Transcranial Motor Evoked Potentials of Lower Limbs Can Prognosticate Ambulation in Hemiplegic Stroke Patients.

OBJECTIVE: To examine the association between motor evoked potentials (MEPs) in lower limbs and ambulatory outcomes of hemiplegic stroke patients. METHODS: Medical records of hemiplegic patients with the first ever stroke who received inpatient rehabilitation from January 2013 to May 2014 were reviewed. Patient who had diabetes, quadriplegia, bilateral lesion, brainstem lesion, severe musculoskeletal problem, and old age over 80 years were excluded. MEPs in lower limbs were measured when they were transferred to the Department of Rehabilitation Medicine. Subjects were categorized into three groups (normal, abnormal, and absent response) according to MEPs findings. Berg Balance Scale (BBS) and Functional Ambulation Category (FAC) at initial and discharge were compared among the three groups by one-way analysis of variance (ANOVA). Correlation was determined using a linear regression model. RESULTS: Fifty-eight hemiplegic patients were included. BBS and FAC at discharge were significantly (ANOVA, p<0.001) different according to MEPs findings. In linear regression model of BBS and FAC using stepwise selection, patients' age (p<0.01), BBS at admission (p<0.01), and MEPs (p<0.01) remained significant covariates. In regression assumption model of BBS and FAC at admission, MEPs and gender were significant covariates. CONCLUSION: Initial MEPs of lower limbs can prognosticate the ambulatory outcomes of hemiplegic patients.

Ultrasonographic Evaluation of the Effects of Progressive Resistive Exercise in Breast Cancer-Related Lymphedema.

OBJECTIVE: To investigate the ultrasonic effects of progressive resistance exercise (PRE) for the treatment of patients with breast cancer-related lymphedema (BCRL). SUBJECTS AND METHOD: The 32 patients with diagnosed BCRL were randomly divided into two groups: the PRE group and the non-PRE group. After complex decongestive physiotherapy, PRE was performed by 0.5 kg dumbbell while wearing a compression stocking or a multilayer bandage to avoid aggravation of the lymphedema in the shoulder and arm. In the first week, the PRE group performed five repetitions of each exercise, twice a day, and the exercise were increased to five repetitions every week during 8 weeks. The thickness of muscle and subcutaneous tissue and circumferences of proximal and distal upper limbs were measured at baseline, 4 weeks, and 8 weeks. Examiners measured the circumference of upper limbs with tape measure, then the thickness of the muscle and subcutaneous tissue were measured by ultrasonography. RESULTS: Muscle thickness of the upper limbs was less in the affected limb than that of the nonaffected limb at pretreatment. The thickness of subcutaneous tissue and circumferences of the arm was more decreased in the PRE group than that of the non-PRE group. The thickness of muscle of the arm was more significantly increased in the PRE group than that of the non-PRE group (p < 0.05). CONCLUSION: For the treatment of patients with BCRL, PRE with complex decongestive physiotherapy did not cause additional swelling, and it reduced arm circumference by decreased subcutaneous tissue thickness and increased muscle thickness.

Tibial somatosensory evoked potential can prognosticate for ambulatory function in subacute hemiplegic stroke.

Early prediction of expected recovery in stroke can help in planning appropriate medical and rehabilitation interventions. Recovery of ambulation is one of the essential endpoints in stroke rehabilitation. However, the correlation of somatosensory evoked potentials (SSEP) with clinical parameters and their predictive significance are not clearly defined. We aimed to examine the association between tibial nerve SSEP and ambulatory outcomes in subacute hemiplegic stroke patients. We reviewed medical records for hemiplegic patients with first-ever stroke who received inpatient rehabilitation from January 2009 to May 2013. We excluded patients with diabetes mellitus, quadriplegia, bilateral lesions, brainstem lesions, those aged over 80 years, and those with severe musculoskeletal problems. Tibial nerve SSEP were performed when they were transferred to the rehabilitation department. SSEP findings were divided into three groups; normal, abnormal and absent response. Berg balance scale and functional ambulation category (FAC) at discharge were compared with initial tibial SSEP findings using one-way analysis of variance. Thirty-one hemiplegic patients were included. Berg balance scale and FAC were significantly different according to the SSEP (P<0.001). Post hoc analysis showed a significant difference between normal and absent response in Berg balance scale (P<0.001) and FAC (P<0.001), and between abnormal and absent response in Berg balance scale (P=0.012) and FAC (P=0.019). Functional outcomes of the normal response group were better than the abnormal response group, but there was no statistical significance. These findings suggest that initial tibial nerve SSEP may be a useful biomarker for prognosticating functional outcomes in hemiplegic patients.

The Effects of Shoulder Slings on Balance in Patients With Hemiplegic Stroke.

OBJECTIVE: To investigate the effects of a shoulder sling on balance in patients with hemiplegia. METHODS: Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. RESULTS: The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (p<0.05). This weight asymmetry pattern did not improve with either the Bobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. CONCLUSION: The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position.