Spasticity has been defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflex (muscle tone). Muscle tone consists of mechanical-elastic characteristics, reflex muscle contraction and other elements. The aims of this study were to determine whether to assess spasticity quantitatively, and to characterize biomechanical and electromyographic spasticity assessment parameters. These assessment parameters were described by investigating the correlation between clinical measures and the response to passive sinusoidal movement with consecutive velocity increments. Twenty post-stroke hemiplegic patients and twenty normal healthy volunteers were included in the study. Five consecutive sinusoidal passive movements of the ankle were performed at specific velocities (60, 120, 180, and 240 degrees/ sec). We recorded the peak torque, work, and threshold angle using a computerized isokinetic dynamometer, and simultaneously measured the rectified integrated electromyographic activity. We compared these parameters both between groups and between different velocities. The peak torque, threshold angle, work, and rectified integrated electromyographic activity were significantly higher in the post-stroke spastic group at all angular velocities than in the normal control group. The threshold angle and integrated electromyographic activity increased significantly and linearly as angular velocity increased, but the peak torque and work were not increased in the post-stroke spastic group. Peak torque, work, and threshold angle were significantly correlated to the Modified Ashworth scale, but the integrated electromyographic activity was not. The biomechanical and electromyographic approach may be useful to quantitatively assess spasticity. However, it may also be very important to consider the different characteristics of each biomechanical parameter.
Adult ; Aged ; Ankle/*physiopathology ; Biomechanics ; Cerebrovascular Accident/*physiopathology ; Electromyography ; Female ; Humans ; Male ; Middle Aged ; Muscle Spasticity/*physiopathology ; Regression Analysis ; Research Support, Non-U.S. Gov't ; Torque

OBJECTIVE: Spinal epiduroscopy has been introduced. Thus, we herein present low back pain patients with variable duration of herniated intervertebral disc (HIVD), spinal stenosis and failed back surgery syndrome to determine and analyze the result of spinal epiduroscopy. METHOD: Fifty low back pain patients who enrolled in Bundang CHA rehabilitation center from April 2000 to November 2001 with variable duration of HIVD, spinal stenosis and failed back surgery syndrome were treated with spinal epiduroscopy. The patients were grouped according to the duration and the disease. The efficacy of treatment was assessed with visual analog scale (VAS), Oswestry low back pain (LBP) questionnaire and Pain Disability Index (PDI)before the treatment, at 1 day, 1 week, 3 months and 6 months after the treatment. RESULTS: VAS of all patients after spinal endoscopic epiduroplasty were significantly decreased (p<0.05). PDI of all patients after spinal endoscopic epiduroplasty were significantly decreased (p<0.05). Oswestry LBP questionnaire of all patients after spinal endoscopic epiduroplasty were significantly decreased (p<0.05). CONCLUSION: Spinal endoscopic epiduroplasty is one of the best treatment that can be applied to low back pain patients with variable duration of HIVD, spinal stenosis and failed back surgery syndrome.
Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc ; Low Back Pain* ; Surveys and Questionnaires ; Rehabilitation Centers ; Spinal Stenosis ; Visual Analog Scale

OBJECTIVE: To evaluate the effect of repetitive bilateral arm training with rhythmic auditory cueing (BATRAC) on functional motor performances of the hemiplegic upper limb. METHOD: Twenty four subjects with stroke (12 males, 12 females) were enrolled and classified into two groups, experimental and control group. The control group received conventional rehabilitation therapy while the experimental group received additional BATRAC. The motor function of patient's upper extremity was assessed by Fugl-Meyer Motor Function Assessment (FMA), Manual Function Test (MFT), and Functional Independence Measure (FIM) before the treatment, at 4 weeks and at 6 weeks after begining of the treatment. RESULTS: There were no differences in FMA between two groups before the treatment and the continual improvements in the function at 4 weeks and at 6 weeks after begining of the treatment (p<0.05). Furthermore, the experimental group revealed higher performances in FMA than control group (p<0.05). However, there were no differences in FIM and MFT before the treatment and in the improvements of function after the treatment between two groups (p>0.05). CONCLUSION: BATRAC improves motor performance of the paretic upper extremity and will be useful as an additional tool of improving motor function in patients with stroke.
Arm* ; Cues* ; Humans ; Male ; Rehabilitation ; Stroke* ; Upper Extremity

OBJECTIVE: The purpose of this study were to investigate the temporospatial, kinematic data and energy consumption in hemiplegic patients according to the types of ankle-foot orthosis (AFO), and to determine the most effective type of AFO for gait training. METHOD: A prospective study was performed for 10 patients with hemiplegia who was able to walk independently at indoor level. The temporospatial, kinematic data and energy consumption were compared in each five different conditions: 1) barefoot, 2) donning AFO with posterior leaf spring (PLS), 3) donning PLS with the distal part of metatarsal head trimmed off (PLS-C), 4) donning hinged PLS (HPLS), 5) donning hinged PLS with the distal part of metatarsal head trimmed off (HPLS-C). RESULTS: With four types of PLS, maximal ankle plantar flexion was significantly decreased, however we didn't find any difference in kinematic data of the pelvis and hip as compared with barefoot and with PLS, HPLS, HPLS-C and maximal knee extension angle was significantly decreased compared with barefoot. With HPLS-C, cadence and walking speed significantly increased and double support time and oxygen cost significantly decreased as compared with barefoot. CONCLUSION: This study showed increased walking speed, decreased energy cost and improvedgait pattern after donning HPLS-C especially in hemiplegic patients. So HPLS-C may be effective in hemiplegic patients for gait training.
Ankle* ; Foot Orthoses* ; Foot* ; Gait Disorders, Neurologic ; Gait* ; Head ; Hemiplegia ; Hip ; Humans ; Knee ; Metatarsal Bones ; Orthotic Devices ; Oxygen ; Pelvis ; Plastics* ; Prospective Studies ; Walking

OBJECTIVE: The purpose of this study was to investigate the effect of dietary soluble fibers added to nasogastric tube-fed formulas and to compare the difference of the degree of diarrhea according to the amount of dietary soluble fibers in stroke or traumatic brain injury patients for comprehensive rehabilitative management. METHOD: Fifty-two stroke or traumatic brain injury patients fed by nasogastric tube due to dysphagia were included. They received fiber-free formulas for the first 30 days and then they were randomly assigned to three groups, including the control (fiber-free) group, moderate fiber (3.5 gm fiber/L) group and high fiber (7 gm fiber/L) group. Each group received their respective formulas for the next 30 days. We compared diarrhea score and frequency. RESULTS: In the control group, the degree of diarrhea was not changed with time. In the moderate and high fiber groups, daily diarrhea score and monthly diarrhea frequency were low compared to the control group (p<0.05). Also, the incidence of pseudomembraneous colitis was low in fiber groups. CONCLUSION: We concluded that adding dietary soluble fibers to nasogastric tube-fed formulas may be helpful to reduce the diarrhea and the development of pseudomembraneous colitis. The proper fiber amount will be determined through the following more case studies.
Brain Injuries* ; Colitis ; Deglutition Disorders ; Diarrhea* ; Humans ; Incidence ; Stroke*

OBJECTIVE: The purpose of this study was to evaluate the prognostic value of sleep apnea syndrome in stroke patients by polysomnography. METHOD: Fifteen patients with ischemic stroke were studied with polysomnography. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded. Patients were observed by physician for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Modified Barthel Index (MBI). To evaluate the autonomic nervous system, heart rate variability (HRV) study was done. RESULTS: Mean SaO2 during polysomnography was 88.2%, and mean recording time was 321 minutes. Apnea types were obstructive, mixed, and central. Respiratory Distress Index (RDI) correlated with functional outcome and mean SaO2. HRV study showed no significant changes under the orthostatic stress in apnea patients. CONCLUSION: We concluded that the sleep apnea syndrome could be a prognostic factor in rehabilitation outcome of stroke.
Apnea ; Autonomic Nervous System ; Heart Rate ; Humans ; Polysomnography ; Prognosis* ; Sleep Apnea Syndromes* ; Snoring ; Stroke* ; Treatment Outcome

OBJECTIVE: The ability to get up from a chair is an important component in maintaining independence and a prerequisite for upright mobility for stroke patients. The purpose of this study was to compare the sit-to-stand movement in stroke patients with that in healthy adult. METHOD: Twenty-three stroke patients and thirty-seven young healthy subjects were included in this study. Subjects sat on an adjustable chair with their feet on force plates and performed the standing up movement at a self-paced, comfortable speed. The study patients were tested barefoot. The changes in joint angle, maximal moment, power, and ground reaction force in lower limb were calculated using 3 dimensional motion analyzer throughout the sit-to-stand transfer. RESULTS: The mean time needed was significantly longer in stroke patients than in young healthy subjects. Pelvic tilting and hip flexion angle at initial and final angle were significantly greater in stroke patients than in young healthy subjects. Maximal momentum, power and change of ground reaction force in ankle joint were significantly lower in stroke patients than in young healthy subjects. Hip external rotation angle at standing point showed significant correlation with maximal hip external rotation and slow walking speed during the comfortable walking. CONCLUSION: We concluded that the analysis of sit-to-stand movement in stroke patients may provide a useful guide for gait recovery and training.
Adult ; Ankle Joint ; Foot ; Gait ; Hip ; Humans ; Joints ; Lower Extremity ; Stroke* ; Walking

OBJECTIVE: To investigate the autonomic activities in spinal cord injured patients, and to compare their activities according to the level and completeness of spinal cord lesions. METHOD: Thirty-five spinal cord injured patients and thirty healthy adults participated in this study. The ECG signals were recorded at the tilt angle of 0o and 70o for 5 minutes, and power spectral analysis of Heart Rate Variability (HRV) was done at each angle. RESULTS: The data reveals two major components such as a low-frequency (LF) component (0.05~0.15 Hz) reflecting primarily sympathetic activities with orthostatic stress, and a high- frequency (HF) component (0.2~0.3 Hz) reflecting parasympathetic activity. In supine position, all frequency components were not significantly different regardless the level and completeness of spinal cord lesion. At 70o head-up tilt position, the LF power and heart rate didn't increase in complete tetraplegia but significantly increased in paraplegia and healthy adults (p<0.05). However, the HF power didn't reveal any differences in four groups by decreasing significantly in all groups. CONCLUSION: We concluded that there is an abnormal control of autonomic activities especially the sympathetic function in complete tetraiplegia, compared with paraplegia and healthy adults.
Adult ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Paraplegia ; Quadriplegia ; Spinal Cord Injuries ; Spinal Cord* ; Supine Position

OBJECTIVE: To examine the correlation between bone mineral density and intervertebral disc degeneration through retrospective study. METHOD: Bone mineral density (BMD) and Magnetic resonance (MR) image of lumbar spine from 61 postmenopausal women were assessed to examine the correlation between bone mineral density and intervertebral disc degeneration. We determined BMD of lumbar spine using the dual energy X-ray absorptiometry (DEXA). And we evaluated signal intensity of intervertebral disc, disc height and disc herniation at each lumbar disc level using the MR image. The correlation between BMD (mean value of 2nd, 3rd and 4th lumbar spine BMD) and the sum of grading scores of intervertebral disc degeneration was assessed in all the patients. RESULTS: There was a positive correlation between BMD of lumbar spine and the sum of grading scores of intervertebral disc degeneration (r=0.415, p value=0.00087). CONCLUSION: Bone mineral density has an inverse correlation to intervertebral disc degeneration and which is important when considering degenerative spinal disease and osteoporosis.
Absorptiometry, Photon ; Bone Density* ; Female ; Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration* ; Osteoporosis ; Retrospective Studies ; Spinal Diseases ; Spine

The purpose of this study is to compare the effectiveness of the Rolyan, hemisling, remodified Bobath, and the newly designed triangular Bobath slings. Sixteen patients with a shoulder subluxation were evaluated by the simple shoulder AP X-rays with and without slings. The hemisling was applied with the elbow flexed at 90 and 120 degrees. The radiologic evaluation for the detection of shoulder subluxation was done by measuring the vertical and horizontal displacement on a plain AP view. The mean value of vertical displacement without a sling application was 5.21 cm which was reduced to 4.30 cm by a triangular Bobath sling application and 4.32 cm by a hemisling application at 120degrees elbow flexion. These two slings significantly corrected the vertical displacement, but other were not. In nine of sixteen patients, the triangular Bobath sling was the best sling for the vertical correction. All slings except a hemisling increased the horizontal displacement even though it was not statistically significant. The triangular Bobath sling improved the discomfort of the axilla better than the remodified Bobath sling. The results support that the triangular Bobath sling was the best among 4 slings for the correction of shoulder subluxation, although a reduction in lateral displacement and an improvement in applicability need to be explored further.
Axilla ; Elbow ; Hemiplegia* ; Humans ; Shoulder*