Usefulness of the Oxygen Uptake Efficiency Slope in the Evaluation of Cardiorespiratory Fitness of the Stroke Patients

OBJECTIVE: To investigate the usefulness of the oxygen uptake efficiency slope (OUES) in the evaluation of cardiorespiratory fitness of the stroke patients. METHOD: 25 stroke patients who could walk independently were included in this syudy. The symptom-limited graded treadmill test was performed to assess cardiovascular fitness. During the test, minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER) and anaerobic threshold (AT) were measured through respiratory gas analysis. A linear relationship was established between the oxygen consumption and the logarithmic transformation of minute ventilation. From this linear relationship, we obtained a slope that represented the OUES. OUES values were obtained from data corresponding to 75% (OUES75), 90% (OUES90) and 100% (OUES100) of the exercise duration. RESULTS: The differences among OUES75, OUES90 and OUES100 groups were not statistically significant and these three groups were highly correlated to each other. Maximal oxygen consumption (VO2max) was positively correlated with OUES75 (r=0.723), OUES90 (r=0.762), OUES100 (r=0.809) and AT (r=0.696), respectively (p<0.01). CONCLUSION: OUES is considered to be the valuable submaximal index to evaluate the cardiorespiratory fitness of stroke patients who can not reach maximal exercise.

The Effects of Shoe Lifts to the Unaffected Limb on Gait Pattern in Hemiplegic Stroke Patients

OBJECTIVE: To evaluate the effects of shoe lift to the unaffected limb on hemiplegic gait after stroke. METHOD: Three dimensional gait analysis was performed in 20 chronic hemiplegic patients with shoe lifts (5, 10, 15 mm) to the unaffected limb. The order of experimental series was randomized among subjects. Temporal gait parameters were measured and compared according to the height of shoe lifts in the affected and unaffected limbs. RESULTS: The stride time of both limbs and step time of the affected limb were decreased, and stride length of both limbs and step length of unaffected limb were increased after shoe lift apply (p<0.05). Thus walking velocity and cadence were increased. In gait cycle, there was decreased double limb support phase of affected limb (p<0.05). These improvement of gait patterns of hemiplegics was maximum after shoe lift of 10 mm height. CONCLUSION: Weight bearing with shoe lift may contribute to improved postural control and gait performance in hemiplegics. Furthermore, the study about long-term effects of shoe lifts to the unaffected limb may be necessary.

Multiple Symmetric Lipomatosis with Peripheral Neuropathy: A case report

Multiple symmetric lipomatosis is a rare disorder characterized by massive fatty deposits arranged symmetrically around the neck, shoulder, abdomen and back. It is typically associated with high alcohol consumption and a high prevalence of peripheral neuropathy. The pathogenesis of the syndrome is still unknown, but mitochondrial abnormality or metabolic abnormalities are occasionally found in the affected patients. In our patient, clinical and electrophysiologic signs of a generalized peripheral sensorimotor neuropathy and a multiple bilateral lumbosacral radiculopathy were observed. Sural nerve biopsy demonstrated many small unmyelinated fibers with complete loss of axoplasm and a extensive loss of myelinated fibers. Lipoma biopsy demonstrated non-capsulated mature adipose cells in the subcutaneous tissue. Serum lipid studies were normal. MERRF point mutation of mitochondrial DNA were negative in blood. We reported a case of multiple symmetric lipomatosis and peripheral polyneuropathy with the review of literature.

A Survey on Spinal Cord Injury Persons in Suwon City

OBJECTIVE: To collect the informations of the traumatic spinal cord injury persons in Suwon city. METHOD: Seventy-five traumatic spinal cord injury persons were evaluated by the neurological level, American Spinal Injury Association scale, Functional Independence Measure (FIM), Craig Handicap Assessment and Reporting Technique (CHART), Beck Depression Inventory (BDI), and questionnaire on their voiding methods, complications, etc. RESULTS: The leading cause of 75 persons with traumatic spinal cord injury was a traffic accident. Among them, paraplegics were 46 persons. The most common complication was a pressure sore which was also the leading cause of their rehospitalization. Twenty-six persons voided by reflex. Among five dimensions of CHART, the physical independence score was the highest and the economic self sufficiency score was the lowest. The total CHART scores were significantly correlated with BDI scores, FIM scores, and level of injury. CONCLUSION: This study revealed that physical impairment, disability and depression affect the handicaps of spinal cord injury persons. These data could be used to develop a social rehabilitation program for the spinal cord injury persons in the community.

Quality of Life in Spinal Cord Injured Persons

OBJECTIVE: The purpose of this study was to analyze relationships between injury-related variables, demographic variables, disability, handicap and life satisfaction of persons with spinal cord injury. METHOD: Data was collected through personal interviews of 96 persons with spinal cord injury. Neurologic variables, demographic variables, FIM (functional independence measure) scores and CHART (Craig Handicap Assessment and Reporting Technique) scores were obtained. Life domain satisfaction measure, a self-administered questionnare containing 12 items, was used to assess the life satisfaction. RESULTS: Life satisfaction was related with the total CHART score (p=0.00), severity of disability (p=0.02), annual family income (p=0.019) and employment status (p=0.008). Life satisfaction was not related with the level of injury, age, duration of injury, sex or marital status (p>0.05). Social integration was the most strong predictor of life satisfaction (p=0.00). Economic-self sufficiency (p=0.004) and FIM scores (p=0.018) were also predictors of the life satisfaction. CONCLUSION: The result of this study provides an evidence that social integration and employment warrant a priority in rehabilitation efforts to promote the quality of life following spinal cord injury.

Bladder Volume Measurement using Bladder Manager PCI 5000 in Spinal Cord Injury Patients

A portable ultrasound scanner has been developed to provide a noninvasive technique of measuring the bladder urine volume. This study was undertaken to determine if bladder volumes could be accurately measured in a group of spinal cord injury patients on a clean intermittent catheterization program, using a portable ultrasound scanner(BladderManager PCI 5000). We assessed the effects of different patient positions, presence of central obesity and bladder types by the urodynamic study on the accuracy of measurements as well as the inter-tester difference. Ultrasound measurements of urine volume performed by two physicians were compared to the volumes obtained by catheterization in 17 spinal cord injury patients. Subjects were tested in the seated and supine positions. The results showed a good correlation between the catheterized volumes and ultrasound measurements (Pearson correlation coefficient=0.97, r2=0.88). The mean % error was 18% for the catheterized volumes within the ranges of 45ml-640ml. But the ultrasound measurements revealed a significantly higher % error for the bladder volumes less than 200ml. Ultrasound measurements were more accurate in a supine position and among the non-obese subjects(p<0.05). There was no significant difference in the ultrasound measurements between areflexic type bladder and hyperreflexic type bladder neither in the inter-tester measurements. We conclude that the Bladder Manager PCI 5000 is not an accurate tool for the assesssment of post-void residual urine volumes, however it can be a useful tool for the patients with neurogenic bladder who are performing volume-directed clean intermittent catheterization, in reducing the unnecessary catheterization or preventing the bladder overdistensions.

A Study on Handicap of Persons with Spinal Cord Injury in Korea by CHART

According to the World Health Organization(WHO), handicaps exist when individual is unable to fulfill expected social roles. The purposes of this study were to assess the handicap in spinal cord injury(SCI) outpatients, and to investigate the correlation of handicaps, impairments, disabilities and depression. Eighty-five SCI outpatients were evaluated by the Craig Handicap Assessment and Reporting Technique(CHART), Katz scale, neurologic level and Frankel classification and Beck Depression Inventory (BDI). Seventy(82.4%) were male and 15(17.6%) were female. Average age of the subjects was 34.5 years with the age range of 18 to 63. The subjects were devided into four groups: complete quadriplegics (9), incomplete quadriplegics(12), complete paraplegics (41) and incomplete paraplegics(23). There was no significant statistical difference in total CHART scores between male and female subjects. However, male subjects had higher mobility and social integration scores than female subjects. The occupation score was low and the social integration score was high in all groups. No correlation was found between sex, severity and the level of injury, time since injury and the CHART scores. However, significant correlation was noted between the CHART scores and BDI scores. We can carefully conclude that the CHART can be a valuable tool in the assessment of handicaps of disabled people. Futher extensive studies are recommended to identify the factors which might influence the handicaps of spinal cord injury persons.