Provision of Artificial Hand and Cosmetic Hand and Rehabilitation Training on Bilateral Transradial Amputation Patient －A case report－

Upper limb amputation is not frequent but losing a hand or hands results in great functional loss. When a patient has bilateral upper limb amputation, the patient loses complete capability to perform independent daily living movement. The subject was a 20 years old female patient who had bilateral transradial amputation because of frostbite and she had spent a year without using prosthesis. In order to secure independency of patient, hook-type terminal device was applied first so that the patient can lead daily living independently using the prosthesis. Later, artificial hand was applied on the right hand (dominant hand) and cosmetic hand was equipped on the left hand so that the patient can do basic movement during outdoor activity. It was a successful rehabilitation therapy of applying two types of prosthesis, one focusing on functionality and the other focusing on cosmetic aspect, to a patient with bilateral transradial amputation.ope

Usefulness of Magnetic Resonance Neurography for Diagnosis of Piriformis Muscle Syndrome and Verification of the Effect After Botulinum Toxin Type A Injection: Two Cases

Piriformis muscle syndrome (PMS) is a controversial neuromuscular disorder that is presumed to involve compression neuropathy of the sciatic nerve at the level of the piriformis muscle. Botulinum toxin A (BTX-A) injection into the piriformis muscle is widely used as a treatment aimed at relieving sciatic nerve compression. In 2 patients with PMS, magnetic resonance neurography (MRN) was taken before and after BTX-A injection. The first MRN was performed as a diagnostic tool, and the second to identify the effect of the treatment. Signal change of the sciatic nerve under the hypertrophied piriformis muscle was confirmed by MRN. In follow-up MRN performed after BTX-A injection into the piriformis muscle, changes of the sciatic nerve and piriformis muscle were noticed as well as improvement of clinical symptoms. MRN is a useful tool to add certainty of diagnosis and verify the effect of treatment in PMS.ope

Stepwise Rehabilitation of the Triple Amputee Combined With Dysfunction of the Sound Limb

To find a multiple amputee more severe than a triple amputee is not easy. This is a report of a 36-year-old patient with right knee disarticulation, left trans-femoral amputation and right elbow disarticulation due to peripheral ischemic necrosis, when he was applied vasopressor in septic shock condition. His left hand was also 2nd, 3rd, 4th, and 5th distal interphalangeal joint disarticulation status, and it was more difficult for him to do rehabilitation program, such as donning and doffing the prostheses. For more efficient rehabilitation training program, we first focused on upper extremities function, since we believed that he might need a walking aid for gait training later. After 13 weeks of rehabilitation program, he has become sit to stand and walk short distance independently with an anterior walker. Although he still needs some assistance with activities of daily living, his Functional Independence Measure score improved from 48 to 90 during the course of 13 weeks.ope

Epidemiologic change of patients with spinal cord injury.

OBJECTIVE: To evaluate the epidemiologic change of patients with spinal cord injury who were admitted to a Rehabilitation Hospital, Yonsei University College of Medicine, during 1987-1996 and 2004-2008. METHODS: Medical records of 629 patients with spinal cord injury admitted to the Rehabilitation Hospital, Yonsei University College of Medicine, from 2004 to 2008 were collected and reviewed retrospectively. RESULTS: The male-to-female ratio decreased to 2.86:1, the mean age at injury increased, nontraumatic etiology increased, traffic accident remained to be the most common in traumatic spinal cord injury, and falling increased significantly. Tumor was the most common etiology in nontraumatic spinal cord injury, tetraplegia and incomplete injuries occurred more than paraplegia and complete injuries, indwelling catheter was the most common voiding method, and the duration of hospitalization decreased CONCLUSION: Many trends changed in epidemiology of spinal cord injury.ope

Diagnostic Value of Facial Nerve Antidromic Evoked Potential in Patients With Bell’s Palsy: A Preliminary Study

OBJECTIVE: To assess the practical diagnostic value of facial nerve antidromic evoked potential (FNAEP), we compared it with the diagnostic value of the electroneurography (ENoG) test in Bell's palsy. METHODS: In total, 20 patients with unilateral Bell's palsy were recruited. Between the 1st and 17th days after the onset of facial palsy, FNAEP and ENoG tests were conducted. The degeneration ratio and FNAEP latency difference between the affected and unaffected sides were calculated in all subjects. RESULTS: In all patients, FNAEP showed prolonged latencies on the affected side versus the unaffected side. The difference was statistically significant. In contrast, there was no significant difference between sides in the normal control group. In 8 of 20 patients, ENoG revealed a degeneration ratio less than 50%, but FNAEP show a difference of more than 0.295±0.599 ms, the average value of normal control group. This shows FNAEP could be a more sensitive test for Bell's palsy diagnosis than ENoG. In particular, in 10 patients tested within 7 days after onset, an abnormal ENoG finding was noted in only four of them, but FNAEP showed a significant latency difference in all patients at this early stage. Thus, FANEP was more sensitive in detecting facial nerve injury than the ENoG test (p=0.031). CONCLUSION: FNAEP has some clinical value in the diagnosis of facial nerve degeneration. It is important that FNAEP be considered in patients with facial palsy at an early stage and integrated with other relevant tests.ope

Efficacy and safety of NABOTA in post-stroke upper limb spasticity: a phase 3 multicenter, double-blinded, randomized controlled trial

Botulinum toxin A is widely used in the clinics to reduce spasticity and improve upper limb function for post-stroke patients. Efficacy and safety of a new botulinum toxin type A, NABOTA (DWP450) in post-stroke upper limb spasticity was evaluated in comparison with Botox (onabotulinum toxin A). A total of 197 patients with post-stroke upper limb spasticity were included in this study and randomly assigned to NABOTA group (n=99) or Botox group (n=98). Wrist flexors with modified Ashworth Scale (MAS) grade 2 or greater, and elbow flexors, thumb flexors and finger flexors with MAS 1 or greater were injected with either drug. The primary outcome was the change of wrist flexor MAS between baseline and 4weeks post-injection. MAS of each injected muscle, Disability Assessment Scale (DAS), and Caregiver Burden Scale were also assessed at baseline and 4, 8, and 12weeks after the injection. Global Assessment Scale (GAS) was evaluated on the last visit at 12weeks. The change of MAS for wrist flexor between baseline and 4weeks post-injection was -1.44±0.72 in the NABOTA group and -1.46±0.77 in the Botox group. The difference of change between both groups was 0.0129 (95% confidence interval -0.2062-0.2319), within the non-inferiority margin of 0.45. Both groups showed significant improvements regarding MAS of all injected muscles, DAS, and Caregiver Burden Scale at all follow-up periods. There were no significant differences in all secondary outcome measures between the two groups. NABOTA demonstrated non-inferior efficacy and safety for improving upper limb spasticity in stroke patients compared to Botox.ope

Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction

PURPOSE: To assess the morphologic changes in herniated lumbar intervertebral disks and surrounding structures during lumbar traction by using real-time magnetic resonance (MR) imaging. MATERIALS AND METHODS: This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. Forty-eight consecutive patients with lumbar disk herniation (13 men and 35 women) were treated with continuous lumbar traction by using a nonmagnetic traction device. Real-time MR imaging of the lumbar spine was performed before the initiation of traction and at 10-minute intervals during 30 minutes of 30 kg of continuous traction. Sagittal and axial MR images were analyzed to determine qualitative changes during lumbar traction. Quantitative changes caused by traction on the lumbar spine were determined by measurement of lumbar vertebral column elongation and the disk reduction ratio. RESULTS: Continuous traction on herniated lumbar disks and surrounding structures resulted in change in disk shape, disk reduction with opening in the intervertebral disk, reduction of herniated disk volume, separation of the disk and adjoining nerve root, and widening of the facet joint. Both the mean lumbar vertebral column length (elongation of 1.45% after 30 minutes, P < .001) and the mean disk reduction ratio (8.57%, 15.24%, and 17.94% after 10, 20, and 30 minutes of traction, respectively) increased with time of traction. CONCLUSION: The results of this study demonstrated that the real-time effects of continuous traction on herniated lumbar intervertebral disks and their surrounding structures can be visualized by using MR imaging.ope