Influence of Nasogastric Tubes on Swallowing in Stroke Patients: Measuring Hyoid Bone Movement With Ultrasonography

OBJECTIVE: To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. METHODS: Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R–S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid−mandible approximation (Interval) was calculated by a computer program. RESULTS: From group A: R–S and (R–S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R–S and (R–S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. CONCLUSION: A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.

Compound Nerve Action Potential of Common Peroneal Nerve and Sural Nerve Action Potential in Common Peroneal Neuropathy

To enhance the accuracy for determining the precise localization, the findings of the compound nerve action potentials (CNAPs) of the common peroneal nerve (CPN) were investigated in patients with common peroneal mononeuropathy (CPM) in the knee, and the sural sensory nerve action potentials (SNAPs) were also analyzed. Twenty-five patients with CPM in the knee were retrospectively reviewed. The findings of the CNAPs of the CPN recorded at the fibular neck and the sural SNAPs were analyzed. The lesion was localized at the fibular head (abnormal CNAPs) and at or distal to the fibular head (normal CNAPs). Seven patients were diagnosed as having a lesion at or distal to the fibular neck, and 18 cases were diagnosed as having a fibular head lesion. The sural SNAPs were normal in all the cases of lesion at or distal to the fibular neck. Among 18 cases of fibular head lesion, the sural SNAPs were normal in 7 patients: two cases of conduction block and 5 cases of mild axon loss. Eleven patients showed abnormal sural SNAPs. Of those, 9 cases were severe axon loss lesions and 2 patients were diagnosed as having severe axon loss with conduction block. The recording of the CNAPs may enhance precise localization of CPM in the knee. Moreover, the sural SNAPs could be affected by severe axonal lesion at the fibular head.

Correlation between Severity of Diabetic Neuropathy and Somatosensory Evoked Potentials Study

OBJECTIVE: To investigate the clinical applicability of the somatosensory evoked potentials (SEPs) study in early detection of diabetic neuropathy, and compare the results in different degrees of the disease. METHOD: The study was performed retrospectively with prospective data collection. The Toronto clinical scoring system was taken as well as nerve conduction study, needle electromyography, and SEPs study with median and posterior tibial nerve stimulations in thirty-eight diabetic patients and twenty non-diabetic adults. The subjects were divided into the non-neuropathy group and the neuropathy group, and the latter was divided into three subgroups (suspected, probable, and definite) according to the degree of neuropathy. Statistical analysis was performed with height and age-related correction of reference values of the latency of SEPs with posterior tibial nerve stimulation. RESULTS: The Toronto clinical scoring system showed concordance with the degree of the diabetic neuropathy (p<0.05, correlation coefficient=0.827). SEPs study with posterior tibial nerve stimulations showed statistically significant latency delay, not only in the neuropathy group, but also in the non-neuropathy group, compared with the non-diabetic group (p<0.05). Moreover, the latency delay was noted in proportion to the degree of the diabetic neuropathy within the neuropathy group. Interpretation of the data with height and age-corrected reference values of latency of posterior tibial SEPs had stronger correlation. CONCLUSION: The SEPs study is useful in the early diagnosis of diabetic neuropathy. However, application of the SEPs to clinical use needs to go through height and age correction.

Frequency of Carpal Tunnel Syndrome acoording to the Severity of Diabetic Neuropathy

OBJECTIVE: To investigate the frequency of carpal tunnel syndrome (CTS) according to the severity of diabetic polyneuropathy. METHOD: Electrophysiologic study was performed in 456 patients (male 222, female 233, average age 58) with diabetes mellitus. Electrophysiologically diagnosed diabetic neuropathy was classified as suspected, probable or definite. CTS was also diagnosed both in cases with and without underlying diabetic peripheral neuropathy. The ANOVA test was used for statistical analysis. RESULTS: Out of 456 diabetic patients, 228 patients were diagnosed as diabetic peripheral neuropathy. The patients with diabetic neuropathy consisted of 107 cases (23.5%) of sus pected group, 95 cases (20.8%) of probable group and 26 cases (5.7%) of definite group. The frequencies of concomitant CTS were 49 cases (21.5%) in 228 diabetic patients without diabetic polyneuropathy, 31 cases (29%) in suspected group and 30 cases (31.6%) in probable group. These were statistically significant. However, only one case showed concomitant CTS in 26 cases of definite group. CONCLUSION: The frequency of CTS was higher in probable group compared to suspected group. However the frequency decreased in definite group because there is a difficulty in the differential diagnosis of two disease in the cases of advanced peripheral neuropathy.

Clinical Usefulness of Somatosensory Evoked Potentials in Patients with Stroke

OBJECTIVE: To assess the usefulness of the somatosensory evoked potentials in correlating with various clinical features and in predicting the functional outcome in patients with stroke. METHOD: The subjects were 57 patients with first stroke. Somatosensory evoked potential study was performed at the time of transfer to the rehabilitation department. Data of somatosensory evoked potential with median and tibial nerve stimulations were obtained and classified as normal (group 1), abnormal (group 2), and no response group (group 3). Modified Barthel index (MBI), motor and sensory functions were evaluated at the time of transfer and discharge. RESULTS: MBI score was statistically different among the 3 groups based on the findings of median and tibial nerve SSEP at the time of transfer, but not different at the time of discharge. Motor function was statistically different among the 3 groups at the time of transfer and discharge. Sensory function was statistically different among the 3 groups at the time of transfer, but not different at the time of discharge. CONCLUSION: Even though SSEP study reflects the functional status of the patients and correlates well with the findings of brain image, it has limitation in predicting outcome of the patients with stroke.