Hyung-Ik Shin

Relationships between Isometric Muscle Strength, Gait Parameters, and Gross Motor Function Measure in Patients with Cerebral Palsy

Purpose This study investigated the correlation between isometric muscle strength, gross motor function, and gait parameters in patients with spastic cerebral palsy and to find which muscle groups play an important role for gait pattern in a flexed knee gait. Materials and Methods Twenty-four ambulatory patients (mean age, 10.0 years) with spastic cerebral palsy who were scheduled for single event multilevel surgery, including distal hamstring lengthening, were included. Preoperatively, peak isometric muscle strength was measured for the hip flexor, hip extensor, knee flexor, and knee extensor muscle groups using a handheld dynamometer, and three-dimensional (3D) gait analysis and gross motor function measure (GMFM) scoring were also performed. Correlations between peak isometric strength and GMFM, gait kinematics, and gait kinetics were analyzed. Results Peak isometric muscle strength of all muscle groups was not related to the GMFM score and the gross motor function classification system level. Peak isometric strength of the hip extensor and knee extensor was significantly correlated with the mean pelvic tilt (r=-0.588, p=0.003 and r=-0.436, p=0.033) and maximum pelvic obliquity (r=-0.450, p=0.031 and r=-0.419, p=0.041). There were significant correlations between peak isometric strength of the knee extensor and peak knee extensor moment in early stance (r=0.467, p=0.021) and in terminal stance (r=0.416, p=0.043). Conclusion There is no correlation between muscle strength and gross motor function. However, this study showed that muscle strength, especially of the extensor muscle group of the hip and knee joints, might play a critical role in gait by stabilizing pelvic motion and decreasing energy consumption in a flexed knee gait.

Relationship Between Motor Evoked Potential Response and the Severity of Paralysis in Spinal Cord Injury Patients

Objective To investigate the relationship between motor evoked potential (MEP) response and the severity of motor paralysis, evaluated according to the Korean disability evaluation system in patients with spinal cord injury (SCI). Methods We analyzed 192 lower limbs of 96 SCI patients. Lower limbs were classified according to their motor scores, as determined by the International Standards for Neurological Classification of Spinal Cord Injury: motor score <10 (group 1); ≥10 and <15 (group 2); ≥15 and <20 (group 3); and ≥20 (group 4). MEP responses were classified as ‘normal’, ‘delayed’ or ‘absent’, based on their onset latency, which was compared between the different motor score groups. Results MEP responses and limb motor scores were highly correlated (p<0.001). There was a significant difference of MEP responses between the motor score groups (p<0.001). MEP response was markedly poorer in motor group 1 (limb motor score <10) than in the other three groups (p<0.0001). However, there were no differences between the three groups with motor scores of 10 or above. Conclusion Clinical utility of MEP as a complimentary tool to manual muscle tests could be limited to discriminating motor score groups with severe paralysis, i.e., single lower limb motor power grades of 0 or 1, and from grade 2, 3, and 4, or above, in the Korean disability evaluation system.

The natural course of passive tenodesis grip in individuals with spinal cord injury with preserved wrist extension power but paralyzed fingers and thumbs

Study designCross-sectional.ObjectivesTo investigate the natural course of passive tenodesis grip in individuals with spinal cord injury (SCI) with no experience of tenodesis splint application and the related factors for success of the grip.SettingCommunity-dwelling persons with chronic SCI in South Korea.MethodsIndividuals with cervical SCI with preserved wrist extensor power, but completely paralyzed fingers and thumbs, were recruited. For each hand, success or failure of passive tenodesis lateral grip was assessed both in the opening and closing phase. The key task in the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) test was also assessed.ResultsFifty-eight hands of 37 individuals with SCI were analyzed. In 35 of the 58 hands, both opening and closing phases of the grip were achieved. During the closing phase of the passive tenodesis lateral grip, the mean (s.d.) value of the second MP joint flexion angle (°) in the success group was 55.1 (13.6), compared to 38.6 (17.8) in the failure group. The key task in GRASSP was completed in only 14 out of 58 hands. Hands with a wrist extensor power of grade 4 or 5 on a manual muscle test showed higher GRASSP scores than those with a grade 3 wrist extensor power.ConclusionsThe passive tenodesis lateral grip can be achieved in a large number of hands without splint application after SCI, but its use in the key task of the GRASSP is limited.

Obesity cutoff values in Korean men with motor complete spinal cord injury: body mass index and waist circumference

Study designCross-sectional.ObjectivesTo determine the obesity cutoff values for body mass index (BMI) and waist circumference (WC) in Korean men with motor complete spinal cord injury (SCI).SettingTertiary level hospital in Seoul, Korea.MethodsBMI (kg/m2) was calculated and WC (cm) was measured in each participant in the supine position. Percentage of total body fat (%) was determined using whole-body dual-energy X-ray absorptiometry. Receiver operating characteristic curves were generated to determine the obesity cutoff values for BMI and WC. The optimal cutoff values were determined using the Youden index. Identified cutoff values were compared with those of 195 age- and BMI-matched men in the general population (GP), obtained from the Korea National Health and Nutrition Examination Survey.ResultsThis study included 52 Korean men with motor complete SCI. A BMI of 20.2u2009kg/m2 and WC of 81.3u2009cm were identified as obesity cutoff values in Korean men with motor complete SCI. The area under the curve (AUC) was 0.928, specificity was 100%, and sensitivity was 84.8% according to the ROC curve of BMI for participants. AUC was 0.964, specificity was 100%, and sensitivity was 84.8% in the ROC curve of WC for participants. A BMI of 22.5u2009kg/m2 and WC of 85.5u2009cm were identified as obesity cutoff values in age- and BMI-matched men in the GP.ConclusionsThe obesity cutoff values in Korean men with motor complete SCI that were determined in this study were lower than those of the Korean GP and western people with SCI.

Stress Signals During Sucking Activity Are Associated With Longer Transition Time to Full Oral Feeding in Premature Infants

Several treatments have been proposed to shorten the time to the attainment of full oral feeding (FOF) for premature infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the Neonatal Oral-Motor Assessment Scale (NOMAS) could estimate the time to FOF in preterm infants with feeding difficulty. Preterm infants diagnosed with a disorganized sucking pattern in the NOMAS evaluation before 50u2009weeks of postmenstrual age were included. Video recordings of at least 2u2009min of oral feeding were further analyzed retrospectively by two assessors and the premature infants who exhibited disorganized sucking patterns (nu2009=u2009109) were divided into three clusters (clusters 2–4). The observational items compatible with disorganization in the original NOMAS were divided into three groups: cluster 2 (disorganized: arrhythmical), cluster 3 (disorganized: arrhythmicalu2009+u2009unable to sustain), and cluster 4 (disorganized: arrhythmicalu2009+u2009incoordinationu2009±u2009unable to sustain) and further divided into incoordination-positive (cluster 4) and incoordination-negative groups (clusters 2 and 3). Premature infants in the incoordination-positive group (cluster 4, which means stress signals) showed a median transition time of 22u2009days (range: 4–121u2009days) which was longer than that in the incoordination-negative group (median 6u2009days; range: 1–25u2009days). Univariate linear regression analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2 and 3), birth weight, total parenteral nutrition (TPN) duration, non-invasive positive pressure ventilation duration, the presence of moderate to severe bronchopulmonary dysplasia, pulmonary hypertension, sepsis, small for gestational age (SGA), and necrotizing enterocolitis are associated with the transition time to FOF. In a multivariate linear regression analysis, the variables revealed to be associated with the transition time were TPN duration, SGA, and the presence of stress signals (incoordination-positive group) among disorganized sucking patterns. When selecting premature infants to be treated with swallowing therapy, it is reasonable to pay more attention to the incoordination-positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain FOF.

Lower extremity joint contracture according to ambulatory status in children with Duchenne muscular dystrophy

BackgroundLower extremity joint contractures have negative effects on gait in children with Duchenne muscular dystrophy (DMD). Thus, contracture prevention is essential for maintaining a patient’s functional ability and an acceptable quality of life. This study investigated hip flexion (HF), knee flexion (KF), and ankle joint plantar flexion (APF) contractures among male patients with DMD, based on the patients’ ambulatory status. Differences in major joint contractures, based on passive stretching exercise participation, were also investigated.MethodsA total of 128 boys with DMD, followed at the DMD clinic of a tertiary care hospital, were included in this cross-sectional study. The passive ranges-of-motion of the hip, knee, and ankle joints were measured, in the sagittal plane, using a goniometer. The Vignos Scale was used to grade ambulatory function. Boys with DMD who performed stretching exercises for more than 5xa0min/session, >u20093 sessions/week, were classified into the stretching group.ResultsThe HF (23.5o), KF (43.5o), and APF (34.5o) contracture angles in the non-ambulatory group were more severe than those in the ambulatory group. APF contractures (41 patients, 52.6%) were more frequently observed early, even within the ambulatory period, than were hip (8 patients, 10.3%), and knee joint (17 patients, 21.8%) contractures. Passive stretching exercises >u20093 sessions/week were not associated with the degree of lower extremity joint contractures in the ambulatory or non-ambulatory group.ConclusionHF, KF, and APF contractures are more common and severe when there is deterioration of ambulatory function. Stretching exercises alone are unlikely to prevent lower extremity joint contractures.

Needs for Medical and Rehabilitation Services in Adults With Cerebral Palsy in Korea

Objective To investigate medical comorbidities and needs for medical and rehabilitation services of adults with cerebral palsy (CP) in Korea. Methods This was a prospective cross-sectional study. One hundred fifty-four adults with CP were enrolled in the study between February 2014 and December 2014. Information was obtained from participants regarding functional status, demographic and socioeconomic data, medical problems, and requirements for and utilization of medical and rehabilitation services. Results The participants included 93 males and 61 females with a mean age of 40.18±9.15 years. The medical check-up rate of adults with CP was lower than that of healthy adults and the total population with disabilities (53.2% vs. 58.6% vs. 70.4%). A quarter of the subjects failed to visit the hospital during the past year, and the main reason was the financial burden. Due to a cost burden and lack of knowledge, more than one-third of the subjects had unmet needs for rehabilitation services; the majority reported needs for rehabilitation services, such as physical therapy for pain management. Conclusion The medical check-up rate was lower in the adults with CP, even though their medical comorbidities were not less than those of healthy people. Several non-medical reasons hindered them from receiving proper medical and rehabilitation services. Such barriers should be managed effectively.