Therapeutic Effects of Mechanical Horseback Riding on Gait and Balance Ability in Stroke Patients

OBJECTIVE: To investigate the therapeutic effects of mechanical horseback riding for gait and balance parameters in post-stroke patients. METHOD: This study was a non randomized prospective positive-controlled trial over a 12 week period. From May 2011 to October 2011, 37 stroke patients were recruited from our outpatient clinic and divided into two groups. The control group received the conventional physiotherapy while the intervention group received the conventional physiotherapy along with mechanical horseback riding therapy for 12 weeks. Outcome measurements of gait included the Functional Ambulation Category (FAC) and gait part of the Performance Oriented Mobility Assessment (G-POMA) while those of balance included the Berg Balance Scale (BBS) and the balance part of the Performance Oriented Mobility Assessment (B-POMA). These measurements were taken before and after treatment. RESULTS: There were no significant differences in the baseline characteristics and initial values between the two groups. When comparing baseline and 12 weeks post treatment in each group, the intervention group showed significant improvement on BBS (39.9+/-5.7 --> 45.7+/-4.8, p=0.001) and B-POMA (10.4+/-2.6 --> 12.6+/-2.1, p=0.001), but significant improvement on gait parameters. When comparing the groups, the dynamic balance category of BBS in post treatment showed significant difference (p=0.02). CONCLUSION: This study suggests that mechanical horseback riding therapy may be an effective treatment tool for enhancing balance in adults with stroke.

A Qualitative Analysis of Factors Influencing the Intention of Selecting the Charged Nursing Care Facilities

OBJECTIVE: To provide information of charged nursing care facility for helping to establish geriatric health care policy, and to figure out which factors would be the main determinants for the choice of it. METHOD: 46 males and 53 females, and the same number of their caregivers admitted into the charged nursing care facility were recruited for intensive interview including personal information, disease information, and economic, familial, marital and emotional statuses. This is a cross sectional study and we analyzed the data qualitatively. RESULTS: Patients had 3.2 diseases and a hospitalization for 2.3 years on average. They were consists of 46 singles (46.9%), 8 unmarried (8.2%), 5 divorced (5.1%) and 32 married (32.7%). More than two third (70.1%) were supported by their eldest son or daughter. Mostly, the family caregivers decided to admit into the facilities by the doctor's recommendation (68.4%). When they made a choice for a facility, most of them (42.9%) considered environmental and sanitary conditions. According to their expectation for management in nursing care facility, most caregivers (59.2%) wanted simple-staying for the duration, but most patients (61.3%) expected to be home after taking comprehensive rehabilitation. Three quarter of the caregivers would agree to use nursing care facilities in the future, if they would be the same situation. CONCLUSION: Life style and environment are rapidly changing. In the near future, we need lots of the charged nursing care facilities for the old, thus this study can be the good reference for the preparing upcoming aged and super aged society.

Positioning of Lumbar Facet Joints by Analysis of Surface Anatomy in Korean Adults

OBJECTIVE: To determine the Korean adult standard of mean length and depth from spinous process which is palpable landmark of back to each facet joint. METHOD: The horizontal line was made between the posterior end of each facet joint, and the rectangular line was made on the horizontal line at the level of spinous process, respectively. We measured the length from the point of intersection to the posterior end of each facet joint (SFL), and the depth from the tip of spinous process to the point of intersection (SFD). All parameters were measured in 30 volunteers (Exp. 1) using computed tomography and in 30 cadavers (Exp. 2). RESULTS: The lower lumbar spine revealed the longer SFL (p0.05). There was no correlation with height and weight, either (r<0.04). CONCLUSION: We measured the standard for SFL and SFD in Korean. We suggest that these results will be useful in clinical practice including blind approach of spinal intervention to the facet joints.

Induced Life-Threatening Electrolyte Imbalance in Sub-clinical Hyperthyroidism -A case report-

Thyrotoxic periodic paralysis (TPP) is rare in white Caucasian but a few in Asian. A 36-year-old man presented with suddenly developed paraparesis was brought by ambulance. He got some medications and injection for the upper respiratory infection in the morning of admission day. On admission he revealed bilateral proximal muscle weakness without pain. He didn't have any specific medical history of himself and his family. The laboratory results on admission revealed severe hypokalemia (2.1 mM/l). Potassium replacement was immediately started and his symptom was gone. We found TSH was extremely decreased (<0.005 microIU/ml) but T3 and T4 were within normal level. We guess TPP was induced by some drugs to the patient with sub-clinical hyperthyroidism. Hyperthyroidism is not always clinically apparent and then may be easily missed. However just a single medication or injection that is usually prescribed can induce critical progressive hypokalemia.

A Spontaneous Atlantoaxial Subluxation: A case repor

The atlantoaxial joint has a little stability and is secured and supported chiefly by soft tissue such as ligaments and articular capsule, so it has free motions to all directions. Relaxation or rupture of these supportive structures due to inflammation or trauma may cause instability or subluxation, and it results in compression of the spinal cord and it reveals various neurologic symptoms. The atlantoaxial rotatory subluxation, the rare disease found in children mostly, is known to be one of the reasons of the temporal torticollis in children. An adult type is very rare, but it is possible to be combined with rheumatoid arthritis and/or trauma, but we experienced the 25-year-old female patient who had the atlantoaxial rotatory subluxation spontaneously without rheumatoid arthritis and/or trauma, so we report this case with review of literature.

Ultrasonographic Study of Median Nerve according to Changed Wrist Position

OBJECTIVE: To compare the diagnostic value between Phalen's test and reverse Phalen's test using a morphological change of the median nerve and the carpal tunnel seen by high-resolution ultrasonography and to research on an ultrasonography as an available tool for the screening and follow up aid-test of the carpal tunnel syndrome (CTS). METHOD: A cross-sectional area and a flattening ratio of the median nerve, and a cross-sectional area of the carpal tunnel were measured in neutral, maximally flexed (Phalen's test), and maximally extended (reverse Phalen's test) positions in 59 wrists of 30 normal subjects. RESULT: The cross-sectional area of median nerve was significantly decreased in maximal flexion (p<0.01), and in maximal extension (p<0.01). The mean flattening ratio of median nerve was revealed significant change in maximal flexion (p<0.01), and in maximal extension (p<0.01). The mean cross-sectional area of the carpal tunnel was significantly decreased in maximal flexion (p<0.01), and in maximal extension (p<0.01), with comparing to neutral position, respectively. CONCLUSION: Phalen's test reveals higher degree of irritation to median nerve. The high-resolution ultrasonography is suggested as an available tool for the screening and follow up aid-test for the CTS.

Development of the Automatic Identifying Instrument for the Spinal Epidural Space

OBJECTIVE: To confirm practical usefulness of the newly invented automatic identifying instrument for the spinal epidural space. METHOD: Epidural block with blind approach has been done for the patients who suffered from lower back pain with radiating pain due to spinal disorders. Conventional blind approaches using the glass syringe (control group) and the newly invented instrument (experimental group) were applied to each 30 patients, respectively. Epidurography was used for the confirmation to conclude success or not. RESULTS: Two cases were failed in the control group. One case showed injected contrast media in the interspinal ligament, another case revealed dura-puncture. But there was no failure in the experimental group. The mean timefrom skin-penetration to epidurography was 299.7+/-13.6 second in control group and 184.0+/-16.3 second in experimental group. The mean time from changing to glass syringe (control group) or epidural detector (experimental group) to epidurography was 146.0+/-14.0 second in control group and 60.0+/-7.0 second in experimental group. The time for epidural block was much less in experimental group (p<0.001). CONCLUSION: This newly invented epidural detector could make the epidural block easier, safer, and faster. We suggest this instrument is useful complementary method for spinal epidural procedure.

Ultrasonographic Study of Median Nerve According to Changed Wrist Position in Diabetics and Normal Subjects

BACKGROUND: To compare the diagnostic value between Phalen's test and reverse Phalen's test using a morphological change of the median nerve and the carpal tunnel in diabetics and normal controls seen by high-resolution ultrasonography and to research on an ultrasonography as an available tool for the screening and follow up aid-test of the carpal tunnel syndrome(CTS). METHODS: A cross-sectional area and a flattening ratio of the median nerve, and a cross-sectional area of the carpal tunnel were measured in neutral, maximally flexed(Phalen's test), and maximally extended (reverse Phalen's test) positions in 59 wrists of 30 normal controls and 60 wrists of 30 diabetics. RESULTS: 1) In controls and diabetics, the mean cross-sectional area of median nerve at the hamatum were 8.8/10.2 mm2, 8.0/9.5 mm2, 8.3/9.4 mm2, the mean flattening ratio were 3.0/3.0 mm2, 2.4/2.0 mm2, 3.2/3.0 mm2, the mean cross-sectional area of carpal tunnel were 176.5/197.7 mm2, 157.9/187.0 mm2, 170.6/192.5 mm2 in neutral, maximal flexion and maximal extension. 2) In controls, the cross-sectional area of median nerve and carpal tunnel were significantly decreased in maximal flexion(p<0.01), and in maximal extension(p<0.01). 3) In controls, the mean flattening ratio of median nerve was revealed significant change in maximal flexion(p<0.01), and in maximal extension(p<0.01). 4) In diabetics, the flattening ratio was significantly decreased in maximal flexion(p<0.01) with com- paring to neutral position. 5) In diabetics, the cross-sectional area of median nerve and carpal tunnel were significantly increased in all positions(p<0.05), and the mean flattening ratio of median nerve was similar to controls. CONCLUSION: In diabetics, increased cross-sectional area of median nerve can be explained by swelling of median nerve, also increased cross-sectional area of carpal tunnel is can be said to have taken place by the decreasing of the useful space in between the median nerve and carpal tunnel, this show that the diabetics have the high risk of the CTS. Phalen's test reveals higher degree of irritation to median nerve, The high-resolution ultrasonography is suggested as an available tool for the screening and follow up aid-test for the CTS

Determination of Follow-up Time of Abnormal Brainstem Auditory Evoked Potential in Infancy

OBJECTIVE: To determine optimal follow-up time of BAEP for the infants with abnormal BAEP at the initial screening test. METHOD: Control group consisted of 85 infants with normal BAEP and experimental group consisted of 41 infants with abnormal BAEP at the first examination but normalized on regular follow-up examinations. Gestational age (correctional age), intrauterine period, birth weight, delivery method, presence of perinatal asphyxia, Apgar score after 1 minute, the highest serum bilirubin level, and the results of cranial ultrasonography were recorded. The above parameters, peak and interpeak latencies of BAEP were compared between both groups. RESULTS: Lower correctional age at the first BAEP, shorter intrauterine period, and lower birth weight were noted in experimental group (p<0.001). The average correctional age when BAEP had normalized in experimental group was 45.0+/-5.8 weeks, which was much later than 40.2+/-2.8 weeks in control group (p<0.001). 90.2% of infants among experimental group revealed normalized BAEP within 48 weeks, and 95.1% within 51 weeks according to correctional age, or within 12 weeks after initial examination. CONCLUSION: We recommend that BAEP should be rechecked after 48 weeks by correctional age for the high risk infants who were abnormal with initial screening BAEP.

Median Nerve Conduction Study in Different Wrist Position in the Diabetes with or without Polyneuropathy

OBJECTIVE: To acknowledge whether flexion or extension of wrist joint produces any changes in median nerve conduction of the diabetes with or without polyneuropathy. METHOD: With thirty healthy adults selected as control, 33 diabetes with polyneuropathy (Group I) and 21 diabetes without polyneuropathy (Group II) were studied. Before the study, the wrist joint was positioned in flexion or extension for 5 minutes. The variables used for the statistic analysis were mean changes of latencies and amplitudes in the median motor and sensory responses in neutral, flexed, and extended position. RESULTS: After wrist flexion or extension, there was no significant difference in the mean change of latencies and trans-carpal conduction velocities between Group I and Group II in the median motor and sensory nerve conduction studies, and in the mean change of amplitudes between the two groups in the median motor nerve study. But, there was significant difference in the mean change of amplitude between Group I and Group II in the median sensory nerve study after wrist extension. CONCLUSION: We conclude that the change of amplitude in median nerve conduction study in different wrist position may be helpful to detect carpal tunnel syndrome with diabetic polyneuropathy in its early stage.

The Mixed Nerve Action Potential of the Medial and Lateral Plantar Nerve Conduction Studies in Diabetic Patients

OBJECTIVE: To evaluate the mixed nerve action potential of the medial and lateral plantar nerve conduction studies in diabetic patients with the various factors. METHOD: 69 healthy adults without foot trauma as control group and 78 diabetic patients without foot trauma as subject group were studied. The study was performed by using the orthodromic surface stimulation and recording method of evaluating of the mixed nerve action potential of the medial and lateral plantar nerve conduction studies. RESULTS: The differences in the distal latency (p<0.05), amplitude (p<0.05) and nerve conduction velocity (p<0.05) of the mixed nerve action potential of the medial and lateral plantar nerve conduction studies were statistically significant between the diabetic group and the normal control group. Same results also could be obtained in diabetic patients relating to longer duration of diabetes, presence of diabetic retinopathy, higher blood glucose level, longer duration of oral hypoglycemic agent and insulin treatment (p<0.05). CONCLUSION: The mixed nerve action potential of the medial and lateral plantar nerve conduction studies are useful for the detection of diabetic neuropathic foot.

A Survey of Defecation Pattern after Discharge in Stroke Patients

OBJECTIVE: To investigate the defecation pattern after discharge in stroke patients with bowel problems. METHOD: Subjects were 50 stroke patients who underwent rehabilitation program and discharged to home. The information about the defecation pattern were taken through interview or review of medical records as follows: anatomical lesion site, consciousness, admission period, operation history, co-morbidity, ambulation distance, water & food intake, assistive device use, voiding dysfunction, urine output, stool softner use, fecal incontinence, and defecation frequency. We compared the defecation frequency according to the various factors obtained from the medical records and interview. RESULT: The defecation frequency were significantly higher in patients without co-morbidily or fecal incontinence, with longer-distance ambulation, large amount of water & food intake (p0.05). CONCLUSION: Considering the various factors noted above, comprehensive rehabilitation program to relieve bowel problems should be established in the rehabilitation management of stroke patients.

Three Kinds of Problem-Based Learning Formulas Experienced in Konkuk University College of Medicine / 한국의학교육

We performed three kinds of problem-based learning (PBL) formulas in all of forty-one 3rd grade students after the final examination of the first semester from June 28, 1999 to July 9, 1999 at Konkuk University College of Medicine to investigate which formula is the most efficient and helpful in medical education and polyclinic course. The PBL formulas applied were the typical face-to-face PBL accompanied by mini-lecture (Type I) or by distribution of the guidelines without lecture (Type II) and cyber PBL using web-based module and discussion over cyber space (Type III). Response of students was surveyed using some questionnaires and the evaluation results of each PBL were analyzed with Pearson's correlation test. All participating students were satisfied with the face-to-face PBL especially in applying time of PBL, using discussion to solve the problem, and studying with tutors. In cyber PBL, in spite of excellency of the contents, limitations in discussion over cyber space and computer skills, misunderstanding of computer system, and additional cost for private PC rent seemed to decrease the satisfaction with this PBL. Experience in Type II PBL was turned out to be the most helpful and discussion among fellow students in PBL to be the most useful experience for incoming polyclinic course. There were no significant correlations between the evaluation results of face-to-face PBL and cyber PBL or between the evaluation results of each type of PBL and the average credit of that semester, suggesting that evaluation of the newly acquired knowledge through PBL using tools such as Triple Jump, OSCE (objective structured clinical examination), and MEQ (modified essay question) should be included in assesment of academic achievement in addition to the evaluation of activities during PBL.

Median Nerve Conduction Study in different Wrist Position in Normal Persons and the Patients with Diabetes mellitus

OBJECTIVE: To determine whether flexion and extension of the wrist joint produce the change in the conduction study of the median nerve in the normal and diabetic patients, and to compare the susceptibility of median nerve compression injury in two groups. METHOD: Thirty healthy adults as control and thirty diabetic patients without carpal tunnel syndrome were studied. The wrist joint was maintained in flexion or extension position for 5 minutes before performing conduction study. The variables used for statistical analysis included the mean difference of amplitude and latency in median motor and sensory responses in neutral, flexion, and extension positions. RESULTS: The results showed that significant differences in the latency and amplitude of median motor and sensory responses between neutral, extension, and flexion of wrist within each group (p<0.01). The differences in the median sensory latency (p<0.01), amplitude (p<0.05) and the change of wrist-palm segmental conduction velocity (p<0.01) were statistically significant between the diabetes and the normal control. CONCLUSION: The results of this study suggest that median nerves are susceptible to compression pressure in diabetic patients. Therefore, the position of the wrist joint should be considered in the median nerve conduction study.

Assessment of Cerebral Hemodynamics Using Transcranial Doppler Sonography in Normal Adults

OBJECTIVE: To establish the normal values of the transcranial doppler sonography in healthy Korean adults according to the increasing age and sex. METHOD: We examined 68 healthy adult volunteers who had no history of diabetes mellitus, hypertension, cerebrovascular disease or other neurological illness. The study included 54 subjects from whom good doppler signals from the middle, anterior, and posterior cerebral arteries could be obtained. Mean blood flow velocity (MBFV), Resistance index (RI), and Pulsatility index (PI) were analyzed by Angiodine 2 Doppler System operating at 2 MHz frequency. RESULTS: MBFV significantly decreased with the increasing age in the middle, anterior and posterior cerebral arteries (p0.05). There was no significant difference in the RI and PI between the male and female subjects. CONCLUSION: We suggest that the transcranial doppler sonography can be used as one of the useful screening tools for the diagnosis of cerebrovascular diseases.

A Comparison of Therapeutic Effects of Lidocaine Injection and Dry Needling in the Treatment of Myofascial Pain Syndrome Using Digital Infrared Thermographic Imaging

OBJECTIVE: To analyze the diagnostic value of digital infrared thermographic imaging(DITI) and to compare the therapeutic effects of lidocaine injection(LI) and dry needling(DN) in the treatment of myofacial pain syndrome(MPS) by using the DITI and visual analogue scale(VAS). METHOD: After 20 minutes adaptation time, 41 patients with MPS and 15 controls undertook DITI. LI and DN were randomly given in the trigger points of the patient group and to either side of the upper trapezius muscle in the controls. The effects of treatment were immediately assessed by measuring the temperature difference(deltaT) of the involved area and the corresponding area on the opposite side of the body using the DITI and VAS. Follow up assessments of VAS, change of VAS, deltaT and change of deltaT were performed 1, 3, 5 and 7 days after the treatment, respectively. RESULT: 1) The sensitivity and specificity of hot spots for TrP were 78.1% and 73.3 %, respectively. 2) deltaT and VAS continuously declined for 7 days after the treatment as compared to before the treatment in groups Ia (n= 16, deltaT>0.6degrees C, LI) and Ib (n=16, deltaT>0.6degrees C, DN). 3) deltaT and VAS ware not statistically different for groups Ia and Ib. 4) There was no statistically significant correlation between deltaT and VAS in both groups I and Ib. CONCLUSION: These data suggest that DITI can be used as one of the valuable tools for the evaluation of trigger points. No significant difference noted in the therapeutic effects of LI and DN for MPS.

Clinical Application of Digital Infrared Thermographic Imaging for the Prediction of Foot Ulcer Development in Diabetic Patients

OBJECTIVE: To investigate the regional differences of skin blood flow and to evaluate the effects of foot temperature on the severity of neuropathic pain and to predict the development of plantar foot ulceration by measuring of the temperature variations on the plantar surface of feet in the diabetic patients. METHOD: We measured the temperature variations on plantar surface of the feet in controls (n=18) and diabetic patients with(n=20) or without(n=23) polyneuropathy. The surface temperature from the 3rd metatarsal head(MTH), greater toe(GT), heel, medial and lateral longitudinal arch(LA) was measured by Digital Infrared Thermographic Imaging(DITI). RESULTS: The mean foot temperature of diabetic patients with polyneuropathy was significantly increased compared to controls or diabetic patients without polyneuropathy(p<0.001). The surface temperature readings of the GT, medial LA and the 3rd MTH tended to be increased in controls and patients with polyneuropathy. The mean plantar surface temperature was significantly increased according to the duration of diabetes mellitus(DM)(p<0.05). CONCLUSION: The results suggest that DITI provides a diagnostic modality in the prediction of neuropathic foot and increased risks of foot ulcer development in the diabetic patients.

Effect of Postures on Residual Urine Following Catheterization in Spinal Cord Injured Patients

Intermittent catheterization has reduced the frequency of urinary tract infection(UTI), calculus formation and vesicourethral reflux in spinal cord injured(SCI) patients. Still the residual urine (RU) following catheterization has been suggested as one of the possible causes of UTI. The purpose of this study was to identify the effect of postures on RU following catheterization, for the rehabilitation of neurogenic bladder in SCI patients. The inclusion criteria were: SCI patients with neurogenic bladder; completion of bladder rehabilitation program; good sitting balance and intact hand function. twelve SCI patients fulfilled the criteria and completed ultrasonographic RU measurement in sitting and supine posture following catherterization, respectively. We also studied the frequency of UTI, the functional type of neurogenic bladder and the postures during bladder evacuation at home. All patients had ultrasonographical evidence of RU following catheterizations both in sitting and supine postures. Residual urine volume following catheterization was significantly smaller in sitting posture than in supine posture(p<0.05). Frequency of UTI was significantly lower in the patients who performed catheterizations in sitting posture than in supine posture(p<0.05). In conclusion, bladder training in sitting posture would be better than in supine posture to minimize RU in SCI patients with good sitting balance and intact hand function.

Median Nerve Residual Latency in Normal Controls and Patients with Diabetes Mellitus

Residual latency is the difference between the expected and measured terminal latencies in nerve conduction study. The main contributors to the residual latency are the nerve tapering in the hand and fingers and the neuromuscular delay. We measured median motor and sensory residual latencies in the controls and in patients with diabetes mellitus(DM) to establish the normal values, to evaluate the diagnostic value of the residual latency in diabetic polyneuropathy. we studied 50 healthy controls and 100 diabetic patients with or without polyneuropathy. The normal residual latency values were 1.42+/-0.41 msec(mean+/-SD) in motor part and 0.44+/-0.20 msec in sensory part of median nerve. The standard deviation of residual latency in median motor nerve was decreased by 12% as compared with that of distal latency in the patient with diabetic polyneuropathy. Duration of DM and age were not related to the residual latency of median nerve. The results suggest that the residual latency of median motor nerve provides a narrower normal range in the diagnosis of diabetic polyneuropathy irrespective of duration of DM or age.

Effect of physical exercise on plasma beta-endorphin level and pain threshold

No abstract available.