Parasympathetic Effect Induces Cell Cycle Activation in Upper Limbs of Paraplegic Patients with Spinal Cord Injury

The present study aimed to investigate gene expression changes related to cell cycle activation in patients with spinal cord injury (SCI) and to further evaluate the difference between the upper and lower limbs of SCI patients. Fibroblasts were obtained from the upper and lower limbs of SCI patients and healthy subjects. To investigate gene expression profiling in the fibroblasts from SCI patients compared to the healthy subjects, RNA-Seq transcriptome analysis was performed. To validate the parasympathetic effects on cell cycle activation, fibroblasts from upper or lower limbs of SCI patients were treated with the anticholinergic agents tiotropium or acetylcholine, and quantitative RT-PCR and Western blot were conducted. Cell proliferation was significantly increased in the upper limbs of SCI patients compared with the lower limbs of SCI patients and healthy subjects. The pathway and genes involved in cell cycle were identified by RNA-Seq transcriptome analysis. Expression of cell-cycle-related genes CCNB1, CCNB2, PLK1, BUB1, and CDC20 were significantly higher in the upper limbs of SCI patients compared with the lower limbs of SCI patients and healthy subjects. When the fibroblasts were treated with tiotropium the upper limbs and acetylcholine in the lower limbs, the expression of cell-cycle-related genes and cell proliferation were significantly modulated. This study provided the insight that cell proliferation and cell cycle activation were observed to be significantly increased in the upper limbs of SCI patients via the parasympathetic effect.ope

Improvement in Pulmonary Function with Short-term Rehabilitation Treatment in Spinal Cord Injury Patients

Cervical and upper thoracic spinal cord injury causes impairments in respiratory muscle performance, leading to variable degrees of pulmonary dysfunction and rendering deep breathing difficult for affected individuals. In this retrospective study, we investigated the effects of self-directed respiratory muscle training in this context by assessing pulmonary function relative to spinal cord injury characteristics. A total of 104 spinal cord injury patients (tetraplegia/paraplegia; 65/39, acute/subacute/chronic; 14/42/48) were admitted for short-term (4-8 weeks) in-patient clinical rehabilitation. Initial evaluation revealed a compromised pulmonary function with a percentage of predicted value of 62.0 and 57.5 in forced vital capacity in supine and forced vital capacity in sitting positions, respectively. Tetraplegic patients had more compromised pulmonary function compared with paraplegic patients. At follow-up evaluation, the percentage of predicted value of forced vital capacity in supine and sitting position improved overall on average by 11.7% and 12.7%, respectively. The peak cough flow improved by 22.7%. All assessed pulmonary function parameters improved significantly in all subgroups, with the greatest improvements found in patients with tetraplegia and subacute spinal cord injury. Therefore, short-term self-directed respiratory muscle training should be incorporated into all spinal cord injury rehabilitation regimens, especially for patients with tetraplegia and subacute spinal cord injury, as well as those with chronic spinal cord injury.ope

Epidemiologic Study of Spinal Cord Injury

Objective : The purpose of this study is to present epidemiological data on patients with spinal cord lesion admitted to the Rehabilitation Hospital, YUCM. Method : Review of medical records of 590 patients with spinal cord injury admitted to the Rehabilitation Hospital, YUCM from 1987 to 1996 retrospectively. Results : 1) Sex: Males account for 79.6% of the SCI patients. 2) Age: The largest number of injuries occurs in the 20∼29 years of age group (32.5% of patients). 3) Etiology: Trauma accounts for 91.2% of all spinal cord injuries. The leading causes of traumatic spinal cord injury are traffic accidents (57.6%) and falls (26.4%). 4) Level of injury: Complete tetraplegia accounts for 20.5% of all SCI patients, incomplete tetraplegia 23.9%, complete paraplegia 38.8% and incomplete paraplegia 16.5%. In tetraplegics, incomplete injuries increased from 40% in 1987∼1991 to 56.7% in 1992∼1996. 5) Methods : of bladder management: 87% of patients voids by reflex. Intermittent catheterization is practiced by 8% of patients Conclusion : Epidemiologic data of 590 patients admitted to the Rehabilitation Hospital, YUCM, from 1987 to 1996 is presented with changes of epidemiology in each period. The patients suffered SCI from trauma, and traffic accidents and sports as causes were increasing. Female patients and incomplete injuries were also increasing. Mean duration of hospitalization decreased.ope

Early Treatment Effect in Children with Cerebral Palsy and Delayed Development

Objective : To compare the effects of early and late treatment and to evaluate the contributing factors for the therapeutic outcome in cerebral palsy children. Method : Three hundred twenty four children with delayed development including cerebral palsy who were admitted to the Department of Rehabilitation at Yonsei University Medical Center from January 1992 to December 1995 were studied. They were divided into two groups according to the initiation of treatment: early and late treatment groups. Early treatment was defined as treatment started at or before 6 months and the late treatment was after 6 months. They were also divided into groups according to the diagnosis, responsiveness to treatment and initial motor quotient. And then the motor developments during the follow-up period between each groups were compared as the effects of treatment. Results : The development of the motor milestone was faster in the early treatment group than in the late treatment group. The group which initially showed a higher motor quotient had a higher response rate to the treatment and a faster development of the motor milestone than the group with a lower motor quotient. Conclusion : These results suggest that the initiation of treatment and the severity of delayed development are important contributing factors for an outcome of treatment.ope

Effect of Seizure Disorders on Developmental Disability in Patients with Cerebral Palsy or Delayed Development

Objective : To investigate the effect of epilepsy and neonatal seizure on development in children with cerebral palsy (CP) or delayed development (DD). Method : The subjects were 135 patients with CP or DD. Development was evaluated by Bayley Scale of Infant Development II (BSID II). Epilepsy was diagnosed on the base of clinical features, past history and electroencephalography. Results : The incidence of epilepsy was 18.4% in CP, and 37.8% in DD. Spastic quadriplegia of CP has the highest incidence of epilepsy (38.4%). First seizure attack was occurred before 6 months old of age in 66.7% of CP with epilepsy and in 64.3% of DD with epilepsy. The prevailing type of epilepsy was generalized seizure in DD (57.1%), partial seizure in CP (50.0%). The group with epilepsy had lower psychomotor and mental development quotient on BSID II than the group without epilesy (p＜0.05). Polytherapy was more used to control epilepsy than monotherapy. Valproate (50.0%), phenobarbital (37.5%), carbamazepine (31.3%) were commonly used drugs for controlling epilepsy. Conclusion : The epilpesy has a negative effect on psychomotor and mental development in the children with CP or DD.ope

ffect of Clonidine on Spasticity in Patients with Spinal Cord Injury

Objective : Spasticity has been reported to be one of the common complications in patients with spinal cord injury. The purposes of this study were to investigate the proper dosage, the therapeutic and undesirable effects of clonidine with combined used of baclofen for the management of spasticity. Method : A prospective study was performed for 17 patients with spinal cord injury who did not improve spasticity with 80 mg baclofen administration. The degree of spasticity was assessed in the more-affected knee by modified Ashworth scale, pendulum test at pre-treatment and at 7 days after receiving clonidine. We also investigated the complications and subjective satisfaction. Results : Seven of 13 patients with spinal cord injury showed subjective improvement in spasticity. We found significant improvement in the relaxation index by pendulum test after administration of more than 0.3 mg of clonidine. There was no significant difference between the subgroups depending on the extent of spinal cord injury. We didn't find any serious complication in adjuvant clonidine therapy. Conclusion : Adjuvant clonidine therapy can be effective in spasticity of spinal cord injured patients without serious complication.ope

Clinical Anatomy of the Puboprostatic Ligament for the Safe Guidance for the Prostate Surgery

OBJECTIVE: To provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy. MATERIALS AND METHODS: Pelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments. RESULTS: The puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament. CONCLUSION: Puboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.ope

Characteristics of the 3D Gait Analysis in Gait MaturationProcess in Korean Children

Objective: To find out the characteristics of gait maturation process in Korean normal children. Method: Three dimensional kinematic gait analysis using Vicon 370 system from Oxford Metrics Company was performed for 72 children (33 females) without known gait anomalies aging between one and six years old. The data were compared with those from 41 normal adults which were collected previously using the same method, and with those from study by Sutherland et. al. Results: 1. The initial heel contact, initial flexion wave of the knee joint during the early stance phase and reciprocal arm swing were found before the age of 3.5. 2. Pelvic motion in transverse plane, hip joint motion in all the three planes, knee joint motion in coronal plane, and ankle joint motion in transverse plane remained greater than those of Caucasian children of Sutherland et. al. 3. Single stance period remained shorter than that of Caucasian children. 4. Internal rotation of hip joint and varus motion of the knee joint remained greater than those of Caucasian children. Conclusion: The difference between Korean and Caucasian children were 1. Development of muscles' ability which stabilize the large leg joints during gait seems slower among Korean children than Caucasian children. 2. These differences are probably from the anthropometrical characteristics of Korean and Caucasian growing children. Also, the different definition of angle systems between the Korean and Caucasian data might case some erroneous effect on the interpretation of result.ope

Effects of Botulinum Toxin A Therapy on Gastrocnemiusin Spastic Cerebral Palsied Children

Objectives: The aim of this study was to assess the changes of the spasticity and gait pattern after botulinum toxin A injection on the gastrocnemius muscle. Method : Thirty five legs of twenty-six ambulatory cerebral palsy children aged from two to sixteen year old were treated. Botulinum toxin A (Allergan, USA) from 2 to 8 U/Kg bodyweight was injected on the gastrocnemius without sedation and electromyographic guidance. The modified Ashworth scale, the reflex excitability test were used for the assessment of spasticity. The changes of gait pattern were collected using 6 camera VICON system. All assessments were measured before and at two weeks after injection. Results : 1) The modified Ashworth scale of ankle plantar flexor improved significantly. 2) The reflex excitability test result decreased significantly in gain. 3) The kinematic data showed significant improvements in sagittal plane of the ankle at two weeks after injection. The children with the genu recurvatum showed improvement in sagittal plane of the knee and those with the crouch gait didn't show aggravation of gait pattern after the injection. Conclusion : The intramuscular botulinum toxin A injection reduced the spasticity and improved the gait pattern in the cerebral palsied children with ankle plantar flexor spasticity.ope

Rehabilitation treatment system for the convalescent and maintenance periods

Since rehabilitation treatment does not simply treat a disease, but treats the patient who has a disease, it is not desirable to determine the treatment strategies based soly on the time of onset of a disease. Rehabilitation treatment should involve carefully evaluating the features of the disease and the patient, which requires considerable time. The convalescent (subacute) period requires a system in which rehabilitation treatment for central nervous system diseases can be administered for at least 2 years. In addition, the definitions and details of rehabilitation treatment that can be conducted by a rehabilitation specialist in the convalescent period and those of rehabilitation treatment conducted in the maintenance (chronic) period should be determined in advance, and these steps should be combined with the development of appropriate provisions in the medical insurance system for each period.ope