approach and showed practical recommendations for each items. With knowledge of this evidence-based management, appropriate management with better outcome may be accomplished in acute staged TBI.

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