Taikon Kim

Relationship among fear of falling, physical performance, and physical characteristics of the rural elderly.

ObjectiveThe aim of this study was to evaluate the relationship between the fear of falling, physical performance, and physical characteristics in an elderly population. DesignThis study is a cross-sectional study with 883 community dwellers 60 yrs or older from a rural area. They completed surveys and evaluations including demographics, the Korean version of the Falls Efficacy Scale-International, the Short Physical Performance Battery, the timed up and go (TUG) test, grip strength, and bone mineral density. ResultsThe subjects who had experienced a fall showed lower physical performance than those who had not experienced a fall. Regardless of a previous experience of a fall, the score on the Korean version of the Falls Efficacy Scale-International had a positive correlation with TUG time and negative correlations with the score on the Short Physical Performance Battery, grip strength, and bone mineral density. Compared with the group without the fear of falling, the group with the fear of falling showed a lower score on the Short Physical Performance Battery, longer TUG time, weaker grip strength, and lower bone mineral density. The subjects with osteoporosis showed significantly higher scores on the Korean version of the Falls Efficacy Scale-International. ConclusionsThe experience of falls had a significant relationship with the fear of falling and physical performance, and greater fear of falling was related to poorer physical performance, independent of the experience of falls. This result implies that more attention should be paid to seniors with the fear of falling and the experience of falls, and screening and consequent intervention for fall prevention should be warranted in this population. For this purpose, the TUG test may be recommended as a screening tool because TUG time reflects the fear of falling and the experience of falls as well as physical performance.

The Andersson lesion in ankylosing spondylitis: DISTINGUISHING BETWEEN THE INFLAMMATORY AND TRAUMATIC SUBTYPES

A number of causes have been advanced to explain the destructive discovertebral (Andersson) lesions that occur in ankylosing spondylitis, and various treatments have been proposed, depending on the presumed cause. The purpose of this study was to identify the causes of these lesions by defining their clinical and radiological characteristics. We retrospectively reviewed 622 patients with ankylosing spondylitis. In all, 33 patients (5.3%) had these lesions, affecting 100 spinal segments. Inflammatory lesions were found in 91 segments of 24 patients (3.9%) and traumatic lesions in nine segments of nine patients (1.4%). The inflammatory lesions were associated with recent-onset disease; a low modified Stoke ankylosing spondylitis spine score (mSASSS) due to incomplete bony ankylosis between vertebral bodies; multiple lesions; inflammatory changes on MRI; reversal of the inflammatory changes and central bony ankylosis at follow-up; and a good response to anti-inflammatory drugs. Traumatic lesions were associated with prolonged disease duration; a high mSASSS due to complete bony ankylosis between vertebral bodies; a previous history of trauma; single lesions; nonunion of fractures of the posterior column; acute kyphoscoliotic deformity with the lesion at the apex; instability, and the need for operative treatment due to that instability. It is essential to distinguish between inflammatory and traumatic Andersson lesions, as the former respond to medical treatment whereas the latter require surgery.

Spinal Mobility, Vertebral Squaring, Pulmonary Function, Pain, Fatigue, and Quality of Life in Patients With Ankylosing Spondylitis

Objective To investigate the relationships between spinal mobility, pulmonary function, structural change of the spine, pain, fatigue, and quality of life (QOL) in patients with ankylosing spondylitis (AS). Methods Thirty-six patients with AS were recruited. Their spinal mobility was examined through seven physical tests: modified Schober test, lateral bending, chest expansion, occiput to wall, finger to ground, bimalleolar distance, and range of motion (ROM) of the spine. Pulmonary Function Test (PFT) was performed using a spirometer, and vertebral squaring was evaluated through the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). QOL, disease activity, functional capacity, and fatigue were evaluated by SF-36 Health Survey (SF-36), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Multidimensional Assessment of Fatigue (MAF) scale, respectively. Perceived physical condition and degree of pain were assessed using 10 cm visual analogue scale. Results Participants showed reduced spinal mobility, which was negatively correlated with mSASSS. PFT results showed reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and increased FEV1/FVC. Reduced FEV1 and FVC showed positive correlations with reduced spinal mobility and a negative relationship with mSASSS. Perceived physical condition and degree of pain were both significantly related to the SF-36, BASDAI, BASFI, and MAF scores. Conclusion This study shows that both reduced spinal mobility and radiographic changes in the vertebral body may have a predictive value for pulmonary impairment in patients with AS. Likewise, pain and perceived physical condition may play an important role in the QOL, functional capacity, and fatigue level of these patients.

Recombinant human erythropoietin reduces aggregation of mutant Cu/Zn-binding superoxide dismutase (SOD1) in NSC-34 cells.

Human erythropoietin (hEPO) has multiple actions in non-hematopoietic tissues, including neurotrophic, anti-oxidant, anti-apoptotic, and anti-inflammatory effects. To examine the effect of EPO in an vitro model of amyotrophic lateral sclerosis (ALS), we stably overexpressed wild SOD1 and a mutant form, SOD1/G93A, in NSC-34 motoneuron-like cells. Transformants harboring the wild and mutant forms of SOD1 were selected by G418 selection and immunoblot analysis. RT-PCR analysis showed that cox-2 expression was increased in the NSC-34/mSOD1s, and MTT assays and BrdU-ELISAs revealed reduced cell growth and proliferation in the NSC-34/mSOD1 cell line. Incubation with 5 or 10IU/mL rhEPO increased the viability and decreased the cox-2 expression in the dNSC-34/mSOD1s cells. Immunocytochemical staining with anti-SOD1 antibody revealed the presence of aggregates of mSOD1 protein in dNSC-34/mSOD1 cells. Incubation with10IU/mL rhEPO reduced the proportion of cells containing such aggregates. Our findings suggest that the anti-oxidant and anti-inflammatory effects of EPO increase the survival of NSC-34/mSOD1 cells and reduce aggregation of the mutant SOD1 protein.

The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison

Objective: To evaluate the effect of an arm sling on gait speed and energy efficiency of patients with hemiplegia. Design: A randomized crossover design. Setting: A rehabilitation department of a university hospital. Subjects: Thirty-seven outpatients with hemiplegia were included in this study. Interventions: All patients walked on a 20-m walkway twice on the same day, randomly with and without an arm sling, at a self selected speed. Main measures: The heart rate, gait speed, oxygen cost and oxygen rate were measured on all patients. We analysed all values with and without an arm sling and also compared them after all patients being stratified according to demographic and clinical characteristics. Results: When we compared the heart rate between walking with (90.7 ± 17.2 beats/min) and without (91.2 ± 18.6 beats/min) the arm sling, it was significantly decreased while walking with the arm sling. When we compared the gait speed between walking with (32.8 m/min) and without (30.1 m/min), it was significantly increased with the arm sling walking. The O2 rate in hemiplegic patients walking with the arm sling was significantly decreased by 7%, compared to walking without arm sling (5.8 mL/kg min and 6.2 mL/kg min, respectively). The O2 cost in hemiplegic patients walking without arm sling was significantly 1.4 times greater than walking with it (0.2 mL/kg m and 0.3 mL/kg m, respectively). Conclusion: An arm sling can be used to improve the gait efficiency.

Effect of Ultra-marathon (308 km) Race on Bone Metabolism and Cartilage Damage Biomarkers

Objective To evaluate the potential effects of a 308-km ultra-marathon on bone and cartilage biomarkers. Method Venous blood samples were collected at pre-race, 100 km, 200 km, and 308 km checkpoints. The following markers of cartilage damage and bone metabolism were studied: osteocalcin (OC), osteoprotegerin (OPG), and calcium, phosphorous, and cartilage oligomeric matrix protein (COMP). Results Blood samples were taken from 20 male runners at four different checkpoints. Serum COMP was increased by 194.1% (130.7% at 100 km and 160.4% at 200 km). Serum OPG was significantly increased by 158.57% at 100 km and 114.1% at 200 km compared to the pre-race measures. OC was transiently suppressed at 200 km. Serum calcium and phosphorous concentrations decreased compared to the pre-race measures. Conclusion This study showed that the 308-km ultra-marathon induced several changes, including transient uncoupling of bone metabolism, increased bone resorption, suppressed bone formation, and bone turnover and had a major impact on cartilage structure.

Correlations Between Electrically Quantified Pain Degree, Subjectively Assessed Visual Analogue Scale, and the McGill Pain Questionnaire: A Pilot Study

Objective To evaluate the clinical utility of the electrically calculated quantitative pain degree (QPD) and to correlate it with subjective assessments of pain degree including a visual analogue scale (VAS) and the McGill Pain Questionnaire (MPQ). Methods We recruited 25 patients with low back pain. Of them, 21 patients suffered from low back pain for more than 3 months. The QPD was calculated using the PainVision (PV, PS-2100; Nipro Co., Osaka, Japan). We applied electrodes to the medial forearm of the subjects and the electrical stimulus was amplified sequentially. Minimum perceived current (MPC) and pain equivalent current (PEC) were defined as minimum electrical stimulation that could be sensed by the subject and electrical stimulation that could trigger actual pain itself. To eliminate individual differences, we defined QPD as the following: QPD=PEC-MPC/MPC. We scored pre-treatment QPD three times at admission and post-treatment QPD once at discharge. The VAS, MPQ, and QPD were evaluated and correlations between the scales were analyzed. Results Result showed significant test-retest reliability (ICC=0.967, p<0.001) and the correlation between QDP and MPQ was significant (at admission SRCC=0.619 and p=0.001; at discharge SRCC=0.628, p=0.001). However, the correlation between QPD and VAS was not significant (at admission SRCC=0.240, p=0.248; at discharge SRCC=0.289, p=0.161). Conclusion Numerical values measured with PV showed consistent results with repeated calculations. Electrically measured QPD showed an excellent correlation with MPQ but not with VAS. These results demonstrate that PV is a significantly reliable device for quantifying the intensity of low back pain.

A randomized comparison of energy consumption when using different canes, inpatients after stroke

Objectives: To investigate the differences in oxygen consumption associated with gait in hemiplegic patients according to the type of cane they use. Design: A randomized crossover design. Setting: University hospital-based rehabilitation center, Korea. Subjects: Thirty consecutive patients (mean ± SD age, 56.3 ± 3.2 years) with chronic stroke, 17 (56.7%) males and 13 (43.3%) females. Interventions: At approximately the same time of day for three consecutive days, each participant completed a walk with one of three randomly assigned types of canes: a single-point cane, a quad cane, and a hemi-walker. Main outcome measure: Energy expenditure (O2 rate, mL/kg/min), energy cost (O2 cost, mL/kg/m), and heart rate (HR) via a portable gas analyzer, a 10-meter walk test (10MWT), and a 6-minute walk test (6MWT). Results: Energy expenditure, gait endurance, and gait velocity for a single-point cane were higher (p<0.001 or p=0.005) than for any other type of cane. Energy cost (0.5 ± 0.2 mL/kg/m vs. 0.6 ± 0.2 mL/kg/m vs. 0.6 ± 0.2 ml/kg/m, respectively, p=0.001) was lower for the single-point cane, except for HR (p ≥ 0.05) after the Bonferroni correction (0.05/5=0.01). Conclusions: A single-point cane requires less oxygen use at a given speed, or permits greater speed for the same oxygen consumption.

Disparity in the Fear of Falling Between Urban and Rural Residents in Relation With Socio-economic Variables, Health Issues, and Functional Independency

Objective To investigate disparities in the fear of falling between urban and rural communities in relation to socio-demographics, health status, and functional level. Methods A total of 974 subjects aged 40 years or older participated in this study (335 urban residents and 639 rural). They completed a questionnaire about socio-demographics, health-related variables, and experience with falls. We employed both direct questioning and the Korean version of Falls Efficacy Scale-International (KFES-I) to investigate fear of falling in terms of perceptive fear and higher level of concern over falling during daily activities. The Korean version of Instrumental Activities of Daily Living was used to assess functional independency. Results Aging, female gender, fall history, and the presence of chronic medical problems were independently associated with higher prevalence for the fear of falling. Both perceptive fear of falling and a higher level of concern over falling were more prevalent in the rural senior population compared with those in the urban population when they had the following characteristics: lower income or educational background, physical laborer or unemployed, no chronic medical morbidity, or functional independency in daily activities. Conclusion The disparity in the fear of falling between the two areas is thought to be related to age structure, and it may also exist in healthy or functionally independent senior populations under the influence of socio-environmental factors. A senior population with lower socio-economic status residing in a rural area might be related with a greater vulnerability to the fear of falling. We should consider regional characteristics when we design fall-related studies or develop fall-prevention programs at the community level.

The Prevalence and Characteristics of Depression in Work-related Musculoskeletal Disease

Objective To reveal the relationship between depression and WMSD. Method Five physiatrists participated in the workplace musculoskeletal survey and diagnosed 724 office workers with WMSD by performing detailed history taking and physical examination. All subjects were asked to answer the Korean version of the Beck depressive inventory (K-BDI), and to express their pain according to the visual analogue scale (VAS) score. We categorized the subjects into 4 groups, myofascial pain syndrome (MPS), herniated intervertebral disk (HIVD), tenosynovitis, and others, and investigated the prevalence of depression in desk workers and relationship between WMSD and depression, and we compared pain intensity between the depression and non-depression groups. Correlation analysis was carried out between K-BDI and VAS scores in each group. Results The mean K-BDI score were 8.7±6.68. The prevalence of depression was higher in females than in male, and there was no relationship between age and depression. There was a significant connection between HIVD and depression (p<0.05). However, the other groups did not have significant connection to depression. The VAS score (5.02) of the depression group was significantly higher than that (4.10) of the non-depression group. In addition, there was a significant difference of VAS scores between the depression group and non-depression group in each disease group. Conclusion The mean VAS score of the depression group in WMSD was significantly higher than in the non-depression group. The correlation between BDI and VAS scores in the subjects was present, and the highest was in the HIVD group.