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1.  Effect of Robotic-Assisted Gait Training in Patients With Incomplete Spinal Cord Injury 
Annals of Rehabilitation Medicine  2014;38(6):719-725.
Objective
To determine the effect of robotic-assisted gait training (RAGT) compared to conventional overground training.
Methods
Sixty patients with motor incomplete spinal cord injury (SCI) were included in a prospective, randomized clinical trial by comparing RAGT to conventional overground training. The RAGT group received RAGT three sessions per week at duration of 40 minutes with regular physiotherapy in 4 weeks. The conventional group underwent regular physiotherapy twice a day, 5 times a week. Main outcomes were lower extremity motor score of American Spinal Injury Association impairment scale (LEMS), ambulatory motor index (AMI), Spinal Cord Independence Measure III mobility section (SCIM3-M), and walking index for spinal cord injury version II (WISCI-II) scale.
Results
At the end of rehabilitation, both groups showed significant improvement in LEMS, AMI, SCIM3-M, and WISCI-II. Based on WISCI-II, statistically significant improvement was observed in the RAGT group. For the remaining variables, no difference was found.
Conclusion
RAGT combined with conventional physiotherapy could yield more improvement in ambulatory function than conventional therapy alone. RAGT should be considered as one additional tool to provide neuromuscular reeducation in patient with incomplete SCI.
doi:10.5535/arm.2014.38.6.719
PMCID: PMC4280366  PMID: 25566469
Walking; Spinal cord injuries; Robotics; Recovery of function; Rehabilitation
2.  Effect of Virtual Reality on Cognitive Dysfunction in Patients With Brain Tumor 
Annals of Rehabilitation Medicine  2014;38(6):726-733.
Objective
To investigate whether virtual reality (VR) training will help the recovery of cognitive function in brain tumor patients.
Methods
Thirty-eight brain tumor patients (19 men and 19 women) with cognitive impairment recruited for this study were assigned to either VR group (n=19, IREX system) or control group (n=19). Both VR training (30 minutes a day for 3 times a week) and computer-based cognitive rehabilitation program (30 minutes a day for 2 times) for 4 weeks were given to the VR group. The control group was given only the computer-based cognitive rehabilitation program (30 minutes a day for 5 days a week) for 4 weeks. Computerized neuropsychological tests (CNTs), Korean version of Mini-Mental Status Examination (K-MMSE), and Korean version of Modified Barthel Index (K-MBI) were used to evaluate cognitive function and functional status.
Results
The VR group showed improvements in the K-MMSE, visual and auditory continuous performance tests (CPTs), forward and backward digit span tests (DSTs), forward and backward visual span test (VSTs), visual and verbal learning tests, Trail Making Test type A (TMT-A), and K-MBI. The VR group showed significantly (p<0.05) better improvements than the control group in visual and auditory CPTs, backward DST and VST, and TMT-A after treatment.
Conclusion
VR training can have beneficial effects on cognitive improvement when it is combined with computer-assisted cognitive rehabilitation. Further randomized controlled studies with large samples according to brain tumor type and location are needed to investigate how VR training improves cognitive impairment.
doi:10.5535/arm.2014.38.6.726
PMCID: PMC4280367  PMID: 25566470
Brain tumors; Cognition; Virtual reality therapy
3.  Clinical Characteristics Associated With Aspiration or Penetration in Children With Swallowing Problem 
Annals of Rehabilitation Medicine  2014;38(6):734-741.
Objective
To evaluate demographic characteristics of children with suspected dysphagia who underwent videofluoroscopic swallowing study (VFSS) and to identify factors related to penetration or aspiration.
Methods
Medical records of 352 children (197 boys, 155 girls) with suspected dysphagia who were referred for VFSS were reviewed retrospectively. Clinical characteristics and VFSS findings were analyzed using univariate and multivariate analyses.
Results
Almost half of the subjects (n=175, 49%) were under 24 months of age with 62 subjects (18%) born prematurely. The most common condition associated with suspected dysphagia was central nervous system (CNS) disease. Seizure was the most common CNS disorder in children of 6 months old or younger. Brain tumor was the most important one for school-age children. Aspiration symptoms or signs were the major cause of referral for VFSS in children except for infants of 6 months old or where half of the subjects showed poor oral intake. Penetration or aspiration was observed in 206 of 352 children (59%). Subjects under two years of age who were born prematurely at less than 34 weeks of gestation were significantly (p=0.026) more likely to show penetration or aspiration. Subjects with congenital disorder with swallow-related anatomical abnormalities had a higher percentage of penetration or aspiration with marginal statistical significance (p=0.074). Multivariate logistic regression analysis revealed that age under 24 months and an unclear etiology for dysphagia were factors associated with penetration or aspiration.
Conclusion
Subjects with dysphagia in age group under 24 months with preterm history and unclear etiology for dysphagia may require VFSS. The most common condition associated with dysphagia in children was CNS disease.
doi:10.5535/arm.2014.38.6.734
PMCID: PMC4280368  PMID: 25566471
Fluoroscopy; Pediatrics; Dysphagia; Premature infant; Aspiration pneumonia
4.  Korean Version of the Scale for the Assessment and Rating of Ataxia in Ataxic Stroke Patients 
Annals of Rehabilitation Medicine  2014;38(6):742-751.
Objective
To investigate the intra-rater and inter-rater reliability and usefulness of the Korean version of the Scale for the Assessment and Rating of Ataxia (K-SARA) in ataxic stroke patients.
Methods
The original SARA was translated into Korean, back translated to English, and compared to the original version. Stroke patients (n=60) with ataxia were evaluated using the K-SARA by one physiatrist and one occupational therapist. All subjects were rated twice. We divided the subjects into 5 groups by Functional Ambulation Category (FAC) and 3 groups based on the ataxia subscale of the National Institutes of Health Stroke Scale (NIHSS). The mean K-SARA scores representing each group of FAC and the ataxia subscale of NIHSS were compared.
Results
The test-retest correlation coefficient of the K-SARA was 0.997 by the therapist and 1.00 by the physiatrist (p<0.001). The inter-rater correlation coefficient of the K-SARA was 0.985 (p<0.001). The ataxia subscale of NIHSS did not correlate with K-SARA. There was a significant difference in the mean K-SARA score by FAC (p<0.001).
Conclusion
K-SARA is a reliable and valid measure of ataxia in stroke patients in Korea.
doi:10.5535/arm.2014.38.6.742
PMCID: PMC4280369  PMID: 25566472
Ataxia; Ataxia assessment; Stroke; Rehabilitation
5.  The Differences in Clinical Aspect Between Specific Language Impairment and Global Developmental Delay 
Annals of Rehabilitation Medicine  2014;38(6):752-758.
Objective
To compare and analyze the clinical characteristics of children with delayed language acquisition due to two different diagnoses, which were specific language impairment (SLI, a primarily delayed language development) and global developmental delay (GDD, a language delay related to cognitive impairment).
Methods
Among 1,598 children who had visited the developmental delay clinic from March 2005 to February 2011, 467 children who were diagnosed with GDD and 183 children who were diagnosed with SLI were included in this study. All children were questioned about past, family, and developmental history, and their language competences and cognitive function were assessed. Some children got electroencephalography (EEG), in case of need.
Results
The presence of the perinatal risk factors showed no difference in two groups. In the children with GDD, they had more delayed acquisition of independent walking and more frequent EEG abnormalities compared with the children with SLI (p<0.01). The positive family history of delayed language development was more prevalent in children with SLI (p<0.01). In areas of language ability, the quotient of receptive language and expressive language did not show any meaningful statistical differences between the two groups. Analyzing in each group, the receptive language quotient was higher than expressive language quotient in both group (p<0.01). In the GDD group, the Bayley Scales of Infant Development II (BSID-II) showed a marked low mental and motor quotient while the Wechsler Intelligence Scale showed low verbal and nonverbal IQ. In the SLI group, the BSID-II and Wechsler Intelligence Scale showed low scores in mental area and verbal IQ but sparing motor area and nonverbal IQ.
Conclusion
The linguistic profiles of children with language delay could not differentiate between SLI and GDD. The clinicians needed to be aware of these developmental issues, and history taking and clinical evaluation, including cognitive assessment, could be helpful to diagnose adequately and set the treatment plan for each child.
doi:10.5535/arm.2014.38.6.752
PMCID: PMC4280370  PMID: 25566473
Language development; Specific language impairment; Global developmental delay
6.  Characteristics of Cognitive Impairment in Patients With Post-stroke Aphasia 
Annals of Rehabilitation Medicine  2014;38(6):759-765.
Objective
To analyze cognitive functions of post-stroke aphasia patients compared to patients having right hemispheric stroke and left hemispheric lesions without aphasia, and to look for a relationship between cognitive deficits and aphasia severity.
Methods
Thirty-six patients with right hemispheric stroke (group 1), 32 with left hemispheric lesion without aphasia (group 2), and 26 left hemispheric stroke patients with aphasia (group 3) completed a set of tests in the computerized neurocognitive function batteries for attention, executive function and intelligence and Korean version of Western Aphasia Battery. Data analyses explored cognitive characteristics among the three groups and the correlation between cognitive deficits and aphasia severity.
Results
Right hemispheric and left hemispheric stroke patients without aphasia showed similar findings except for digit span forward test. Cognitive tests for working memory and sustained attention were significantly impaired in the aphasic patients, but intelligence was shown to be similar in the three groups. Significant correlation between cognitive deficit and aphasia severity was only shown in some attention tests.
Conclusion
Cognitive deficits may be accompanied with post-stroke aphasia and there are possible associations between language and cognitive measures. Therefore, detection and treatment towards coexisting cognitive impairment may be necessary for efficient aphasia treatment.
doi:10.5535/arm.2014.38.6.759
PMCID: PMC4280371  PMID: 25566474
Stroke; Aphasia; Cognition
7.  Effects of Atrial Fibrillation on the Outcome of the Rehabilitation in Patients With Cerebral Infarction 
Annals of Rehabilitation Medicine  2014;38(6):766-774.
Objective
To evaluate the influence of atrial fibrillation (Af) on the clinical characteristics and rehabilitation outcomes of patients with cerebral infarction.
Methods
We evaluated 87 of 101 consecutive patients with cerebral infarction admitted to the department of physical medicine and rehabilitation during their rehabilitation period. The patients were divided into two groups, Af and non-Af groups. We estimated characteristics of patient demographic features, disease duration, length of hospital stay, other comorbidities and risk factors for stroke, and functional status at admission and at discharge and compared those in patients with and without Af. Functional Independence Measure (FIM), the Modified Barthel Index (MBI), and the PULSES profile (PULSES) were used to evaluate functional status.
Results
The number in the Af group was 20 (22.9%) and that of the non-Af group was 67 (77.1%). Demographic features, other comorbidities, motor function, cognitive function, neurological scales, and brain lesions did not differ significantly between the groups. The incidence of coronary artery disease and valvular heart disease were significantly correlated with the incidence of Af in multivariate analysis. Based on FIM, MBI, and PULSES scores, functional improvement in the Af group after rehabilitation was significantly less than that of the non-Af group.
Conclusion
Af was shown to be associated with a markedly negative result in rehabilitation in patients with cerebral infarction. Thus, early recognition and proper treatment of Af may help patients achieve more effective rehabilitation.
doi:10.5535/arm.2014.38.6.766
PMCID: PMC4280372  PMID: 25566475
Atrial fibrillation; Cerebral infarction; Rehabilitation outcomes
8.  Usual Dose of Caffeine Has a Positive Effect on Somatosensory Related Postural Stability in Hemiparetic Stroke Patients 
Annals of Rehabilitation Medicine  2014;38(6):775-783.
Objective
To evaluate the effect of caffeine on balance control of hemiparetic stroke patients, we investigated the difference in postural stability before and after drinking coffee by observing changes in stability index (SI) from posturography.
Methods
Thirty patients with history of stroke and 15 age-matched healthy subjects participated in this study. Effect of group factor (of the control and stroke groups) and treatment factor (pre- and post-drinking of coffee) on SI were tested in three conditions: with eyes opened, with eyes closed, and with a pillow support. The effects of these factors on visual deprivation and somatosensory change of subjects were also tested.
Results
Under all conditions, SI was higher in the stroke group than in the control group. Under eyes-open condition, the treatment factor was not statistically significant. Under eyes-closed condition, the interaction between group and treatment factor was statistically significant. After the subjects drank coffee, SI in the control group was increased. However, SI in the stroke group was decreased. Under pillow-supported condition, the interaction between group and treatment factor appeared marginally significant. For visual deprivation effect, the interaction between treatment and group factor was statistically significant. After caffeine consumption, the visual deprivation effect was increased in control group but decreased in the stroke group. For somatosensory change effect, the interaction between group and treatment factor was not statistically significant.
Conclusion
Postural stability of hemiparetic stroke patients related to somatosensory information was improved after intake of usual dose of caffeine.
doi:10.5535/arm.2014.38.6.775
PMCID: PMC4280373  PMID: 25566476
Caffeine; Stroke; Balance
9.  Age Specificity in General and Rehabilitation Medical Services in Children With Cerebral Palsy 
Annals of Rehabilitation Medicine  2014;38(6):784-790.
Objective
To review the medical utilization in children with cerebral palsy according to age and discern particularities
Methods
From January 2007 to December 2007, 10,659 children and adolescents between 1 and 18 years of age who had filed national insurance claims for a diagnosis of cerebral palsy were selected. Age was chosen as an independent variable, and the population was categorized into specific age groups to verify any differences in medical service utilization. Admission duration to rehabilitation, number of visits to rehabilitation outpatient clinics, numbers of admission dates and outpatient clinic visits for general medical services, number of rehabilitation utilizations, and type of rehabilitations treatment were selected as dependent variables. One-way ANOVA was used for statistical evaluation, and analysis was done with SAS software.
Results
In general medical use, adolescences diagnosed with cerebral palsy had the highest mean admission duration (p<0.001). The mean visit day to outpatient clinics for general medical services was highest for infants (p<0.001). In rehabilitation treatment, infants diagnosed with cerebral palsy had the highest mean admission duration (p<0.001). The mean visit day to outpatient clinics for rehabilitation treatment was highest for infants (p<0.001).
Conclusion
Significant differences in use of general and rehabilitation medical services among pediatric age groups with cerebral palsy were evident. This implies that particular attention is necessary when setting up a national medical care policy for patient with cerebral palsy.
doi:10.5535/arm.2014.38.6.784
PMCID: PMC4280374  PMID: 25566477
Cerebral palsy; Age; Cost; Visit; Treatment
10.  Use of Magnetic Resonance Imaging to Identify Outcome Predictors of Caudal Epidural Steroid Injections for Lower Lumbar Radicular Pain Caused by a Herniated Disc 
Annals of Rehabilitation Medicine  2014;38(6):791-798.
Objective
We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD).
Methods
Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc).
Results
A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical.
Conclusion
The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome.
doi:10.5535/arm.2014.38.6.791
PMCID: PMC4280375  PMID: 25566478
Radicular pain; Epidural injections; Caudal; Ultrasound; Magnetic resonance image
11.  Cardiac Rehabilitation After Acute Myocardial Infarction Resuscitated From Cardiac Arrest 
Annals of Rehabilitation Medicine  2014;38(6):799-804.
Objective
To examine the safety and effectiveness of cardiac rehabilitation on patients resuscitated from cardiac arrest due to acute myocardial infarction.
Methods
The study included 23 subjects, including 8 with history of cardiac arrest and 15 without history of cardiac arrest. Both groups underwent initial graded exercise test (GXT) and subsequent cardiac rehabilitation for 6 weeks. After 6 weeks, both groups received follow-up GXT.
Results
Statistically significant (p<0.05) increase of VO2peak and maximal MVO2 but significant (p<0.05) decrease of submaximal MVO2 and resting heart rate were observed in both groups after 6 weeks of cardiac rehabilitation. An increasing trend of maximal heart rates was observed in both groups. However, the increase was not statistically significant (p>0.05). There was no statistically significant change of resting heart rate, maximal heart rate, maximal MVO2, or submaximal MVO2 in both groups after cardiac rehabilitation. Fatal cardiac complications, such as abnormal ECG, cardiac arrest, death or myocardial infarction, were not observed. All subjects finished the cardiac rehabilitation program.
Conclusion
Improvement was observed in the exercise capacity of patients after aerobic exercise throughout the cardiac rehabilitation program. Therefore, cardiac rehabilitation can be safely administered for high-risk patients with history of cardiac arrest. Similar improvement in exercise capacity can be expected in patients without cardiac arrest experience.
doi:10.5535/arm.2014.38.6.799
PMCID: PMC4280376  PMID: 25566479
Cardiac arrest; Myocardial infarction; Rehabilitation
12.  Effects of Repeated Steroid Injection at Subacromial Bursa With Different Interval 
Annals of Rehabilitation Medicine  2014;38(6):805-811.
Objective
To evaluate the effects of repeated steroid injection at subacromial bursa with different interval for patient with periarticular shoulder disorder.
Methods
Group A (n=10) received subacromial bursa injection only on their first visit, group C (n=10) received the injection on their first visit and one week later, and group B (n=10) received the injection on their first visit and two weeks later. All injections were done with a combination of 40 mg (1.0 mL) of triamcinolone and 5.0 mL 0.5% lidocaine (6 mL total). We examined the active range of motion (AROM) of the shoulder joint, visual analogue scale (VAS), and shoulder disability questionnaire (SDQ) at baseline at 1, 2, and 4 weeks after the initial injection.
Results
In VAS, comparing the changes in VAS between groups, group B showed significant improvements compared with group A or C at 4 weeks after the initial injection (p<0.05). In SDQ, comparing the changes in SDQ between the groups, group B and C showed more improvement than group A at 4 weeks after the initial injection, but these results were not statistically significant (p>0.05). In AROM, comparing the changes in AROM of external rotation between groups, group B and C showed significant improvement compared with group A at 4 weeks after the initial injection (p<0.05).
Conclusion
It may be more effective in pain relief for patients with periarticular disorder to receive subacromial bursa injections twice with 2-week interval, as opposed to once.
doi:10.5535/arm.2014.38.6.805
PMCID: PMC4280377  PMID: 25566480
Effect repeated steroid injection; Subacromial bursa; Periarticular shoulder disorder
13.  Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients 
Annals of Rehabilitation Medicine  2014;38(6):812-820.
Objective
To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients.
Methods
A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling.
Results
DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients.
Conclusion
CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.
doi:10.5535/arm.2014.38.6.812
PMCID: PMC4280378  PMID: 25566481
Computed tomography; Edema; Venography; Venous thrombosis
14.  Radiologic Assessment of Forward Head Posture and Its Relation to Myofascial Pain Syndrome 
Annals of Rehabilitation Medicine  2014;38(6):821-826.
Objective
To assess head posture using cervical spine X-rays to find out whether forward head posture is related to myofascial pain syndrome (MPS) in neck and shoulder.
Methods
Eighty-eight participants who were diagnosed with MPS in neck and shoulder were evaluated in this study. Four parameters (distance among head, cervical spines, and shoulder, and cervical angle) were measured from lateral view of cervical spine X-ray. The location and number of trigger points in the neck and shoulder and symptom duration were evaluated for each patient.
Results
Both horizontal distances between C1 vertebral body and C7 spinous process and between the earhole and C7 vertebral body were negatively correlated with cervical angle reflecting cervical lordosis (p<0.05). Younger patients had significantly (p<0.05) less cervical angle with more forward head posture. There was no relationship between MPS (presence, location, and number of trigger points) and radiologic assessments (distance parameters and the cervical angle).
Conclusion
Forward head posture and reduced cervical lordosis were seen more in younger patients with spontaneous neck pain. However, these abnormalities did not correlate with the location or the number of MPS. Further studies are needed to delineate the mechanism of neck pain in patients with forward head posture.
doi:10.5535/arm.2014.38.6.821
PMCID: PMC4280379  PMID: 25566482
Cervical vertebrae; Lordosis; Neck pain; Myofascial pain syndromes; Trigger points
15.  Prognostic Factors Predicting Early Recovery of Pre-fracture Functional Mobility in Elderly Patients With Hip Fracture 
Annals of Rehabilitation Medicine  2014;38(6):827-835.
Objective
To investigate the prognostic factors predicting the recovery of pre-fracture functional mobility, we evaluated this by the use of ambulatory assistive devices in short-term follow-up.
Methods
Five hundred and fifty-three elderly patients who had undergone hip fracture operations from January 2006 to June 2013 were enrolled in this retrospective study. Clinical characteristics and predicted factors affecting functional recovery, such as the delay of rehabilitation after the operation, were reviewed. The functional status of the gait was classified as either a bedridden state, wheelchair-bound state, walker gait, single cane gait, and self-gait without any ambulatory assistance device. When this functional grade in patients who recovered after the surgery was compared to before the surgery, this state was considered 'functional recovery'.
Results
One hundred and ninety-two patients (34.7%) showed recovery of preoperative mobility in the first month after their operation. Multiple logistic regression analysis identified that the following four factors were significantly associated with a deterioration of functional recovery: old age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.97), delays in rehabilitation after operation (OR, 0.94; 95% CI, 0.89-0.98), the presence of cognitive dysfunction (OR, 0.36; 95% CI, 0.18-0.71), and trochanteric fracturing (OR, 0.58; 95% CI, 0.36-0.94).
Conclusion
We found that old age, cognitive dysfunction, trochanteric fracture type, and delay of rehabilitation were associated with the deterioration of functional recovery after a hip fracture operation in the short-term. Therefore, early rehabilitation was required to acquire functional recovery after a hip fracture operation in the short-term.
doi:10.5535/arm.2014.38.6.827
PMCID: PMC4280380  PMID: 25566483
Hip fractures; Prognosis; Rehabilitation; Recovery of function
16.  Determination of an Ideal Stimulation Site of the Medial Antebrachial Cutaneous Nerve Using Ultrasound and Investigation of the Efficiency 
Annals of Rehabilitation Medicine  2014;38(6):836-842.
Objective
To determine an ideal stimulation site of the medial antebrachial cutaneous nerve (MACN) using ultrasound measurement and to compare the efficiency of the new stimulation site with the conventional stimulation site on the nerve conduction study.
Methods
Both arms of 15 healthy participants were measured using ultrasound. The MACN was identified in the transverse view at each 0, 2, 4, 6, and 8 cm proximal sites from the medial epicondyle, and the distances to the median nerve and to the skin from the MACN were measured. The ideal stimulation site should be located at the level which can give the shortest distance from the skin and the longest distance from the median nerve in terms of volume conduction. To confirm the efficiency of the ideal site, we measured the amplitude of the MACN conduction study at the ideal site against one at the 4 cm proximal to the medial epicondyle (conventional site).
Results
The ultrasound showed the ideal stimulation site for the MACN could be the elbow crease line. However, the nerve conduction study revealed that the amplitudes of the MACN were significantly larger at the 4 cm proximal to the medial epicondyle compared with ones at the ideal site.
Conclusion
The ideal stimulation site based on the ultrasound did not permit better stimulation site for the nerve conduction study of the MACN compared with the conventional site. Careful adjustment of the stimulation site on the basis of this study would contribute to an accurate conduction study of the MACN.
doi:10.5535/arm.2014.38.6.836
PMCID: PMC4280381  PMID: 25566484
Medial antebrachial cutaneous nerve; Ultrasonography; Neural conduction
17.  Ruptured Popliteal Cyst Diagnosed by Ultrasound Before Evaluation for Deep Vein Thrombosis 
Annals of Rehabilitation Medicine  2014;38(6):843-846.
Most popliteal cysts are asymptomatic. However, cysts may rupture, resulting in pain and swelling of the leg that could also arise from other diseases, including deep vein thrombosis, lymphedema, cellulitis, and tear of a muscle or tendon. Therefore, it is difficult to diagnose a ruptured popliteal cyst based on only a patient's history and physical examination. Musculoskeletal ultrasound has been regarded as a diagnostic tool for ruptured popliteal cyst. Here, we describe a patient who was rapidly diagnosed as ruptured popliteal cyst by ultrasonography. Therefore, ultrasound could be used to distinguish a ruptured popliteal cyst from other diseases in patients with painful swollen legs before evaluation for deep vein thrombosis.
doi:10.5535/arm.2014.38.6.843
PMCID: PMC4280382  PMID: 25566485
Calf pain; Complicated popliteal cyst; Ultrasonography
18.  Apraxia of Eyelid Opening After Brain Injury: A Case Report 
Annals of Rehabilitation Medicine  2014;38(6):847-851.
Apraxia of eyelid opening (AEO) is a syndrome characterized by the patient's difficulty in initiating eyelid elevation spontaneously. Most of the reported cases were associated with extrapyramidal diseases. We report a case of AEO presented after traumatic brain injury, not with extrapyramidal diseases, and improved by dopaminergic treatment. A 49-year-old man underwent a traffic accident and was transferred to the emergency room in an unconscious state. Brain computed tomography (CT) revealed a subdural and epidural hemorrhage at right temporal and bilateral frontal lobes, and he received burr-hole trephination. After receiving comprehensive treatment including occupational therapy, cognition and mobility gradually improved, but he could not open his eyes voluntarily. With dopaminergic treatment (levodopa/benserazide 200/50 mg), he started to open his eyes spontaneously, especially when eating and undergoing physical training. This case showed that AEO may occur after brain injury and that dopaminergic treatment is beneficial also in AEO patients without extrapyramidal diseases.
doi:10.5535/arm.2014.38.6.847
PMCID: PMC4280383  PMID: 25566486
Apraxia of eyelid opening; Brain injury; Agents; Dopaminergic
19.  Churg-Strauss Syndrome Presented With Hearing Impairment and Facial Palsy 
Annals of Rehabilitation Medicine  2014;38(6):852-855.
Churg-Strauss syndrome (CSS) is a rare systemic necrotizing vasculitis. Cranial nerve involvement is very rare in CSS. A 59-year-old woman had complained of both hearing impairments for eight months and left facial palsy for three months. Left facial and cochlear neuropathies were detected in electrodiagnostic studies. Paranasal sinus computed tomography (CT) showed chronic pansinusitis. Chest CT revealed eosinophilic infiltration in the right upper lobe. Tissue biopsy of the right inferior turbinate displayed necrotizing vasculitis with eosinophilic infiltration. She was diagnosed as CSS, based on the presence of eosinophilia, pulmonary infiltration, paranasal sinusitis, and biopsy containing blood vessels with extravascular eosinophils. She was treated with intravenous and oral steroids and azathioprine, showing relatively good prognosis on facial palsy and hearing impairment. We report a very rare case of CSS presented with hearing impairment and facial palsy.
doi:10.5535/arm.2014.38.6.852
PMCID: PMC4280384  PMID: 25566487
Churg-Strauss syndrome; Facial paralysis; Hearing loss
20.  Paraplegia in a Patient With IgG4-Related Sclerosing Disease: A Case Report 
Annals of Rehabilitation Medicine  2014;38(6):856-860.
Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic disease, characterized by mass forming inflammatory lesions which respond well to steroid therapy. Pancreas is the most common site of involvement, and other organ involvements are also common. However, there are only a few reports about central nervous system involvement. We report a case of IgG4-related sclerosing disease which involves spinal cord causing paraplegia. A middle-aged female presented with sudden lower limb weakness. Magnetic resonance imaging showed a soft tissue mass which was diffusely compressing spinal cord along the C7 to T5 levels. Intravenous steroid pulse therapy and emergent operation was performed. The immunopathologic findings revealed IgG4-related sclerosing pachymeningitis postoperatively. There was no evidence of other organ involvement. Her neurologic deficit remained unchanged after two months of comprehensive rehabilitation therapy.
doi:10.5535/arm.2014.38.6.856
PMCID: PMC4280385  PMID: 25566488
Immunoglobulin G; Spinal cord compression; Paraplegia
21.  Chest Wall Pain as the Presenting Symptom of Leptomeningeal Carcinomatosis 
Annals of Rehabilitation Medicine  2014;38(6):861-864.
Leptomeningeal metastasis (LMM), also referred to as leptomeningeal carcinomatosis, results from diffuse infiltration of the leptomeninges by malignant cells originating from extra-meningeal primary tumors. It occurs in approximately 5%-10% of patients with solid tumor. Among solid tumors, the most common types leading to infiltration of the leptomeninges are breast cancer, lung cancer, and melanoma. Patients with LMM may present various signs and symptoms. Herein, we report a rare case with initial presentation of isolated chest wall pain. Computed tomography of the chest with contrast revealed a 2.5-cm nodule over the left upper lung. Biopsy confirmed the diagnosis of adenocarcinoma. Later, cerebrospinal fluid cytology exam also confirmed leptomeningeal seeding. It is rare for leptomeningeal carcinomatosis patients to present with chest wall pain. Therefore, a high index of suspicion is mandatory for accurate and prompt diagnosis.
doi:10.5535/arm.2014.38.6.861
PMCID: PMC4280386  PMID: 25566489
Meningeal carcinomatosis; Neoplasm metastasis; Chest pain; Lung cancer; Leptomeningeal metastasis
22.  Kinematic Changes in Swallowing After Surgical Removal of Anterior Cervical Osteophyte Causing Dysphagia: A Case Series 
Annals of Rehabilitation Medicine  2014;38(6):865-870.
This retrospective case series included five patients who underwent surgical resection of the cervical anterior osteophyte due to dysphagia. Videofluoroscopic swallowing studies (VFSSs) were performed before and after surgery on each patient, and kinematic analysis of the video clips from the VFSS of a 5-mL liquid barium swallow was carried out. Functional oral intake improved after surgery in 3/4 patients who had required a modified diet before surgery. Kinematic analysis showed increases in the maximal hyoid vertical movement length (13.16±5.87 to 19.09±4.77 mm, p=0.080), hyoid movement velocities (170.24±84.71 to 285.53±104.55 mm/s, p=0.043), and upper esophageal sphincter opening width (3.97±0.42 to 6.39±1.32 mm, p=0.043) after surgery. In conclusion, improved upper esophageal sphincter opening via enhancement of hyoid movement after cervical anterior osteophyte resection may be the kinetic mechanism of improved swallowing function.
doi:10.5535/arm.2014.38.6.865
PMCID: PMC4280387  PMID: 25566490
Deglutition disorders; Osteophyte; Hyoid bone
23.  Intracranial Hemorrhage in the Corpus Callosum Presenting as Callosal Disconnection Syndrome: FDG-PET and Tractography: A Case Report 
Annals of Rehabilitation Medicine  2014;38(6):871-875.
We report the findings of 18F-fluorodeoxyglocese positron emission tomography (FDG-PET) and diffusion tensor tractography (DTT) in a right-handed patient presenting with callosal disconnection syndrome, including alien hand syndrome, after an anterior communicating artery aneurysmal rupture. The 49-year-old patient had right hemiparesis and unintended movement of the right hand during action of the left hand. A brain magnetic resonance imaging revealed lesions in the upper part of the genu and body in the corpus callosum as well as hemorrhage in the inter-hemispheric fissure. We observed extensive disruption of corpus callosum fibers in the upper genu and trunk by DTT for the evaluation of inter-hemispheric connection. FDG-PET revealed severe hypometabolism in the left cerebral hemisphere, including basal ganglia and thalamus, and hypermetabolism in the right cerebral hemisphere. Based on findings of FDG-PET and DTT, the callosal disconnection syndrome presented in the patient could be the result of loss of transcallosal inhibition in the contralateral hemisphere.
doi:10.5535/arm.2014.38.6.871
PMCID: PMC4280388  PMID: 25566491
Corpus callosum; Positron emission tomography; Diffusion tensor imaging

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