Comparision of nonaffected hand function of hemiplegic children with bilateral hand function of normal children

보건정책 및 관리학과/석사[한글] 본 연구의 목적은 편마비 아동을 대상으로 Jebsen Hand Function 평가 도구를 이용하여 편마비아동의 건측과 정상아동의 양손의 기능을 비교하여 그 차이가 있나를 알아보는 데 있다. 연구의 대상자로는 연세 대학교 의과대학 재활 병원과 서울장애자복지관의 작업 치료실과 인천 세브란스 병원 물리 치료실을 방문한 6세의 편마비 아동 19명과 같은 나이의 인천 시내의 한 유치원 아동 20명을 대상으로 1996년 4월에서 5월까지 손의 기능을 측정하였다. 이 연구의 결과는 다음과 같다. 편마비아동의 건측손이 오른손일 때 정상아동의 오른손과 비교하면 작은 물건들, 먹기 흉내, 장기말 쌓기의 영역에서 정상 아동이 유의하게 빨랐다. 또 편마비아동의 건측손이 왼손일 때 정상아동의 왼손과 비교하면 작은 물건들, 장기말 쌓기, 크고 가벼운 깡통, 크 고 무거운 깡통에서 정상 아동이 유의하게 빨랐다. 그리고 진단 받은 시기가 늦을수록, 치료 기간이 길수록 건측손의 기능은 감소하였다. 위의 결과로 미루어 볼 때 편마비아동의 환측손의 기능만이 아니라 건측손의 기능도 정상아동의 양손보다 감소되어 있었다. 따라서 편마비아동의 치료시에는 양손 모두를 평가하고 치료해야 할 것이다. [영문] The purpose of this study was to investigate whether the function of the nonaffected hand of hemiplegic children is comparable to the hand function with both normal hands. The subjects of the study were 19 hemiplegic children and 20 normal children, all six years of age. The hemiplegic children were treated at one of three facilities: Yonsei University Rehabilitation Hospital,Seoul Community Rehabilitation Center and Inchon Severance Hospital during in period March to April,1996. The normalchildren were randomly selected from a kindergarten in Inchon City. All hand function was measured by Jebsen Hand Function Test. Subtest was analysed statistically using the basic statistic analysis, Mann-Whitney test and Pearson correlation test. The results were as follows: The normal children had faster right hand function than hemiplegic children whose nonaffected hand was their right hand, for the small objects, simulated feeding, checkers subtests. Normal children had faster left hand function than hemiplegic children whose nonaffected hand was their left hand, for the small objects, checkers, large light objects and large heavy objects. The unaffected hand function of the hemiplegic children had a negative correlation with time of diagnosis, and treatment duration. These results showed that the nonaffected hand function of hemiplegic children differed from the respective hand of normal children. Therefore, when hemiplegic children are treated, both the affected and unaffected hand must be treated as this will affect the treatment result.restrictio

Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multidetector CT

At magnetic resonance (MR) imaging and multidetector computed tomography (CT), artifacts arising from metallic orthopedic hardware are an obstacle to obtaining optimal images. Although various techniques for reducing such artifacts have been developed and corroborated by previous researchers, a new era of more powerful MR imaging and multidetector CT modalities has renewed the importance of a systematic consideration of methods for artifact reduction. Knowledge of the factors that contribute to artifacts, of related theories, and of artifact reduction techniques has become mandatory for radiologists. Factors that affect artifacts on MR images include the composition of the metallic hardware, the orientation of the hardware in relation to the direction of the main magnetic field, the strength of the magnetic field, the pulse sequence type, and other MR imaging parameters (mainly voxel size, which is determined by the field of view, image matrix, section thickness, and echo train length). At multidetector CT, the factors that affect artifacts include the composition of the hardware, orientation of the hardware, acquisition parameters (peak voltage, tube charge, collimation, and acquired section thickness), and reconstruction parameters (reconstructed section thickness, reconstruction algorithm used, and whether an extended CT scale was used). A comparison of images obtained with different hardware and different acquisition and reconstruction parameters facilitates an understanding of methods for reducing or overcoming artifacts related to metallic implants.ope

Role of magnetic resonance imaging in entrapment and compressive neuropathy—what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity

The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon’s canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.ope

Role of magnetic resonance imaging in entrapment and compressive neuropathy—what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 1. Overview and lower extremity

The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the general concepts that should be known to evaluate the entrapment and compressive neuropathy in MR imaging. We also review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the lower extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the lower extremity are as follows: sciatic nerve around the piriformis muscle; tibial nerve at the popliteal fossa and tarsal tunnel, common peroneal nerve around the fibular neck, and digital nerve near the metatarsal head. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.ope

Chronic Tibiofibular Syndesmosis Injury of Ankle: Evaluation with Contrast-enhanced Fat-suppressed 5D Fast Spoiled Gradient-recalled Acquisition in the Steady State MR Imaging

PURPOSE: To retrospectively determine the accuracy of coronal contrast material-enhanced fat-suppressed three-dimensional (3D) fast spoiled gradient-recalled acquisition in the steady state (SPGR) magnetic resonance (MR) imaging, as compared with that of routine transverse MR imaging, in the assessment of distal tibiofibular syndesmosis injury, with arthroscopy as the reference standard. MATERIALS AND METHODS: The review board of the College of Medicine in Yonsei University approved this study; informed consent was waived. The study group comprised 45 patients (26 men, 19 women; mean age, 32.1 years; range, 18-58 years) with a chronic ankle injury who had undergone MR imaging and arthroscopic surgery. Three independent readers retrospectively reviewed the two sets of MR images (one set of gadolinium-enhanced 3D fast SPGR images and one set of routine T1-, T2-, and intermediate-weighted images). Scores from 1 to 5 in increasing order of the probability of injury were assigned to both sets. Arthroscopy was the reference standard. Syndesmotic recess height was measured on contrast-enhanced images. The two sets of images were compared for diagnostic performance with receiver operating characteristic (ROC) analysis. Dissection and histologic examination of six cadaveric ankles was performed to assess the syndesmotic area and ascertain the enhancing structure at MR imaging. RESULTS: At arthroscopy, syndesmotic injury was found in 24 ankles but not in 21 ankles. Areas under the ROC curve were significantly higher for the contrast-enhanced images (P<.05). The contrast-enhanced set showed higher accuracy, sensitivity, and specificity compared with the routine set for the assessment of syndesmosis injury. Mean syndesmotic recess height was significantly greater (P<.05) in patients with syndesmotic injury. Dissection and histologic examination revealed a highly vascular synovial fold in the syndesmotic area that is expected to enhance at MR imaging. CONCLUSION: In the assessment of chronic syndesmosis injury, coronal gadolinium-enhanced fat-suppressed 3D fast SPGR MR images were more sensitive, specific, and accurate than routine MR images.ope