Reflex Sympathetic Dystrophy in Cervical Cord Injured Patients

OBJECTIVE: Reflex sympathetic dystrophy (RSD) is a syndrome of post-traumatic neuropathic pain in association with dystrophic changes and signs of sympathetic overactivity. Pain following spinal cord injury occurs frequently, but RSD is not usually considered as one of the common sources of pain. There have only been a few reports of RSD in spinal cord injured patients, although this condition is well-known in the painful upper extremity of hemiplegia due to stroke. The purpose of this study was to investigate the rate of occurrence, characteristic clinical features and more objective evaluation tools for the diagnosis of RSD in cervical cord injured patients. METHOD: Thirty-two cervical cord injured patients were evaluated for hand pain, swelling, vasomotor changes and dystrophic skin or nail changes. The patients were evaluated with studies such as three phase bone scintigrathy, digital infrared thermographic imaging (DITI) and plain roentgenograms of the hands. RESULTS: Eighteen patients (56.3%) were diagnosed as RSD based on the clinical symptoms and findings of three phase bone scintigraphy. Characteristic symptoms were hand pain, edema and dystrophic skin or nail changes, in the order of frequency. In patients with spasticity of the upper extremity, the incidence of RSD was higher than in patients without spasticity. CONCLUSION: We should consider RSD as a cause of upper extremity pain in cervical cord injured patients. This will lead to early diagnosis and treatment of the condition and it will be helpful in preventing various complications.

The Evaluation of Renal Function in Spinal Cord Injury Patients Using Radioisotope Renography

OBJECTIVE: The purposes of this study were to determine the renal function by radioisotope renography and to compare the findings of radioisotope renography in the spinal cord injured patients to the clinical presentations and findings of other conventional urologic examinations. METHOD: Intravenous pyelogram(IVP), voiding cystourethrogram(VCUG) and urodynamic study were performed in twenty-five spinal cord injured patients along with serum BUN/Creatinine levels and 24 hour creatinine clearance tests. Technetium-99 m mercaptoacetyltriglycine was used for the radioisotope renography. RESULTS: One abnormal radioisotope renography finding was noted among 22 normal findings by IVP and VCUG studies, while no abnormal finding by IVP and VCUG studies was noted among the subjects with a normal radioisotope renography. Effective renal plasma flow(ERPF) was significantly lower in patients with lower creatinine clearance. ERPF, cortical retention and creatinine clearance values for hyperreflexic bladders were significantly different from areflexic bladders. ERPF was significantly higher in a clean intermittent catheterization group than in a percussion and Cred method group for the hyperreflexic bladders. CONCLUSION: The study proves that the radioisotope renography is a sensitive and valuable study to evaluate the renal dysfunction in the spinal cord injured patients.

Epidemiology of Pressure Sore in Spinal Cord Injured Patients

OBJECTIVE: To provide epidemiologic data of the pressure sores and to determine the most effective prevention and treatment methods. METHOD: Seventy patients with pressure sores who were admitted to the Rehabilitation Hospital, Yonsei University College of Medicine from 1991 to 1995 were included in this study. RESULTS: The average age of the patients was 36. Traffic accident was the most common(46 cases) cause of injury, followed by falling injury. Thirty-one patients developed pressure sores at home, while 39 patients in various hospitals. According to Frankel's classification, 51 cases were Frankel A, 13 cases were Frankel B, 5 cases were Frankel C and none was Frankel D. Sacrum was the most common site of the sore followed by buttock, ischial tuberosity, greater trochanter, and coccyx. Among many factors investigated, the anemia and hypotension had a significant correlation with the healing time. The treatment methods were variable among the patients depending on the size and severity of the sores. The severe and larger lesions required more surgical managements. CONCLUSION: The results support that an intensive prevention is necessary at homes as well as at the hospitals. More educational programs should be provided not only for the patients, but also for the hospital personnels.

A Case of Cerebrotendinous Xanthomatosis

Cerebrotendinous Xanthomatosis is a rare inherited autosomal recessive disorder characterized by an increased plasma cholestanol level and the accumulation of sterol in tendon and nervous system. The primary biochemical abnormality is a defect in the synthesis of bile acid due to a lack of hepatic mitochondrial sterol-26-hydroxylase activity. The clinical symptoms usually begin in the 2nd decade and include cataract, xanthoma, and progressive neurological dysfunction. There are variable abnormal findings in the eletrophysiologic and radiologic evaluation. The usual treatment consists of long-term administration of the chenodeoxycholic acid (CDCA or UDCA) or cholic acid, which may correct the biochemical abnormality. We report a case of Cerebrotendinous Xanthomatosis in a 32 year old male patient suffered from gait disturbance and tendon xanthoma in both achilles tendons and left knee area.

The Effects of Surface Electrical Stimulation on Spasticity in Spinal Cord Injured Patients

The current available treatment methods of spasticity are consisted of physical therapies, medications, surgeries, injections of phenol or botulinum, and electrical stimulations. The purposes of this study were to evaluate the effectiveness of surface electrical stimulation in reducing spasticity in the spinal cord injured patients, to find out carry-over effects of electrical stimulation and to find out the factors influencing the effects of the treatment. The subjects were 10 quadriplegics with the cervical cord injuries. The electrical stimulation was applied to the antagonists of major spastic muscles of the knee joints for 2 weeks. The evaluation of spasticity were done by using the modified Ashworth scale, beats of ankle clonus, patellar tendon reflex(latency and amplitude), and relaxation index of patellar knee by pendulum test before and after treatment sessions. The results of the study revealed no statistically significant changes in relaxation index, modified Ashworth scale, ankle clonus and the latency and amplitude of patellar tendon reflex(P<0.05), however there were tendencies of improvement in relaxation index and modified Ashworth scale after the stimulations. We could not find out statistically significant factors influencing the effects of the surface electrical stimulation. Further investigations to assess the mechanism of electrical stimulation and the adquate parameters of electrical stimulation in a larger population of subjects will be needed.

Accuracy of a Portable Ultrasound Scanning in the Measurement of Post-void Residual Urine Volume in Patients with Spinal Cord Injury

As a standard method for the measurement of post-void residual urine volume, the urethral catheterization is commonly used. However, it is frequently associated with the discomfort of the patients, urethral trauma and urinary tract infection. A noninvasive method of determining the residual urine volume could minimize unnecessary catheterizations and be useful in the management of neurogenic bladder in the patient with spinal cord injury(SCI). This study was undertaken to evaluate the accuracy of a portable ultrasound scanner for measuring bladder volumes in SCI patients undergoing bladder training and to determine the factors affecting its accuracy. Sixty patients with SCI were included in this study. Two investigators performed the ultrasound measurement of the post-void residual urine volume alternately and the same procedures were repeated. After that, the urethral catheterization was done. In comparison of the residual volume measured by two different methods, the correlation coefficient(R2) of the two different methods was 0.996 and the mean value of difference between the residual volume measured by ulltrasound and by catheterization was 21.6 ml. The accuracy of the ultrasound measurements was not affected by gender, types of the neurogenic bladder, shape of the bladder, trabeculation of the bladder and central obesity. The results indicate that the portable ultrasound scanning method is a useful non-invasive method and can be substituted for the urethral catheterization in determination of bladder volumes in patients with SCI.

Dopa-Responsive Dystonia: A Case Report

Dystonia is a rare syndrome of sustained muscle contractions which frequently causes twisting and repetitive movements or abnormal postures. Dopa-responsive dystonia(DRD) is a slowly progressive dystonia with childhood on set. Initial gait disturbance with toe-walking, diurnal variation of symptoms, dramatic response to levodopa treatment and concurrent signs of parkinsonism are other characteristics of DRD. We report a 22 year old woman who showed the typical characteristics of DRD and was successfully managed with medical, surgical and rehabilitational methods. Better understanding of the disease entity and its treatment options are necessary for comprehensive rehabilitational management of DRD.

A Case of Infantile Neuroaxonal Dystrophy

We herein report a case of infantile neuroaxonal dystrophy (INAD) with protracted course. The 3 year old patient suffered from ataxia, gait disturbance, oculomotor disturbance, psychomotor regression and bilateral pyramida l tract signs since the age of two. Similar neurological symptoms occurred in his elder brother, beginning at the age of one, who eventually died at the age of four. Magnetic Resonance Imaging (MRI) of the patient showed progressive atrophy of cerebral cortex and cerebellum with diffusely increased T2 signal in bilateral cerebellar hemisphere. The patient's brother revealed similar findings. MRI of the suspected cases may facilitate early diagnosis of INAD, and since it is a well-established autosomal recessive neurodegenerative disaese, early and appropriate genetic counseling of the parents is required.

Clinical Utility of a Special Mattress in the Prevention of Pressure Ulcers

We studied a group of spinal cord injured patients, using two different mattresses, to analyze statistically the pressure measured over sacral area and skin changes developed on the dorsal skin surface of patients for pat ients for specific duration of time. Local pressure measured sacral area and skin change score were lower on a Bazooka system than common hospital mattress. And the weight. BMI(Body Mass Index) and % IBW(Ideal Body Weight) of patients significantly correlated with the skin changes developed on the dorsal skin surface after lying on common hospital mattress for 2 hours. But skin changes developed after lying on a Bazooka system for 8 hours didn't correlated with these variables. Therefore a Bazooka system may be effective in the prevention of pressure ulcers for spinal cord injured patients.

Brain MRI and SPECT Findings in Children with Cerebral Palsy

The authors studied 60 children (aged 4 months to 9 years) with cerebral palsy by means of magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) of the brain. MRI showed normal in 15 cases (25.0%) and deep white matter pathology in 37 cases (61.7%), corpus callosum abnormality in 29 cases (48.3%). In addition, abnormal intensity of thalamus or basal ganglia and delayed myelination were found in minor cases. In all of the patients except for 1 case, SPECT showed the abnormal findings SPECT demonstrated hypoperfusion of thalamus in 58 cases (96.7%), cerebellum in 27 cases (45.0%), frontal and parietal lobe in 26 cases (43.3%), basal ganglia in 23 cases (38.3%) and temporal lobe in 22 cases (36.7%). There was no significant correlation between the severity of motor developmental impairment and the radiologic findings. The results of this study suggest that MRI of the brain provides the anatomical information such as deep white matter and corpus callosum pathologies resulted from the hypoxic-ischemic insult and SPECT of the brain is a very sensitive tool for the assessment of the functional abnormalities in cerebral palsy.

The Development of Evaluation Tool for the Early Diagnosis of Cerebral Palsy

Early diagnosis of cerebral palsy may help to provide early therapeutic intervention. The early treatment of cerebral palsy is critical in the prevention of deformity and promotion of normal movement patterns. However, it is difficult to identify those who are at substantial risk of cerebral palsy before the age of one, particularly in its mild and moderate forms. The purpose of this study was to analyze and establish an efficient early diagnostic tool for cerebral palsy. The subjects in this study were 247 infants selected from outpatients at the Rehabilitation Hospital of Yonsei University from December, 1987 to March, 1996. The infants had problems in motor development or a past history of perinatal risks and all were under one year of corrected age. The assessments included a structured developmental history taken from the child's parents, evaluation of motor development status, and neurological examiniations including assessment of muscle tone, several primitive reflexes and Vojta's postural reactions. These infants were assessed every 2-3 months. According to the findings of developmental milestones, muscle tone, and Vojta's postural reactions, we divided the patients into high and low risk groups. The final diagnosis confirmed that 126 children had cerebral palsy, 43 children had other diagnoses while 78 children turned out to be normal. We found that diagnosis of cerebral palsy during the first six months of postnatal period relied mainly on abnormal muscle tone, Vojta's postural reactions, developmental motor delay, a positive finding of asymmetric tonic neck reflex and a negative finding of optical righting reaction. The sensitivity and specificity of the evaluation methods were 91.1% and 66.7%, respectively in the first six months of postnatal period. In conclusion, we have proved that the delayed motor development, abnormal muscle tone and abnormal Vojta's postural reactions are very valuable tools for the early diagnosis of cerebral palsy.

Intraoperative monitoring of microvascular decompression in hemifacial spasm

The significance of intraoperative electrophysiologic monitoring during microvascular decompression was evaluated prospectively in 261 patients with the hemifacial spasm from 1985 to 1995. The patients were divided into a monitored group and a non-monitored group. Identification of the offending vessels was facilitated by the monitoring during the surgical procedure and the complication rate of the monitored group was significantly lower than that of the non-monitored group (p< 0.05). In addition, the abnormal muscle response continued to improve during the follow-up period, thus the electrophysiological status of the hemifacial spasm after the microvascular decompression improved significantly with time (p< 0.05). In conclusion, intraoperative monitoring is useful for identifying the exact offender among multiple vessels, and lowering the complication rate of the microvascular decompression for the hemifacial spasm.

Efficacy of hydrocolloid occlusive dressing technique in decubitus ulcer treatment: a comparative study

The efficacy of hydrocolloid occlusive dressing technique was compared with that of the conventional wet-to-dry gauze dressing technique in decubitus ulcer of stage I and II. Forty-four patients were randomly divided into two treatment groups and each received treatment according to the two different protocols. As a result, 80.8% of the hydrocolloid occlusive dressing group (group 1) and 77.8% of the conventional wet-to-dry gauze dressing group (group 2) healed completely with no statistically significant difference between the two groups. However, the time required for complete healing was shorter in group 1 with 18.9 days compared to 24.3 days in group 2. Ulcer healing speed was also slightly faster in group 1 with 9.1 mm2/day compared to 7.9 mm2/day for group 2. Average treatment time spent by a medical staff member was significantly shorter in group 1 with 20.4 minutes/day compared to 2017 minutes/day in group 2. The hospital cost of the ulcer treatment was higher in group 2 compared to group 1 even without taking into consideration the medical personnel's labor cost. These results indicate that the hydrocolloid occlusive dressing technique offers less time consuming and less expensive method of treatment compared to the conventional technique in stage I andII decubitus ulcers.

Clinical studies on piriformis syndrome

No abstract available.

Factors influencing compliance to home rehabilitation

No abstract available.

Social adaptation in the Korean spinal cord injured patients

No abstract available.

Prognostic factors of ambulation in stroke patients

No abstract available.