Soo Jeong Han

Improvement of the Working Memory and Naming by Transcranial Direct Current Stimulation

Objective To investigate the effects of transcranial direct current stimulation (tDCS) applied over the prefrontal cortex on the improvement of verbal, visuospatial working memory and naming in healthy adults. Method Thirty two healthy adults (15 males and 17 females, mean age 37.3±13.0 years) were enrolled in this study. The subjects were divided into four groups randomly. They underwent sham or anodal tDCS over the left or right prefrontal cortex, for 20 minutes at a direct current of 1 mA. Before and immediately after tDCS, the subjects performed the Korean version of the mini-mental state exam (K-MMSE) and stroop test (color/word/interference) for the screening of cognitive function. For working memory and language evaluation, the digit span test (forward/backward), the visuospatial attention test in computer assisted cognitive program (CogPack®) and the Korean-Boston Naming Test (K-BNT) were assessed before tDCS, immediately after tDCS, and 2 weeks after tDCS. Results The stroop test (word/interference), backward digit span test and K-BNT were improved in the left prefrontal tDCS group compared with that of the sham group (p<0.05). The stroop test (interference) and visuospatial attention test were in the right prefrontal tDCS group compared with that of the sham group (p<0.05). Their improvement lasted for 2 weeks after stimulation. Conclusion tDCS can induce verbal working memory improvement and naming facilitation by stimulating the left prefrontal cortex. It can also improve the visuospatial working memory by stimulating the right prefrontal cortex. Further studies which are lesion and symptom specific tDCS treatment for rehabilitation of stroke can be carried out.

Effect of mild cognitive impairment on balance

OBJECTIVE To investigate the effect of mild cognitive impairment (MCI) on balance. METHODS 87 subjects with subjective memory impairment were enrolled, and subdivided into two groups, MCI and non-MCI, according to diagnostic criteria of amnestic subtype of MCI according to the 1999 MCI international panel (Current Concepts in Mild Cognitive Impairment). These two groups were matched for age and gender. Posturography was used to assess balance by measuring the mediolateral and anteroposterial sway speed and distance in the standing position, with both opened and closed eyes. RESULTS The mediolateral sway speed and distance were higher in the MCI group than the non-MCI group, with both opened and closed eyes (p<0.05). However, there was no significant difference between the MCI group and non-MCI in anteroposterior sway speed and distance. These results were confirmed in a multivariate model adjusting for gender, age, weight, height, foot size, and education. The mediolateral, and anteroposterior sway speed and distance values were higher on eye closing status than on eye opening status in both the MCI and control groups (p<0.00). CONCLUSION The falling risk is assumed to be higher in MCI subjects than in non-MCI subjects, especially due to decreased mediolateral balance, as shown in our adjusted analysis. These findings underscore the importance of specific balance exercise in which mediolateral balance is measured and visual compensation training programs for MCI subjects in order to prevent fall and related fracture, as well as the importance of programs for improvement of cognitive function.

Combination of transcranial direct current stimulation and methylphenidate in subacute stroke

Noninvasive transcranial direct current stimulation (tDCS) and methylphenidate (MP) are associated with motor recovery after stroke. Based on the potentially complementary mechanisms of these interventions, we examined whether there is an interactive effect between MP and tDCS. In this preliminary study, we randomized subacute stroke subjects to receive tDCS alone, MP alone or combination of tDCS and MP. A blinded rater measured safety, hand function, and cortical excitability before and after treatment. None of the treatments caused any major or severe adverse effects or induced significant differences in cortical excitability. Analysis of variance of gain score, as measured by Purdue pegboard test, showed a significant between-group difference (F(2,6)=12.167, p=0.008). Post hoc analysis showed that the combination treatment effected greater Purdue pegboard gain scores than tDCS alone (p=0.017) or MP alone (p=0.01). Our preliminary data with nine subjects shows an interesting dissociation between motor function improvement and lack of motor corticospinal plasticity changes as indexed by transcranial magnetic stimulation in subacute stroke subjects.

Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients

BACKGROUND Rhythmic auditory stimulation (RAS) improves gait velocity, cadence, and stride length in hemiplegic stroke patients, yet little is known about the effectiveness of RAS on standing balance. OBJECTIVES To examine and compare the effectiveness on standing balance and gait parameter of two different types of gait trainings, gait training with RAS versus gait training without RAS, was compared in two groups of hemiplegic stroke patients over a three-week period (RAS group, n = 8; control group = 8). METHODS Sixteen hemiplegic stroke patients were included in the study. Standing balance was measured by using Biosway®. Stride length, gait velocity, and cadence were calculated from the number of steps and required time for a 10 m-walk. RESULTS Pre- to post-test measures showed a significant improvement in RAS group for overall stability index (p = 0.043), mediolateral index (p = 0.006), anteroposterior index (p = 0.016), gait velocity (p = 0.012), stride length (p = 0.03) and cadence (p = 0.012) over the control group. CONCLUSIONS The results of this study showed that RAS was an effective therapeutic method to improve gait velocity, stride length, cadence, and standing balance in hemiplegic stroke patients.

Extracorporeal Shock Wave Therapy in Myofascial Pain Syndrome of Upper Trapezius

Objective To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analogue scale (VAS) and pressure threshold by digital algometer. Method Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm2, 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm2. The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer. Results There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91±1.76 to 2.27±1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4±9.94 N to 61.2±12.16 N in the treated group (p<0.05), but there was no significant change in the control group. Conclusion ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.

Colonoscopic lesions in patients with spinal cord injury.

Abstract Background/Objective: In spinal cord injury (SCI), loss of central or peripheral neural control causes neurogenic bowel. Patients may not exhibit the typical signs and symptoms of gastrointestinal disease. Few studies have looked at the risk of gastrointestinal disease in this group and the indications for preventive screening. The objective of this study was to study colonoscopic lesions in patients with SCI and determine whether there are any differences in the prevalence of lesions between SCI and control patients. Design: Case control study. Methods: Twenty-five patients with SCI were compared with 41 control patients who received colonoscopy at the same time. Mann-Whitney test for continuous variable, and Fisher exact test for frequency variables were used. Outcome Measures: Demographic information, duration of SCI, and colonoscopy findings were gathered. Results: Colonic lesions were observed in 52% of patients with SCI and in 41.5% of control patients. Most frequent lesions in SCI group were inflammatory bowel disease (16%) and polyp (16%), followed by proctitis (12%) and hemorrhoid (12%). In the control group, hemorrhoid (17.1%) was most common, followed by polyp (12.2%) and melanosis coli (9.8%). No significant differences were found between the 2 groups. In the SCI group, no significant differences in lesions were found among the patients with cervical, thoracic, and lumbar SCI in the SCI group. Duration of SCI did not affect the pattern of colonoscopic lesions. Conclusion: Patients with SCI had the same incidence of colonoscopic lesions as control patients. Inflammatory bowel disease, which is a risk factor for cancer, was the most common findings in the SCI group, although there was no significant difference from the control group. In patients with SCI, colonoscopy screening is warranted at the same frequency as for the general population.

Delayed occurrence of spinal arachnoiditis following a caudal block

Abstract Context Spinal arachnoiditis is a rare disease caused by fibrosis and adhesion of the arachnoid membrane due to chronic inflammation. The causes of arachnoiditis are infection, spinal surgery, intraspinal injection of steroid or myelography dye, and spinal anesthesia. Method Case report. Findings A 60-year-old woman presented with progressive weakness and sensory change of both legs and urinary symptoms. She had received a single caudal block 6 months before symptom onset. Magnetic resonance imaging of the thoraco-lumbar spine showed an intradural extramedullary tumor at the T5–T7 level. She underwent laminectomy and tumor resection. The pathological finding was arachnoiditis. After surgery, a rehabilitation program of strengthening exercises of both lower extremities and gait training was started. At 2-month follow-up, she was able to walk with orthoses and performed daily activities with minimal assistance. Conclusion Symptoms of spinal arachnoiditis occurred 6 months after a single caudal block in this woman. Clinicians should be aware of this possible delayed complication.

Effect of exercise on balance in persons with mild cognitive impairment

BACKGROUND Individuals with definite cognitive impairment and mild cognitive impairment (MCI) show motor dysfunction. OBJECTIVE This study aimed to investigate whether exercise changes balance and whether the effects of exercise on balance are different in patients with MCI as compared to the control group. METHODS Posturography was used to assess balance by measuring the mediolateral and anteroposterior sway distance and sway speed. After the baseline balance test (T1), subjects received exercise instruction. Follow-up balance tests were performed at 6 months (T2) and 12 months (T3). RESULTS When comparing persons with MCI (n = 17) with control group (n = 12), four indices of posturography showed differences between groups (p < 0.05). Also, there were improvements in more indices between T1 and T3, rather than between T1 and T2, in both MCI and control groups (p < 0.05). After receiving guidance concerning exercises, the sway values at 12 months were lower than values at the 6-month follow-up (p < 0.05). However, this trend in the sway values did not show a difference between the groups (p > 0.05). CONCLUSION Persons with MCI had poorer balance control ability as compared with normal healthy persons. More than one year of steady exercise can be helpful for the improvement of balance in both MCI and normal persons.

Post-polio syndrome and risk factors in korean polio survivors: a baseline survey by telephone interview.

Objective To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. Methods The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). Results Majority of polio survivors were middle-aged and mean age was 51.2±8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5±11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. Conclusion We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.

Spinal epidural abscess associated with moxibustion-related infection of the finger.

Abstract Objective: To describe a spinal epidural abscess that originated from cellulitis after moxibustion. Methods: Case report. Findings: A 78-year-old woman with diabetes mellitus was diagnosed with tetraplegia due to a cervical spinal epidural abscess extending to the thoracic spinal epidural space. The abscess was caused by osteomyelitis and cellulitis of the right third finger, which had been cauterized repeatedly with moxa. After surgical decompression and drainage of the spinal epidural abscess and comprehensive rehabilitation, motor strength and functional level improved. Conclusions: This case illustrates the risk of spinal epidural abscess in persons with diabetes mellitus who present with focal cellulitis and osteomyelitis.