Two-Year Outcome of Percutaneous Bipolar Radiofrequency Neurotomy of Sacral Nerves S2 and S3 in Spinal Cord Injured Patients with Neurogenic Detrusor Overactivity: A Randomized Controlled Feasibility Study.

BACKGROUND: Little research has been expended on the use of bipolar radiofrequency (RF) lesioning of sacral nerves in spinal cord injured (SCI) patients with neurogenic detrusor overactivity (NDO), and no study has been undertaken to demonstrate its long-term effect. OBJECTIVE: To investigated the effect of bipolar RF ablation of the second and third sacral nerves over 2 years in SCI patients with NDO. STUDY DESIGN: A prospective, randomized controlled feasibility study. SETTING: The outpatient clinic of a single academic medical center in Korea. METHODS: Ten SCI patients with NDO were recruited. These patients were randomly assigned to 2 groups; the intervention group (n = 5) and the control group (n = 5). Control group members received optimized conventional treatment. International Consultation on Incontinence Questionnaire (ICIQ), 3-day voiding diary, and the urinary incontinence quality of life scale (I-QOL) data were obtained at baseline and at 6, 12, and 24 months after intervention. Urodynamic study (UDS) was performed at baseline and 24 months after intervention. In the intervention group, percutaneous bipolar RF neurotomy was performed on both S2 and S3 nerves in each patient. RESULTS: Frequency of urinary incontinence and ICIQ and IQOL scores showed significant effects for time and for the group x time interaction (P < 0.05). Daily mean volume of urinary incontinence showed only a significant group effect. In UDS parameters, comparisons of values at baseline and at 24 months revealed all variables showed significant intergroup differences (P < 0.05). LIMITATION: A small number of patients was recruited. CONCLUSION: Percutaneous bipolar RF ablation of sacral nerves S2 and S3 effectively reduces urinary incontinence and improves quality of life (QoL) in SCI patients with NDO and the effects lasted over 2 years.

The effect of a hand-stretching device during the management of spasticity in chronic hemiparetic stroke patients.

OBJECTIVE: To describe a hand-stretching device that was developed for the management of hand spasticity in chronic hemiparetic stroke patients, and the effects of this device on hand spasticity. METHODS: Fifteen chronic hemiparetic stroke patients with finger flexor spasticity were recruited and randomly assigned to an intervention group (8 patients) or a control group (7 patients). The stretching device consists of a resting hand splint, a finger and thumb stretcher, and a frame. In use, the stretched state was maintained for 10 minutes per exercise session, and the exercise was performed twice daily for 4 weeks. Spasticity of finger flexor muscles in the two groups was assessed 3 times, 4 weeks apart, using the Modified Ashworth Scale (MAS). Patients in the intervention group were assessed twice (pre-1 and pre-2) before and once (post-1) after starting the stretching program. RESULTS: Mean MAS (mMAS) scores at initial evaluations were not significantly different at pre-1 in the intervention group and at 1st assessment in the control group (p>0.05). In addition, no significant differences were observed between mMAS scores at pre-1 and pre-2 in the intervention group (p>0.05). However, mMAS scores at post-1 were significantly lower than that at pre-2 in the intervention group (p<0.05). Within the control group, no significant changes in mMAS scores were observed between 1st, 2nd, and 3rd assessments (p>0.05). In addition, mMAS scores at post-1 in the intervention group were significantly decreased compared with those at the 3rd assessment in the control group (p<0.05). CONCLUSION: The devised stretching device was found to relieve hand spasticity effectively in chronic hemiparetic stroke patients.

Improvements in spasticity and motor function using a static stretching device for people with chronic hemiparesis following stroke.

We investigated the effect of a static stretching device on spasticity and motor function for people with chronic hemiparesis following stroke. Ten participants with chronic hemiparesis following stroke who had severe spasticity and incomplete weakness of the affected wrist and hand were recruited. The stretching device consisted of a resting hand splint, a finger and thumb stretching system, and a frame. The stretched state was maintained for 10 minutes/session, and the static stretching program was performed for 2 sessions/day and 7 days/week for 4 weeks. Spasticity and motor function of the affected wrist and hand were assessed three times with intervals of 4 weeks (twice [Pre-1, Pre-2] before and once [Post-1] after starting the static stretching program). The effect of the static stretching device was assessed using modified Ashworth scale (MAS) scores, by measuring active range of motion (AROM), and using the wrist and hand subsection of the Fugl-Meyer motor assessment (FMA). The main effects of the static stretching program on MAS scores for wrist and metacarpophalangeal (MCP) joints and FMA scores were significant. AROMs of MCPs and wrist showed an increase, however, no significant main effects of the static stretching program were observed. MAS in flexor muscles of MCP joints showed a significant decreased from Pre-2 (mean ± standard deviation (SD): 2.56 ± 0.55; median and interquartile range (IQR): 2.42, 2.12-3.08) to Post-1 (mean ± SD: 1.05 ± 0.49; median and IQR: 1.08, 0.87-1.50) (P < 0.001), and MAS in wrist flexor muscles also showed a significant decrease from Pre-2 (mean ± SD: 3.20 ± 0.78; median and IQR: 3.0, 2.75-4.0) to Post-1 (mean ± SD: 1.90 ± 0.73; median and IQR: 2.0, 1.0-2.5) (P < 0.001). FMA score also showed a significant increase from Pre-2 (11.3 ± 6.09) to Post-1 (14.5 ± 6.20) (P < 0.001). It was found that the static stretching device effectively relieved spasticity and improved motor function in subjects with severe spasticity and incomplete weakness following stroke.

Radiologic differences in white matter maturation between preterm and full-term infants: TBSS study.

BACKGROUND: Widespread white matter (WM) pathology in preterm children has been proposed. OBJECTIVE: The purpose of this study was to investigate maturational differences of WM between preterm infants with thinning of the corpus callosum and full-term infants. MATERIALS AND METHODS: A total of 18 preterm children and 18 full-term children were divided into three subgroups according to the corrected age at the time of diffusion tensor imaging scanning. Tract-based spatial statistics was used for assessing differences in fractional anisotropy (FA) between preterm and full-term children, and between each age-related subgroup in preterm and in full-term children. RESULTS: In the preterm group, FA values of overall WM showed an increase with age. This trend indicates that WM maturation is a gradual occurrence during a child's first 2 years. In the full-term group, most WM structures had reached maturation at around 1 year of age; however, centrum semiovale level showed sustained maturation during the first 2 years. CONCLUSION: Results of our study demonstrate radiologic maturational differences of WM and provide evidence of the need for therapeutic intervention within 2 years of birth to prevent specific functional impairment and to improve clinical outcome in preterm children.

A comparison of microstructural maturational changes of the corpus callosum in preterm and full-term children: a diffusion tensor imaging study.

INTRODUCTION: Preterm children with thinning of the corpus callosum (CC) frequently achieve poor neurodevelopmental outcomes despite the absence of a definite brain lesion. Here, the authors compared the microstructural characteristics of the CC in preterm and full-term children using diffusion tensor imaging (DTI). METHODS: Twenty-two preterm children with no definite focal lesion but with thinning of the CC by conventional magnetic resonance imaging and 23 age-matched full-term children were investigated by DTI. CCs were subdivided into genu, rostral body, body, isthmus, and splenium, and voxel counts (VC), fractional anisotropies (FA), and apparent diffusion coefficients (ADC) were measured in each subdivision. Eleven preterm and 11 age-matched full-term subjects underwent follow-up scanning and interval changes in these parameters for each subdivision were compared. RESULTS: VC and FA were significantly lower in the preterm group than in the full-term group, particularly in the isthmus. Furthermore, incremental changes in VC and FA were significantly smaller in the preterm group. Differences in maturation between the two groups were more pronounced with age in all subdivisions except the splenium. At all ages, noticeable FA differences between the two groups were observed in the isthmus. For white matter tracts, the preterm group displayed lower FA and fiber number, higher ADC values than the term group. CONCLUSIONS: The present study shows that thinning of the CC is correlated with lower FA value and that it is more pronounced in preterm children. In addition, the isthmus was found to be the most vulnerable subdivision in preterm children.