Masaaki Nagata

Functional assessment of patients with spinal cord injury: measured by the motor score and the Functional Independence Measure

There is some information about the Functional Independence Measure (FIM) score of patients with spinal cord injury (SCI), but there are a few publications dealing with the relationship between the FIM score and the motor score of the American Spinal Injury Association (ASIA). We have studied the relationship of all FIM items with the motor score, and reviewed the disability of patients with spinal cord injury in greater detail. The purpose of this study was to describe the characteristics of impairment and disability in patients with SCI, using the FIM and motor score of the ASIA. The subjects were 100 inpatients with SCI (Frankel A, B). Neurological level, days from the onset, and the FIM were examined. In addition to these items, the ASIA motor scores were calculated for 22 tétraplégie patients. We investigated the relationships among these various respects. We also examined the changes of the physical items of the FIM score (physical FIM) over time for 18 patients. The mean FIM scores of those with tetraplegia with C4, C5, C6, C7, C8 lesions, and those with paraplegia with above T5 levels, and those below T6 were 35, 61, 82, 90, 116, 114 and 114 respectively. The FIM score reached the plateau in approximately 10 months, 6 months and 3 months post-injury, in tetraplegia, paraplegia above T5 and that below T6 respectively. The FIM scores in C6 patients were widely distributed from 56 to 104. On the other hand, the ASIA motor score could subdivide C6 patients and related well to the FIM score. The mean FIM scores for each neurological level were similar to those previously reported, thus they appeared to be plateau scores. With regard to the motor score, we feel that it could reflect the disability of the patients better than considering the neurological levels alone. Also considering the changes in the physical FIM score over time within a year from the onset of the injury, there were differences in the ADL improvement patterns among patients with different neurological levels. It appears that timing of the highest physical FIM improvement for each neurological level can exist. Thus it is important not to delay the start of the rehabilitation of patients with spinal cord injury in proper time.

Herpes Zoster–Induced Trunk Muscle Paresis Presenting With Abdominal Wall Pseudohernia, Scoliosis, and Gait Disturbance and Its Rehabilitation: A Case Report

Herpes zoster (HZ)-induced abdominal wall pseudohernia has been frequently reported, but there has been no report describing HZ-induced trunk muscle paresis leading to functional problems. We describe a 73-year-old man with T12 and L1 segmental paresis caused by HZ presenting with abdominal wall pseudohernia, scoliosis, and standing and gait disturbance who responded well to a systematic rehabilitation approach. He first noticed a right abdominal bulge in the 6th postherpetic week, which was gradually accompanied by right convex thoracolumbar scoliosis, pain, and standing and gait disturbance in the 12th week. Needle electromyography revealed abnormal spontaneous activities at rest in the right T12 myotomal muscles, and motor unit recruitment was markedly decreased. We arranged an outpatient rehabilitation program consisting of using a soft thoracolumbosacral orthosis for pain relief and trunk stability, muscle reeducation of the paretic abdominal muscles, strengthening of the disused trunk and extremity muscles, and gait exercise. Based on electromyographic findings, we instructed him in an effective method of muscle reeducation. After 4 months of rehabilitation, he showed marked improvement and became an outdoor ambulator. We suggest that electromyography is a useful tool to evaluate clinical status and devise an effective rehabilitation program in patients with HZ trunk paresis.

87. A parameter of ‘Activity’ is useful for quantitative evaluation of interference pattern in needle electromyography

The aim of this study was to decide an adequate parameter to evaluate interference pattern in needle electromyography quantitatively. We usually evaluate interference pattern by semiquantitative evaluation to 4 from 1;‘4’ is the state that base line is full of motor unit, and‘1’ is only one or two motor units. In this study, we compared semiquantitative evaluation and four quantitative parameters: ‘Activity’, ‘Peak counting’, ‘Integral value’ and ‘Average amplitude’, and considered which parameter was useful. We defined Activity as a ratio more than the threshold of ±50 V. We examined 46 muscles, in which 25 muscles had neurogenic changes, of seven patients who was necessary to take needle electromyography. We used concentric needle electrode for examination. As a result, four parameters showed high correlation between semiquantitative evaluation. A correlation coefficient was highest in Activity: Activity 0.898; Peak counting 0.833; Integral value 0.624; Average amplitude 0.728. Activity was useful when we evaluated semiquantitative evaluation 4, Peak counting was useful in evaluation 1 or 2 more in detail. It is particularly useful in muscle of a neurogenic change.

A comparison of the initial firing rate of motor unit action potentials in first dorsal interosseous and biceps brachii

Bulbar and spinal muscular atrophy (BSMA) is an adult onset motor neuropathy with androgen receptor gene mutation of expanded CAD repeat. But sensory function has been considered to be a little abnormality of vibration sense on a clinical basis. There are several pathologic reports indicating that peripheral sensory fibers are involved in BSMA. To evaluate changes in sensory nerve function quantitatively, we measured nerve conduction study (NCS) of the median, ulnar, peroneal, tibial and sural nerve, and motor deficit with Norris scale and ALSFRS in 72 patients (52.6 ± 9.3 years) with BSMA. In BSMA, amplitude and nerve conduction velocity of CMAP and SNAP was significantly smaller than in normal controls (p < 0.001). Appearance ratio of F wave in upper lib is significantly smaller than in normal controls (p < 0.001). 12.5% and 2.8% of SNAP in sural and ulnar nerve was not evoked. CAG repeat, motor severity and duration of disorder were not correlated with NCS. The Norris scale divided by age is significantly correlated with SCV and amplitude in sural nerve. So sensory nerve abnormality is important parameter in clinical aspect of BSMA.