OBJECTIVE: To evaluate exercise capacity of subacute stroke patients with nonambulatory exercise stress test and to determine whether reduced exercise efficiency is associated with functional performance. METHOD: Experimental design was prospective and observational study. Eighteen patients with moderate to severe impairment after recent stroke performed exercise stress test by repeated knee flexion and extension exercise using isokinetic dynamometer. Work rate, oxygen consumption, heart rate were assessed during exercise stress test. The dynamic response, the ratio of change in oxygen uptake to change in work rate, was measured for correlation with FIM (Functional Independence Measure) scores. Occupational therapist recorded FIM scores on the day of transfer to inpatient rehabilitation unit and on discharge. Age-matched healthy group also performed exercise stress test in same settings. RESULTS: The patients group who had similar dynamic response with age-matched healthy group showed higher FIM scores than the patients group having higher dynamic response. CONCLUSION: Nonambulatory exercise stress test could be effectively used in subacute stroke patients and the ratio of change in oxygen uptake to change in work rate was a useful variable to reveal low exercise efficiency in subacute stroke patients who had a abnormal skeletal muscle metabolic capacity.
Exercise Test ; Heart Rate ; Humans ; Inpatients ; Knee ; Muscle, Skeletal ; Observational Study ; Oxygen Consumption ; Oxygen* ; Prospective Studies ; Rehabilitation ; Research Design ; Stroke*

OBJECTIVE: To investigate the effect of conditioned ischemic stresses on NF-kappaB activities and the protective role of genistein in rat skeletal muscle. METHOD: Rectus femoris muscles of rats were divided into 4 groups according to conditioned ischemic stresses as followings: sham-operated control group; 2 hour ischemia group by clamping the proximal femoral vessel; ischemia-reperfusion group by 30 minutes of reperfusion following 2 hours of ischemia; ischemia-reperfusion-electrical nerve stimulation group in which current was applied at the femoral nerve during 30 min of reperfusion period to induce repetitive muscle contraction. Either genistein-5% dimethyl sulfoxide (DMSO) or DMSO was injected 2 hours before ischemic induction. NF-kappaB activities were analysed by electrophoretic mobility shift assay. RESULTS: NF-kappaB activities pretreated with DMSO were significantly increased in ischemia, ischemia-reperfusion and ischemia-reperfusion-electrical nerve stimulation group compared with those of control group and in ischemia-reperfusion-electrical nerve stimulation group compared with those of ischemia group. Muscle edema was increased in ischemia-reperfusion-electrical nerve stimulation group. But, NF-kappa activities and muscle edema pretreated with genistein were attenuated in ischemia-reperfusion-electrical nerve stimulation group compared with those pretreated with DMSO alone. CONCLUSION: NF-kappaB activities reflect the severity of ischemic stresses. Pretreatment with genistein can attenuate NF-kappa activities and muscle edema in ischemic stress of rat skeletal muscle.
Animals ; Constriction ; Dimethyl Sulfoxide ; Edema ; Electric Stimulation ; Electrophoretic Mobility Shift Assay ; Femoral Nerve ; Genistein ; Ischemia ; Muscle Contraction ; Muscle, Skeletal* ; Muscles ; NF-kappa B* ; Quadriceps Muscle ; Rats* ; Reperfusion

Organophosphate is known to damage both the peripheral and central nervous system. We report a case of organophosphate-induced peripheral polyneuropathy with myelopathy. A 46 years old woman who had ingested a large amount of insecticide (organophosphate) was transported to our hospital. Following medical treatment, she was transferred to the Department of Rehabilitation Medicine 1 month later. Upon admission to rehabilitation medicine, the patient was quadriplegic with markedly decreased muscle tone and strength. Electrodiagnostic examination revealed low amplitude of sensory nerve action potential (SNAP), unevokable compound muscle action potential in distal muscles and abnormal spontaneous activities with needle electromyography, which were compatible with peripheral polyneuropathy. Three months later, motor and sensory function of upper extremities were normalized. The muscle tone of lower extremity increased to Ashworth grade II. Follow-up electrodiagnostic examination revealed normalization of SNAP and disappearance of spontaneous activities, but somatosensory evoked potential which were initially normal, revealed prolonged P40 latencies in the lower extremities. These electrophysiological findings were thought to result from the spinal cord lesion and correlated with clinical findings. We diagnosed the patient as peripheral polyneuropathy with delayed myelopathy induced by organophosphate.
Action Potentials ; Central Nervous System ; Electromyography ; Evoked Potentials, Somatosensory ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Middle Aged ; Muscle Hypotonia ; Muscles ; Needles ; Polyneuropathies* ; Rehabilitation ; Sensation ; Spinal Cord ; Spinal Cord Diseases* ; Upper Extremity

OBJECTIVE: To measure anterior displacement of the humeral head and to observe its relationship with clinical findings in the subluxed hemiplegic shoulders. METHOD: Seventeen hemiplegic patients, having the subluxed shoulder over one finger breadth were subjected. We measured shoulder pain, muscle power of the shoulder abductors, Brunnstrom stage and spasticity in the affected upper extremity. To measure the humeral displacement of the shoulder subluxation, the AP and transthoracic lateral views of simple radiologic picture were taken on both affected and unaffected shoulders, and repeated after donning three kinds of arm slings. RESULTS: Its anterior displacement as well as the inferior displacement occured in all subjects, and was significantly related with the value of shoulder pain and spasticity, and the inferior displacement with Brunnstrom stage and muscle power of the shoulder abductors in the subluxed hemiplegic shoulder (p<0.05). Correction of the humeral displacement occured significantly in anterior direction as well as inferior by use of all tested arm slings. CONCLUSION: Clinical implications of the shoulder subluxation were different according to direction of the humeral displacement, and anterior displacement will be considered for its symptom in hemiplegic shoulder.
Arm ; Fingers ; Hemiplegia ; Humans ; Humeral Head* ; Muscle Spasticity ; Shoulder Pain ; Shoulder* ; Upper Extremity

OBJECTIVE: Post-stroke dysphagia occurs in the form of lingual discoordination, pharyngeal dysmotility, and delayed swallowing reflex. The purpose of this study is to define the pattern of post-stroke swallowing disorder according to the location of brain lesion. METHOD: Thirty-nine post-stroke patients and ten normal persons participated to perform the videofluoroscopic swallowing study (VFSS) with fluid and semisolid gastrograffin. Brain lesions were classified by cortical, subcortical, or brainstem groups and by the involved hemisphere. RESULTS: There was no difference of swallowing pattern between the cortical and subcortical lesions. However patients with brainstem lesion more frequently showed incomplete laryngeal elevation, prolonged pharyngeal transit time, failure of cricopharyngeal muscle relaxation, and aspiration than with cortical and subcortical lesions (p<0.01). In the patients with cortical and subcortical lesions, aspiration occurred before the laryngeal elevation due to discoordination of laryngopharynx. Whereas in the brainstem lesion, aspiration occurred after the laryngeal elevation due to incomplete laryngeal closure. Premature posterior spillage (p<0.05), poor laryngeal elevation(p<0.05), and tracheal aspiration (p<0.01) were more frequently seen in the patients with right hemispheric dysfunction than the left. CONCLUSION: Discoordination of the tongue, oropharynx, and laryngopharynx is predominant in the cortical and subcortical lesion, whereas incomplete laryngeal closure and failure of cricopharyngeal muscle relaxation are predominant in the brianstem lesion.
Brain Stem ; Brain* ; Deglutition Disorders* ; Deglutition* ; Diatrizoate Meglumine ; Humans ; Hypopharynx ; Muscle Relaxation ; Oropharynx ; Reflex ; Stroke ; Tongue

OBJECTIVE: This study was proposed to evaluate the electrophysiologic changes in central motor conduction and in silent period (SP) after paraspinal transcutaneous electrical stimulation near caudal area of the spinal cord. METHOD: Conditioning stimulation was applied to T12 paraspinal area for 20 minutes using interferential current therapy (80~100 Hz) in 11 healthy subjects. The amplitude and latency of central motor conduction and duration of SP were measured in motor evoked potential (MEPs) by using magnetic stimulator, before and after the conditioning stimulation. These variables were recorded in both tibialis anterior muscle, innervated from stimulated spinal area, and both abductor pollicis brevis, innervated from cervical cord not directly stimulated by electrical stimulation. RESULTS: After conditioning stimulation, the amplitudes of central motor conduction decreased (p<0.01), and the latencies did not change in both cervical and lumbar muscles in transcranial and spinal MEP studies, and the duration of SP was decreased in same manner (p<0.01). CONCLUSION: These results mean that the excitability of anterior horn cells decreases and the supraspinal inhibitory mechanism of the central motor conduction is suppressed by a certain conditioned electrical cutaneous stimulation in entire spinal cord.
Anterior Horn Cells* ; Electric Stimulation* ; Evoked Potentials, Motor ; Muscles ; Spinal Cord ; Transcutaneous Electric Nerve Stimulation

OBJECTIVE: The purpose of this study was to investigate the dose-dependent responses to botulinum toxin A (BTX-A) injection on compound muscle action potential (CMAP) amplitude and needle electromyography (EMG) in local and distant muscles. METHOD: The BTX-A (Botox , Allergan Co.) was injected to the left tibialis anterior (TA): 2, 4, 6, 8 U for each 4 Sprague-Dawley rats; 5, 10, 15, 20 U for each 2 rats. The sciatic nerve conduction and needle EMG were performed in the right and left TA immediately before BTX-A injection, on 2 days after injection, weekly for 1 to 10 weeks, and then monthly for 4 months. RESULTS: The range of dose-dependent maximal paralysis of the injected muscle was from 94% to 99.2% on 7 days after injection. With the lapse of time, the amplitudes in the left sciatic nerve conduction recovered, the abnormal spontaneous activities disappeared, and the power in spectral analysis of motor unit action potential increased. The range of dose-dependent reductions of the CMAP amplitude of the right TA was from 41.8% to 69.9% in the distant muscle, but there was no abnormal spontaneous activity in needle EMG study. As higher doses of BTX-A were injected, the degree of amplitude reduction became larger and the duration of amplitude reduction became longer in both local and distant TA muscles. CONCLUSION: We observed the dose-dependent muscle paralysis with injection of BTX-A. The systemic effects by local injection were induced and the durations of local and systemic effects were proportional to the BTX-A dosage.
Action Potentials* ; Animals ; Botulinum Toxins* ; Electromyography* ; Muscles ; Needles ; Paralysis ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve

OBJECTIVE: In patients with a history of acute paralytic poliomyelitis, late progressive muscle weakness, fatigue, pain may arise, a symptom complex of known as post-poliomyelitis syndrome (PPS). Dysphagia may also develop in some PPS patients. The purpose of this study was to assess the presence of is swallowing difficulty in polio survivors and to describe the nature of the swallowing difficulty. METHOD: Polio survivors answered the questionnaire pertaining to swallowing function and received a videofluroscopic evaluation of the oral and pharyngeal phases using 3 consistencies of material: liquid barium; semisolid barium paste; boiled yolk of an egg coated with barium. RESULTS: Of the 16 subjects, 8 had subjective symptoms of swallowing difficulties. All of the 6 PPS patients, regardless of whether they had symptoms of swallowing difficulties, had some abnormal oropharyngeal function through video fluoroscopic swallowing study. CONCLUSION: In patients with post-polio syndrome, there is progressive deterioration of swallowing functions similar to that in the muscles of the limbs. This swallowing dysfunction is not related with their subjective symptoms.
Barium ; Deglutition Disorders ; Deglutition* ; Extremities ; Fatigue ; Humans ; Muscle Weakness ; Muscles ; Ovum ; Poliomyelitis* ; Postpoliomyelitis Syndrome ; Surveys and Questionnaires ; Survivors*

OBJECTIVE: This study was performed to evaluate the prevalence of new neuromuscular symptoms and disabilities and the psychological characteristics-depressioin, anxiety, type A behavior, loneliness, and also to determine any relationships between physical and neuropsychological characteristics in a group of post-polio syndrome (PPS). METHOD: By 70 answered questionnaire, the polio survivors were grouped into PPS and Non- PPS. This questionnaire consisted of questions about acute polio problems; new health problems, fatigue severity scale, visual analog scale, weakness scale, Frenchay activity index, ambulation disability index; socio-economic problems; neuro-psychological inventories, Beck depression index, Spielberger state-trait anxiety inventory, revised UCLA loneliness scale, type A personality score. RESULTS: The median time from polio to the onset of new health problems was 27.6 years. Fatigue, muscle and/or joint pain, weakness in previously affected and unaffected muscles were most common newly appearing problems. The symptoms of PPS was consistent with the distribution of the anterior horn cell; spinal cord, brain stem, cerebral hemisphere, Reticular Activating System (RAS). Neuro-psychological evaluations revealed that fatigue scale was correlated with depression, type A personality. CONCLUSION: In PPS group, pain, weakness, fatigue, autonomous symptoms, decreased concentration were more serious than in Non-PPS group. The fatigue in PPS group was correlated with type A personality, depression, sleep disturbance and concentration problem.
Anterior Horn Cells ; Anxiety ; Arthralgia ; Brain Stem ; Cerebrum ; Depression ; Equipment and Supplies ; Fatigue ; Humans ; Korea* ; Loneliness ; Muscle Fatigue ; Muscles ; Poliomyelitis ; Postpoliomyelitis Syndrome* ; Prevalence ; Surveys and Questionnaires ; Spinal Cord ; Survivors ; Type A Personality ; Visual Analog Scale ; Walking

OBJECTIVE: To evaluate the relationship of the respiration patterns and the abdominal muscle activities during various speech productions in the adults with athetoid cerebral palsy (CP). METHOD: Subjects were 7 athetoid CPs and 7 healthy controls. Respirography and abdominal muscle activities were recorded by use of the pneumobelt and the surface EMG during their performances of six kinds of non-speech and speech tasks. RESULTS: The followings were observed in the athetoid CP. 1) Respiratory phase was irregular and variable in the intensity and period of revolution. The frequency of the respiratory phase was not different from the control in usual respiration, but higher in deep breathing. The time to persist one vowel phonation was shorter. 2) Inappropriate and frequent inspirations were occurred during speech task and the number of syllables was fewer and irregular for one speech breath. 3) The abdominal muscle activities were abrupt, irregular, inconsistent with the respiratory phase during all kinds of non-speech and speech tasks. CONCLUSION: These findings suggest that the abnormal respiration patterns and abdominal muscle activities contribute to the abnormal speech production of athetoid CP and their incoordination is similar to athetoid movement of the extremities. We should consider the athetoid speech production as well as the dysarthria in the athetoid CP.
Abdominal Muscles* ; Adult ; Ataxia ; Athetosis ; Cerebral Palsy ; Dysarthria ; Extremities ; Humans ; Phonation ; Respiration*