Publications by authors named "Jeong-Hwan Seo"

51 Publications

The efficacy of low-intensity pulsed ultrasound on articular cartilage and clinical evaluations in patients with knee osteoarthritis.

J Back Musculoskelet Rehabil 2022 Jun 17. Epub 2022 Jun 17.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea.

Background: While a number of preclinical studies have examined the effectiveness of low-intensity pulsed ultrasound (LIPUS) as a potential treatment for knee osteoarthritis (OA), there have been few clinical studies which have indirectly confirmed cartilage regeneration by magnetic resonance imaging (MRI).

Objective: The aim of this clinical trial was to investigate whether LIPUS effectively increased knee cartilage thickness and improved pain and function in knee OA patients.

Methods: This study was a prospective, single-group, home-based self-therapy trial. We included patients (n= 20) with OA pain. Each patient used an ultrasonic stimulation device (BODITREK JOINT™) for more than 20 sessions. Outcomes were assessed by MRI, Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the 36-Item Short Form Survey (SF-36) for assessing quality of life.

Results: Nineteen subjects completed this study. There was no significant increase in the cartilage thickness measured by MRI after LIPUS treatment. LIPUS therapy significantly decreased VAS score and WOMAC score, and significantly increased SF-36 score. The subgroup analysis in patients with knee OA showed that LIPUS treatment showed better for older patients with lower Kellgren-Lawrence grades.

Conclusion: Pain, function, and quality of life improved after LIPUS, but there was no significant increase in cartilage thickness through MRI.
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http://dx.doi.org/10.3233/BMR-210357DOI Listing
June 2022

Association of bladder trabeculation and neurogenic bladder with spinal cord injury.

J Int Med Res 2022 Jun;50(6):3000605221104768

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.

Objective: To compare clinical findings and urodynamic parameters according to trabeculation grade and analyze their correlations with trabeculation severity in neurogenic bladder caused by suprasacral spinal cord injury (SCI).

Methods: A retrospective chart review was performed of neurogenic bladder caused by SCI. Bladder trabeculation grade was compared with SCI-related clinical parameters and bladder-related urodynamic parameters.

Results: In SCI patients, factors such as disease duration, bladder capacity, detrusor pressure, peak detrusor pressure values, and compliance were significantly different between different grades of bladder trabeculation, while neurological level of injury, completeness, and detrusor sphincter dyssynergia had no clear relationship with bladder trabeculation grade. In the correlation analysis, vesicoureteral reflux was moderately correlated with trabeculation grade (correlation coefficient 0.433), while the correlation coefficients of disease duration, involuntary detrusor contraction, and bladder filling volume were between 0.3 and 0.4.

Conclusion: Bladder trabeculation with suprasacral-type neurogenic bladder was graded. Although disease duration was positively correlated with bladder trabeculation grade, differences in the neurological level of injury or American Spinal Injury Association Impairment Scale score were not observed. Bladder volume, peak detrusor pressure, compliance, reflex volume, and vesicoureteral reflux also showed significant differences according to trabeculation grade. Vesicoureteral reflux was moderately correlated with trabeculation grade.
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http://dx.doi.org/10.1177/03000605221104768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9189534PMC
June 2022

Effects of Low-Frequency Whole-Body Vibration on Muscle Activation, Fatigue, and Oxygen Consumption in Healthy Young Adults: A Single-Group Repeated-Measures Controlled Trial.

J Sport Rehabil 2022 May 16:1-9. Epub 2022 May 16.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju,Korea.

Context: Whole-body vibration (WBV) training improves muscle strength and balance. Few studies have focused on the effects of WBV frequencies below 30 Hz. We aimed to investigate the effect of low-frequency WBV training on muscle activity, fatigue recovery, and oxygen consumption (VO2).

Design: Prospective single-group, repeated-measures study.

Methods: In this controlled laboratory setting study, 20 healthy adults (age 23.26 [1.66] y) performed half squats at 0, 4, 6, 8, 12, 16, 20, 24, and 30-Hz WBV. Muscle activity was evaluated using the root mean square and peak electromyography amplitude of 6 muscles (iliocostalis, rectus abdominis, rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius) obtained via surface electromyography. VO2 was measured during the squats using a gas analyzer, and fatigue recovery was evaluated using measurements of lactate after the squats and after a recovery period. Statistical significance was set at P < .05, and analysis of variance was conducted to determine differences in muscle activity, fatigue, recovery, and VO2, with post hoc analyses as appropriate.

Results: Of the 6 muscles measured, the muscle activity of the gastrocnemius alone significantly increased from 0 Hz at 4, 8, 12, 16, 24, and 30 Hz based on the root mean square values and at 4, 8, 12, and 30 Hz based on the peak electromyography amplitude values. There were no significant differences in the other muscles. There were no significant differences in VO2 or in lactate levels.

Conclusions: Low-frequency WBV during squat exercises significantly increased the activity of the gastrocnemius medialis only at specific frequencies in healthy young adults. Low-frequency WBV is safe and has the potential to increase muscle activity.
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http://dx.doi.org/10.1123/jsr.2021-0170DOI Listing
May 2022

Technical Report of Color Doppler Ultrasonography-Assisted Lumbar Spinal Interventions.

Ultrasound Q 2022 Mar;38(1):53-58

Abstract: Ultrasonography (US) has recently been used more frequently during interventions involving the lumbar spine. However, physicians who are more familiar with musculoskeletal US targeting muscles, tendons, and nerves may find it challenging to perform US-guided lumbar spine interventions using only bony landmarks. This study described the use of color Doppler US for the visualization of the lumbar spinal blood supply to identify vascular landmarks in addition to bony landmarks and thus more easily and accurately perform lumbar spine interventions.
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http://dx.doi.org/10.1097/RUQ.0000000000000575DOI Listing
March 2022

Disruption of sensation-dependent bladder emptying due to bladder overdistension in a complete spinal cord injury: A case report.

World J Clin Cases 2021 Oct;9(29):8946-8952

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea.

Background: Autonomic dysreflexia (AD) can be a life-threatening condition in patients with spinal cord injury. It is important to prevent bladder overdistension in these patients as it may trigger AD. Sensation-dependent bladder emptying (SDBE), as a method of bladder management, improves the quality of life and allows physiologic voiding. In this study, we report disruption of the SDBE habit after bladder overdistension leading to AD with chest pain.

Case Summary: A 47-year-old male with a diagnosis of C4 American Spinal Cord Injury Association impairment scale A had been emptying his bladder using the clean intermittent catheterization method with an itchy sensation in the nose as a sensory indication for a full bladder for 23 years, and the usual urine volume was about 300-400 mL. At the time of this study, the patient had delayed catheterization for approximately five hours. He developed severe abdominal pain and headache and had to visit the emergency room for bladder overdistension (800 mL) and a high systolic blood pressure (205 mmHg). After control of AD, a hypersensitive bladder was observed despite using anticholinergic agents. The sensation indicating bladder fullness changed from nose itching to pain in the abdomen and precordial area. Moreover, the volume of the painful bladder filling sensation became highly variable and was noted when the bladder urine volume exceeded only 100 mL. The patient refused intermittent clean catheterization. Finally, a cystostomy was performed, which relieved the symptoms.

Conclusion: Patients using physiologic feedback, such as SDBE, for bladder management are recommended to avoid bladder overdistension.
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http://dx.doi.org/10.12998/wjcc.v9.i29.8946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546819PMC
October 2021

Timing-Dependent Effects of Transcranial Direct Current Stimulation on Hand Motor Function in Healthy Individuals: A Randomized Controlled Study.

Brain Sci 2021 Oct 6;11(10). Epub 2021 Oct 6.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Geonjiro 20, Deokjin-gu, Jeonju 54097, Korea.

The timing of transcranial direct current stimulation (tDCS) is essential for enhancing motor skill learning. Previously, tDCS, before or concurrently, with motor training was evaluated in healthy volunteers or elderly patients, but the optimal timing of stimulation has not been determined. In this study, we aimed to optimize the existing tDCS protocols by exploring the timing-dependent stimulation effects on finger movements in healthy individuals. We conducted a single-center, prospective, randomized controlled trial. The study participants (n = 39) were randomly assigned into three groups: tDCS concurrently with finger tapping training (CON), tDCS prior to finger tapping training (PRI), and SHAM-tDCS simultaneously with finger tapping training (SHAM). In all groups, the subjects participated in five 40-min training sessions for one week. Motor performance was measured before and after treatment using the finger-tapping task (FTT), the grooved pegboard test (GPT), and hand strength tests. tDCS treatment prior to finger tapping training significantly improved motor skill learning, as indicated by the GPT and hand strength measurements. In all groups, the treatment improved the FTT performance. Our results indicate that applying tDCS before training could be optimal for enhancing motor skill learning. Further research is required to confirm these findings.
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http://dx.doi.org/10.3390/brainsci11101325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534210PMC
October 2021

Motor Organization in Schizencephaly: Outcomes of Transcranial Magnetic Stimulation and Diffusion Tensor Imaging of Motor Tract Projections Correlate with the Different Domains of Hand Function.

Biomed Res Int 2021 6;2021:9956609. Epub 2021 Sep 6.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.

Objective: Schizencephaly is a rare congenital malformation that causes motor impairment. To determine the treatment strategy, each domain of the motor functions should be appropriately evaluated. We correlated a color map of diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) with the hand function test (HFT) to identify the type of hand function that each test (DTI and TMS) reflects. Further, we attempted to demonstrate the motor neuron organization in schizencephaly.

Method: This retrospective study was conducted on 12 patients with schizencephaly. TMS was conducted in the first dorsal interosseous (FDI), biceps (BB), and deltoid muscles of the upper extremity, and contralateral MEP (cMEP) and ipsilateral MEP (iMEP) were recorded. The HFT included the grip strength, box and block (B&B), and 9-hole peg test. The schizencephalic cleft was confirmed using magnetic resonance imaging, and the corticospinal tract (CST) was identified using the color map of DTI. The symmetry indices for the peduncle and CST at pons level were calculated as the ratios of the cross-sectional area of the less-affected side and that of the more-affected side.

Result: In the more-affected hemisphere TMS, no iMEP was obtained. In the less-affected hemisphere TMS, the iMEP response was detected in 9 patients and cMEP in all patients, which was similar to the pattern observed in unilateral lesion. Paretic hand grip strength was strongly correlated with the presence of iMEP ( = 0.044). The symmetry index of the color map of DTI was significantly correlated with the B&B ( = 0.008, = 0.416), whereas the symmetry index of the peduncle was not correlated with all HFTs.

Conclusion: In patients with schizencephaly, the iMEP response rate is correlated with the hand function related to strength, while the symmetricity of the CST by the color map of DTI is correlated with the hand function associated with dexterity. Additionally, we suggest the possible motor organization pattern of schizencephaly following interhemispheric competition.
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http://dx.doi.org/10.1155/2021/9956609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437638PMC
September 2021

Efficacy of an Integrated Training Device in Improving Muscle Strength, Balance, and Cognitive Ability in Older Adults.

Ann Rehabil Med 2021 Aug 30;45(4):314-324. Epub 2021 Aug 30.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea.

Objective: To determine the effects of an integrated training device for strength and balance on extremity muscle strength, postural balance, and cognition in older adults using a combination with various rehabilitation training games, in which balance, strength, and cognitive training were configured in a single device.

Methods: This prospective study included 20 healthy participants aged 65-85 years. Participants trained for 30 minutes daily, 3 days weekly, for 6 weeks with an integrated training device for strength and balance (SBT-120; Man&Tel Inc., Gumi, Korea). Main outcomes were measured using the Korean Mini-Mental State Examination (K-MMSE), Korean version of the Montreal Cognitive Assessment (K-MoCA), Timed Up and Go Test (TUG), Functional Reach Test (FRT), Berg Balance Scale (BBS), and Manual Muscle Test. Measurements were taken at three time points: T0 (pretreatment), T1 (immediately after treatment), and T2 (4 weeks after treatment).

Results: All 20 patients completed the training, and TUG, FRT, and BBS scores significantly improved at T1 and T2 compared to T0. Mean TUG scores decreased by 0.99±2.00 at T1 and 1.05±1.55 at T2 compared to T0. Mean FRT scores increased by 6.13±4.26 at T1 and 6.75±4.79 at T2 compared to T0. BBS scores increased by 0.60±0.94 at T1 and 0.45±1.15 at T2 compared to T0. Moreover, muscle strength and cognition (K-MMSE and K-MoCA scores) increased after training.

Conclusion: Our findings suggest that an integrated training device for strength and balance can be a safe and useful tool for older adults.
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http://dx.doi.org/10.5535/arm.21072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435467PMC
August 2021

Diagnostic Implication and Clinical Relevance of Dermatomal Somatosensory Evoked Potentials in Patients with Radiculopathy: A Retrospective Study.

Pain Res Manag 2021 1;2021:8850281. Epub 2021 Jun 1.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea.

Objective: Dermatomal somatosensory evoked potentials (DSEPs) are used to evaluate abnormalities of the somatosensory tract. There have been some studies on the diagnostic value of DSEP in radiculopathy, but it is still controversial. The purpose of our study is to evaluate the diagnostic implication and clinical relevance of DSEPs in patients with radiculopathy by comparing DSEP findings to radiculopathy symptoms and intervertebral foramen (IVF) or spinal canal stenosis in lumbar magnetic resonance imaging (MRI).

Methods: This retrospective study reviewed the medical records of patients ( = 59) who were examined by DSEP (each L4 and L5 dermatome) and lumbar MRI. Radiculopathy symptoms and DSEPs results were compared. For the evaluation of IVF and spinal canal size, sagittal (each bilateral L4/5 and L5/S1 IVF) and axial MR images were selected at the most stenotic level. The sizes of the IVF and spinal canal were measured by the pixel counts of selected MR images. In addition, stenosis severity was morphologically graded on a 4-point scale. DSEP results were compared with the size and grade of the IVF or spinal canal stenosis.

Results: DSEPs showed high sensitivity for radiculopathy symptoms. The IVF size at L4/5 and L5/S1 (pixel counts) was significantly related to either L4 or L5 dermatomal somatosensory pathway dysfunction, respectively. However, spinal stenosis (pixel counts and grade) and IVF stenosis grade were not significantly related to DSEPs.

Conclusion: This paper could be helpful in the electrophysiologic diagnosis of lumbar radiculopathy.
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http://dx.doi.org/10.1155/2021/8850281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187040PMC
July 2021

Comparing the Efficacy of Combined Treatment with Medial Branch Block and Facet Joint Injection in Axial Low Back Pain.

Pain Res Manag 2021 7;2021:1343891. Epub 2021 Jan 7.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea.

Introduction: Medial branch nerve block (MBB) and facet joint injections (FJIs) can be used to manage axial low back pain. Although there have been studies comparing the MBB and FJI effects, a few studies have compared the therapeutic effects of both interventions combined with each separate intervention. This study aimed to compare the pain relief effect of MBB, FJI, and combined treatment with MBB and FJI in patients with axial low back pain.

Methods: We conducted a retrospective review of patients with axial low back pain who had chart records of the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) scores measured before treatment and within 6 weeks after treatment. The proportion of patients with successful responses (>30%) was calculated and is presented with Wald confidence intervals.

Results: We included 66 patients (33, 17, and 16 patients in the MBB, FJI, and combined treatment with MBB and FJI groups). All the patient groups showed significant posttreatment improvements in the NRS [(proportion >30% decrease: MBB 24.2% (9.6-38.9), FJI 29.4% (7.8-51.1), and MBB + FJI 25.0% (3.8-46.2)] scores and the ODI [proportion >30% decrease: MBB 39.4% (22.7-56.1), FJI 23.5% (3.4-43.7), and MBB + FJI 37.5% (13.8-61.2)] scores. Furthermore, there was no significant among-group difference in the ODI and NRS scores.

Conclusion: MBB, FJI, and combined treatment with MBB and FJI can reduce axial low back pain and improve secondary functional degradation. Although combined treatment with MBB and FJI required a longer intervention time, it did not have a pain relief effect superior to that of MBB or FJI alone.
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http://dx.doi.org/10.1155/2021/1343891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808813PMC
June 2021

Differences in Electrophysiologic Values between Preoperative and Intraoperative Neurophysiologic Monitoring.

Turk Neurosurg 2021 ;31(1):51-58

Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Department of Physical Medicine and Rehabilitation, Jeonju, South Korea.

Aim: To compare preoperative and intraoperative electrophysiologic values in patients who underwent brain and spine surgeries.

Material And Methods: A retrospective medical record review was conducted on patients who underwent brain and spine surgery between January 2014 and July 2018. Patients underwent preoperative electrophysiologic monitoring within a week before the operation and intraoperative monitoring during the surgery. Monitoring parameters included the onset latency (msec) and amplitude (mV) of motor evoked potential (MEP), somatosensory evoked potential (SEP), electroneuronography, and brainstem auditory evoked potential (BAEP).

Results: The latency of the MEP and SEP were significantly prolonged while the amplitude was decreased during operation. Specifically, patients with abnormal findings in their preoperative assessments showed more prominent differences compared to those with normal findings. However, there was no significant difference between preoperative and intraoperative results based on which side of the hemisphere was affected or unaffected. Unlike the MEP and SEP parameters, there were no significant changes in the facial electroneuronography and BAEP parameters.

Conclusion: There were differences in the preoperative and intraoperative monitoring parameters. Further studies are necessary to understand the underlying mechanisms behind these changes during surgery.
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http://dx.doi.org/10.5137/1019-5149.JTN.28409-19.2DOI Listing
March 2021

Clinical evaluation of the effectiveness of a new orthotic device for the non-operative treatment of scoliosis.

Technol Health Care 2020 ;28(S1):229-236

Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Korea.

Background: Bracing is one of the oldest non-operative treatments for patients with scoliosis. However, a wide variety of braces is used, and some show no effect, while others show conflicting results.

Objective: We aimed to evaluate the effectiveness of a new orthotic device for the treatment of adult scoliosis.

Methods: Twenty adult patients who were diagnosed with scoliosis and qualified for the study were selected and all participants were treated for 12 hours/day for 12 weeks using a new orthotic device. Various efficacy assessments (Cobb's angle, spine length, pelvic angle, shoulder angle, thoracic angle, lumbar angle, pelvic sacral angle) were performed before and after the 12-week treatment. The values at each time point were compared.

Results: There were significant treatment effects in a time-dependent manner on every efficacy assessment (p< 0.05) after 12 weeks of bracing.

Conclusion: In this clinical study, it was demonstrated that a new brace that is more comfortable for the wearer reduced scoliosis and may be a useful option for non-operative treatment of scoliosis.
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http://dx.doi.org/10.3233/THC-209023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369089PMC
April 2021

Ten-Year Follow-Up of Transcranial Magnetic Stimulation Study in a Patient With Congenital Mirror Movements: A Case Report.

Ann Rehabil Med 2019 Aug 31;43(4):524-529. Epub 2019 Aug 31.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea.

Most studies concerning congenital mirror movements (CMMs) have been focused on the motor organization in the distal hand muscles exclusively. To the best of our knowledge, there is no data on motor organization pattern of lower extremities, and a scarcity of data on the significance of forearm and arm muscles in CMMs. Here, we describe the case of a 19-year-old boy presenting mirror movements. In these terms, a 10-year transcranial magnetic stimulation study demonstrated that the motor organization pattern of the arm muscles was different from that of distal hand and forearm muscles even in the same upper extremity, and that the lower extremities showed the same pathways as healthy children. Moreover, in this case, an ipsilateral motor evoked potentials (MEPs) for distal hand muscles increased in amplitude with age, even though the intensity of mirror movements decreased. In the arm muscles, however, it was concluded that the contralateral MEPs increased in amplitude with age.
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http://dx.doi.org/10.5535/arm.2019.43.4.524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734025PMC
August 2019

Effects of a Newly Developed Therapeutic Deep Heating Device Using High Frequency in Patients with Shoulder Pain and Disability: A Pilot Study.

Pain Res Manag 2019 2;2019:8215371. Epub 2019 May 2.

Department of Physical Medicine & Rehabilitation, Chonbuk National University Medical School, Jeonju 54907, Republic of Korea.

Objectives: The newly developed therapeutic deep heating device can generate deep heat in focal tissue using high-frequency wave stimulation. The objective of this study was to evaluate and compare the effectiveness of this deep heating device (HIPER-500®) with ultrasound in alleviating pain and improving function in patients with shoulder disability.

Methods: This noninferiority trial was designed to compare the treatment effect of HIPER-500® to that of SonoStim® (ultrasound) on shoulder pain and disability. Thirty-eight patients with shoulder problems were assigned to either the HIPER-500® or SonoStim® group, and each participated in 10 min therapy sessions, five days a week for two weeks (for a total of ten sessions). Shoulder pain and disability were evaluated using the Visual Analogue Scale (VAS), the University of California at Los Angeles score (UCLA score), the Shoulder Pain and Disability Index (SPADI), and the Constant score in both groups before, immediately after, and four weeks after treatment. Statistical analysis was performed to compare the effects of treatment within and between the groups.

Results: A total of 34 patients completed the study. The 18 patients in the HIPER-500® group and 16 patients in the SonoStim® group all showed significant improvements in shoulder pain and function when comparing pretreatment values with the results immediately after treatment and four weeks later. The results before and after treatment did not show a statistically significant difference between the two groups.

Conclusions: The newly developed HIPER-500® for high-frequency deep heat therapy showed similar effects to those of SonoStim® for relieving pain and improving physical performance in the patients of this study. HIPER-500® may be a useful modality for treating shoulder pain and improving physical activity in patients with shoulder disease.
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http://dx.doi.org/10.1155/2019/8215371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525801PMC
December 2019

Efficacy of Virtual Reality Combined With Real Instrument Training for Patients With Stroke: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2019 08 16;100(8):1400-1408. Epub 2019 Apr 16.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Republic of Korea; Translational Research and Clinical Trials Center for Medical Devices, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea. Electronic address:

Objective: To investigate the efficacy of real instrument training in virtual reality (VR) environment for improving upper-extremity and cognitive function after stroke.

Design: Single-blind, randomized trial.

Setting: Medical center.

Participants: Enrolled subjects (N=31) were first-episode stroke, assessed for a period of 6 months after stroke onset; age between 20 and 85 years; patients with unilateral paralysis and a Fugl-Meyer assessment upper-extremity scale score >18.

Interventions: Both groups were trained 30 minutes per day, 3 days a week, for 6 weeks, with the experimental group performing the VR combined real instrument training and the control group performing conventional occupational therapy.

Main Outcome Measures: Manual Muscle Test, modified Ashworth scale, Fugl-Meyer upper motor scale, hand grip, Box and Block, 9-Hole Peg Test (9-HPT), Korean Mini-Mental State Examination, and Korean-Montreal Cognitive Assessment.

Results: The experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and Box and Block Tests. Patients in the experimental group, but not the control group, also showed significant improvements on the lateral, palmar, and tip pinch power, Box and Block, and 9-HPTs from before to immediately after training. Significantly greater improvements in the tip pinch power immediately after training and spasticity of elbow flexion 4 weeks after training completion were noted in the experimental group.

Conclusions: VR combined real instrument training was effective at promoting recovery of patients' upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke.
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http://dx.doi.org/10.1016/j.apmr.2019.03.013DOI Listing
August 2019

Changes in Intracortical Excitability of Affected and Unaffected Hemispheres After Stroke Evaluated by Paired-Pulse Transcranial Magnetic Stimulation.

Ann Rehabil Med 2018 Aug 31;42(4):495-501. Epub 2018 Aug 31.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.

Objective: To assess the altered pattern of intracortical excitability of the affected and unaffected hemispheres in stroke patients using paired-pulse transcranial magnetic stimulation (TMS).

Methods: We evaluated intracortical inhibition (ICI) and intracortical facilitation (ICF) in both hemispheres at acute and subacute stages of 103 stroke patients using paired-pulse TMS. The patients were divided into two groups: mild-to-moderate patients whose motor evoked potential (MEP) was recorded in the affected hemisphere; and severe patients whose MEP was not recorded in the affected hemisphere.

Results: In mild-to-moderate patients, the value of ICI in the affected hemisphere was increased from 70.3% to 77.9% and the value of ICI in the unaffected hemisphere was decreased from 74.8% to 70.3% with eventual progression in acute to subacute stages of stroke. In severe patients, the value of ICI in the unaffected hemisphere was increased from 65.4% to 75.6%. The changes in ICF were not significantly different in this study.

Conclusion: We conclude that the unaffected hemisphere was more disinhibited than the affected hemisphere in acute phase of mild-to-moderate stroke, and the affected hemisphere was more disinhibited in the subacute stage. The unaffected hemisphere was inhibited in severe cases in acute-to-subacute phases of stroke. This finding facilitates appropriate neuromodulation of acute-to-subacute phases in mild-to-severe stroke patients.
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http://dx.doi.org/10.5535/arm.2018.42.4.495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129700PMC
August 2018

Effects of newly developed compact robot-aided upper extremity training system (Neuro-X®) in patients with stroke: A pilot study.

J Rehabil Med 2018 Jul;50(7):607-612

Physical Medicine and Rehabilitation, Chonbuk National University Medical School, KS004 Jeonju city, South Korea.

Objective: Robot-assisted rehabilitation therapy of the upper extremity after stroke has been studied widely; however, robotic devices remain expensive and bulky. The aim of this study was to evaluate the effects of a newly developed, compact upper extremity training system (Neuro-X®) in patients with chronic stroke.

Design: Pilot study.

Subjects: Fifteen patients with hemiplegia.

Methods: Chronic patients with stroke underwent upper extremity training using a newly developed upper extremity training system (Neuro-X®; Apsun Inc., Seoul, Korea). Patients were evaluated using the Fugl-Meyer Assessment (FMA), Hand Function Test (HFT), Modified Ashworth Scale (MAS), and Korean Mini-Mental Status Evaluation (K-MMSE). The assessment started with "pre 1 evaluation" (A1), followed by repeated "pre 2 evaluation" (A2) after 6 weeks without receiving any treatment, in order to generate repeated baseline data. After the A2 evaluation, upper extremity training was performed for 6 weeks. Post-training evaluation (B) was performed after treatment. Obtained data (A1-A2-B) were compared.

Results: During the non-intervention phase (A1 to A2), no significant changes were found in the aforementioned evaluations. However, in the intervention phase (A2 to B), results of the FMA and HFT, and K-MMSE scores, except the MAS score, increased significantly (p <0.05).

Conclusion: The Neuro-X® training system improves functioning of the upper extremity and cognition in patients with stroke after 6 weeks of training.
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http://dx.doi.org/10.2340/16501977-2361DOI Listing
July 2018

Validation of Korean Version of the London Chest Activity of Daily Living Scale in Patients With Chronic Obstructive Pulmonary Disease.

Ann Rehabil Med 2018 Apr 30;42(2):329-335. Epub 2018 Apr 30.

Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Objective: To translate the English version of the London Chest Activity of Daily Living scale (LCADL) into a Korean version and to determine the reliability and validity of the Korean version in patients with chronic obstructive pulmonary disease (COPD).

Methods: The English version of LCADL was translated into Korean and back-translated into English. Subsequently, the back-translated version was reviewed and compared with the original, and thus the final K-LCADL was obtained. To evaluate the validation of the K-LCADL, patients simultaneously completed a pulmonary function test, a 6-Minute Walk Test (6MWT), and questionnaires, including the modified Medical Research Council (mMRC) dyspnea scale, the Korean version of the St. George's Respiratory Questionnaire (K-SGRQ), the Korean version of the COPD Assessment Test (K-CAT), and the Korean version of the EuroQoL-5 Dimensions (K-EQ-5D). To assess test-retest reliability, the K-LCADL was again administered to the same patients within 2 weeks from initial assessment.

Results: A total of 94 patients participated in the present study. The total K-LCADL score was positively correlated with the K-SGRQ (r=0.802, p<0.001), the mMRC dyspnea scale (r=0.603, p<0.001), and the K-CAT score (r=0.714, p<0.001), and negatively correlated with the K-EQ-5D (r=-0.764, p<0.001), 6MWT (r=-0.635, p<0.001), forced expiratory volume in one second 1 (r=-0.416, p=0.002), and forced vital capacity (r=-0.397, p=0.023). Intraclass correlation coefficient of the K-LCADL was 0.951 (p<0.001).

Conclusion: The K-LCADL is a reliable and valid questionnaire for evaluating limitation of activities of daily living in patients with COPD.
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http://dx.doi.org/10.5535/arm.2018.42.2.329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940610PMC
April 2018

Respiratory Muscle Strength in Patients With Chronic Obstructive Pulmonary Disease.

Ann Rehabil Med 2017 Aug 31;41(4):659-666. Epub 2017 Aug 31.

Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Objective: To compare the respiratory muscle strength between patients with stable and acutely exacerbated (AE) chronic obstructive pulmonary disease (COPD) at various stages.

Methods: A retrospective medical record review was conducted on patients with COPD from March 2014 to May 2016. Patients were subdivided into COPD stages 1-4 according to the Global Initiative for Chronic Obstructive Lung Disease guidelines: mild, moderate, severe, and very severe. A rehabilitation physician reviewed their medical records and initial assessment, including spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), COPD Assessment Test, and modified Medical Research Council scale. We then compared the initial parameters in patients with a stable condition and those at AE status.

Results: The AE group (n=94) had significantly lower MIP (AE, 55.93±20.57; stable, 67.88±24.96; p=0.006) and MIP% (AE, 82.82±27.92; stable, 96.64±30.46; p=0.015) than the stable patient group (n=36). MIP, but not MEP, was proportional to disease severity in patients with AE and stable COPD.

Conclusion: The strength of the inspiratory muscles may better reflect severity of disease when compared to that of expiratory muscles.
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http://dx.doi.org/10.5535/arm.2017.41.4.659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608674PMC
August 2017

Ultrasonographic Imaging and Anti-inflammatory Therapy of Muscle and Tendon Injuries Using Polymer Nanoparticles.

Theranostics 2017 24;7(9):2463-2476. Epub 2017 Jun 24.

Department of BIN Convergence Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea.

Ultrasonography is a reliable diagnostic modality for muscle and tendon injuries, but it has been challenging to find right diagnosis of minor musculoskeletal injuries by conventional ultrasonographic imaging. A large amount of hydrogen peroxide (HO) are known to be generated during tissue damages such as mechanical injury and therefore HO holds great potential as a diagnostic and therapeutic marker for mechanical injuries in the musculoskeletal system. We previously developed poly(vanillyl alcohol--oxalate) (PVAX), which rapidly scavenges HO and exerts antioxidant and anti-inflammatory activity in HO-associated diseases. Based on the notion that PVAX nanoparticles generate CO bubbles through HO-triggered hydrolysis, we postulated that PVAX nanoparticles could serve as ultrasonographic contrast agents and therapeutic agents for musculoskeletal injuries associated with overproduction of HO. In the agarose gel phantom study, PVAX nanoparticles continuously generated CO bubbles to enhance ultrasonographic echogenicity significantly. Contusion injury significantly elevated the level of HO in skeletal muscles and Achilles tendons. Upon intramuscular injection, PVAX nanoparticles significantly elevated the ultrasound contrast and suppressed inflammation and apoptosis in the contusion injury of musculoskeletal systems. We anticipate that PVAX nanoparticles hold great translational potential as theranostic agents for musculoskeletal injuries.
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http://dx.doi.org/10.7150/thno.18922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525750PMC
March 2018

Effects of 3-Dimensional Lumbar Stabilization Training for Balance in Chronic Hemiplegic Stroke Patients: A Randomized Controlled Trial.

Ann Rehabil Med 2016 Dec 30;40(6):972-980. Epub 2016 Dec 30.

Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University & Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Objective: To investigate the effects of the newly developed Spine Balance 3D system on the balance and gait abilities of hemiplegic stroke patients.

Methods: Twenty-eight hemiplegic patients with chronic stroke were randomly assigned to an experimental (n=14) or control group (n=14). The experimental and control groups performed balance training by using the newly developed Spine Balance 3D system and the well-known Biodex Balance System 30 minutes per day, three times a week for 7 weeks. The Berg Balance Scale (BBS), 10-m walking test (10mWT), Timed Up and Go Test (TUG), Functional Reach Test (FRT), the Korean version of the Fall Efficacy Scale-International (KFES-I), trunk muscle strength and stability were evaluated before and after 7 weeks of intervention.

Results: The 10mWT improved significantly (p=0.001) in the experimental group (using the Spine Balance 3D system) but not in the control group, and core muscle strength, which we checked using Spine Balance 3D system evaluation program, improved more in the experimental group as well. The results of the BBS, FRT, TUG, KFES-I, and Biodex Balance System evaluation program improved in both groups after 7 weeks of balance training.

Conclusion: We suggest that the newly-developed Spine Balance 3D system can be a more useful therapeutic tool for gait and dynamic balance rehabilitation in hemiplegic patients than a conventional 2D-based balance training system. A large-scale randomized controlled study is needed to prove the effect of this system.
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http://dx.doi.org/10.5535/arm.2016.40.6.972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256321PMC
December 2016

Correlation between muscle electrophysiology and strength after fibular nerve injury.

Neurol Sci 2016 Aug 3;37(8):1293-8. Epub 2016 May 3.

Chonbuk National University Medical School and Hospital, 634-18, Keumam-dong, Dukjin-gu, Jeonju, 561-712, Republic of Korea.

Muscle strength measurement is important when evaluating the degree of impairment in patients with nerve injury. However, accurate and objective evaluation may be difficult in patients with severe pain or those who intentionally try to avoid full exertion. We investigated the usefulness of the affected-to-unaffected side electrophysiological parameter ratios as a measure of objective ankle dorsiflexion (ADF) strength in patients with unilateral fibular nerve injury (FNI). ADF strength was measured in patients with FNI via handheld dynamometer and manual muscle test (MMT). Fibular nerve compound muscle action potential (CMAP) amplitude and latency and ADF strength of the affected side were presented as ratios to the corresponding measurements of the unaffected side. We analysed the correlation of the CMAP ratio with the ADF strength ratio using a dynamometer and compared the CMAP ratios according to MMT grade. Fifty-two patients with FNI were enrolled. The mean CMAP latency ratio did not differ between MMT groups (p = 0.573). The CMAP amplitude ratio proportionally increased with the quantified ADF strength ratio via dynamometer increase (ρ = 0.790; p < 0.001), but the CMAP latency ratio and the quantified ADF strength ratio did not significantly correlate (ρ = 0.052; p = 0.713). The average CMAP amplitude ratio significantly differed between MMT groups (p < 0.001), and post hoc tests showed significant differences in all paired comparisons except of Fair and Good grades (p = 0.064). Electrophysiological parameter ratio, such as the affected-to-unaffected side CMAP amplitude ratio, might be sensitive parameters for ADF power estimation after FNI.
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http://dx.doi.org/10.1007/s10072-016-2584-zDOI Listing
August 2016

Changes in Body Temperature in Incomplete Spinal Cord Injury by Digital Infrared Thermographic Imaging.

Ann Rehabil Med 2015 Oct 26;39(5):696-704. Epub 2015 Oct 26.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School and Chonbuk National University Hospital, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Objective: To investigate changes in the core temperature and body surface temperature in patients with incomplete spinal cord injuries (SCI). In incomplete SCI, the temperature change is difficult to see compared with complete spinal cord injuries. The goal of this study was to better understand thermal regulation in patients with incomplete SCI.

Methods: Fifty-six SCI patients were enrolled, and the control group consisted of 20 healthy persons. The spinal cord injuries were classified according to International Standards for Neurological Classification of Spinal Cord Injury. The patients were classified into two groups: upper (neurological injury level T6 or above) and lower (neurological injury level T7 or below) SCIs. Body core temperature was measured using an oral thermometer, and body surface temperature was measured using digital infrared thermographic imaging.

Results: Twenty-nine patients had upper spinal cord injuries, 27 patients had lower SCIs, and 20 persons served as the normal healthy persons. Comparing the skin temperatures of the three groups, the temperatures at the lower abdomen, anterior thigh and anterior tibia in the patients with upper SCIs were lower than those of the normal healthy persons and the patients with lower SCIs. No significant temperature differences were observed between the normal healthy persons and the patients with lower SCIs.

Conclusion: In our study, we found thermal dysregulation in patients with incomplete SCI. In particular, body surface temperature regulation was worse in upper SCIs than in lower injuries. Moreover, cord injury severity affected body surface temperature regulation in SCI patients.
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http://dx.doi.org/10.5535/arm.2015.39.5.696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654076PMC
October 2015

Correction: Neuroradiological and Neurophysiological Characteristics of Patients With Dyskinetic Cerebral Palsy.

Ann Rehabil Med 2015 Aug;39(4):659

Department of Radiology, Chonbuk National University Medical School, Jeonju, Korea.

[This corrects the article on p. 189 in vol. 38, PMID: 24855613.].
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http://dx.doi.org/10.5535/arm.2015.39.4.659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564718PMC
August 2015

Terson Syndrome in Aneurysmal Subarachnoid Hemorrhage: A Case Report.

Ann Rehabil Med 2015 Aug 25;39(4):640-4. Epub 2015 Aug 25.

Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Terson syndrome refers to oculocerebral syndrome of retinal and vitreous hemorrhage associated with spontaneous subarachnoid hemorrhage or all forms of intracranial bleeding. Recent observations have indicated that patients with spontaneous subarachnoid hemorrhage have an 18% to 20% concurrent incidence of retinal and vitreous hemorrhages with about 4% incidence of vitreous hemorrhage alone. Clinical ophthalmologic findings may have significant diagnostic and prognostic value for clinicians. Here we report a 45-year-old female patient who suffered from blurred vision after subarachnoid hemorrhage. She was diagnosed as Terson syndrome. After vitrectomy, she recovered with normal visual acuity which facilitated the rehabilitative process. We also performed visual evoked potentials to investigate abnormalities of visual dysfunction. Based on this case, we emphasize the importance of early diagnosis of Terson syndrome.
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http://dx.doi.org/10.5535/arm.2015.39.4.640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564714PMC
August 2015

Can motor evoked potentials be an objective parameter to assess extremity function at the acute or subacute stroke stage?

Ann Rehabil Med 2015 Apr 24;39(2):253-61. Epub 2015 Apr 24.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Objective: To investigate whether motor evoked potential (MEP) amplitude ratio measurements are sufficiently objective to assess functional activities of the extremities. We also delineated the distribution between the presence or absence of MEPs and the Medical Research Council (MRC) scale for muscle strength of the extremities.

Methods: We enrolled 183 patients with first-ever unilateral hemiplegia after stroke. The MEP parameters were amplitude ratio (amplitude of affected side/amplitude of unaffected side) recorded at the first dorsal interosseous (FDI) and tibialis anterior (TA) muscles. We performed frequency analyses using the MRC scale for muscle strength and the presence or absence of evoked MEPs. Change on the MRC scale, hand function tests (HFTs), and the Modified Barthel Index (MBI) subscore were compared between the evoked MEP and absent MEP groups using the independent t-test. Receiver operating characteristic curves were used to determine the optimal cutoff scores for the MEP amplitude ratio using the HFT results and MBI subscores. Correlations between the MEP amplitude ratio and the MRC scale, HFTs, and MBI subscore were analyzed.

Results: About 10% of patients with MRC scale grades 0-2 showed evoked MEPs at the FDI muscle, and 4% of patients with MRC scale grades 3-5 did not show MEPs. About 18% of patients with MRC scale grades 0-2 showed evoked MEPs at the TA muscle, and 4% of patients with MRC scale grades 3-5 did not show MEPs. MEP amplitude increased with increasing MRC scale grade. The evoked MEP group had more significant changes on the MRC scale, HFT, and the climbing stair score on the MBI than those in the group without MEPs. Larger MEP amplitude ratios were observed in patients who had more difficulty with the HFTs and ambulation. The MEP amplitude ratio was significantly correlated with the MRC scale, HFT, and MBI subscore.

Conclusion: We conclude that the MEP amplitude ratio may be useful to predict functional status of the extremities in patients who suffered stroke.
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http://dx.doi.org/10.5535/arm.2015.39.2.253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414972PMC
April 2015

Effects of a serious game training on cognitive functions in older adults.

J Am Geriatr Soc 2015 Mar;63(3):603-5

Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea; Medical Device Clinical Trial Center, Chonbuk National University Hospital, Jeonju, Korea.

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http://dx.doi.org/10.1111/jgs.13304DOI Listing
March 2015

Ultrasonic measurement of rectal diameter and area in neurogenic bowel with spinal cord injury.

J Spinal Cord Med 2016 05 11;39(3):301-6. Epub 2016 Feb 11.

a Department of Physical Medicine and Rehabilitation , Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School and Hospital , Jeonju City , Republic of Korea.

Objective: The aim of this study was to determine the efficacy of measuring the diameter and area of the rectum using ultrasonography as an additional parameter for the evaluation of neurogenic bowel in patients with spinal cord injury (SCI).

Participants: In total, 32 patients with SCI (16 patients with upper motor neuron neurogenic bowel (UMNB) and 16 patients with lower motor neuron neurogenic bowel (LMNB)) participated in this study. We divided the patients by the type of neurogenic bowel: UMNB, patients with supraconal lesions and recovery state of spinal shock or LMNB, patients with infraconal/caudal lesions or spinal shock state).

Intervention: Ultrasound was applied on the abdomen and measured the diameter and area of the rectum were measured twice each before and after defecation, respectively.

Outcome Measure: We compared rectal diameter and area before/after defecation between the two groups, and significant differences were found in both rectal diameter and area before/after defecation in each group.

Results: After defecation, those in the UMNB group had smaller rectal diameters and areas than those in the LMNB group. Significant reduction of rectal diameter and area was observed after defecation as well. The LMNB group showed slightly increased rectal area after defecation, but the increase was not statistically significant.

Conclusion: Using ultrasound to measure rectal diameter and area seems helpful for classifying neurogenic bowel types and for understanding the neurogenic bowel among SCI patients with symptoms of neurogenic bowel.
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http://dx.doi.org/10.1179/2045772314Y.0000000282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073751PMC
May 2016

Neuroradiological and neurophysiological characteristics of patients with dyskinetic cerebral palsy.

Ann Rehabil Med 2014 Apr 29;38(2):189-99. Epub 2014 Apr 29.

Department of Radiology, Chonbuk National University Medical School, Jeonju, Korea.

Objective: To investigate neuroradiological and neurophysiological characteristics of patients with dyskinetic cerebral palsy (CP), by using magnetic resonance imaging (MRI), voxel-based morphometry (VBM), diffusion tensor tractography (DTT), and motor evoked potential (MEP).

Methods: Twenty-three patients with dyskinetic CP (13 males, 10 females; mean age 34 years, range 16-50 years) were participated in this study. Functional evaluation was assessed by the Gross Motor Functional Classification System (GMFCS) and Barry-Albright Dystonia Scale (BADS). Brain imaging was performed on 3.0 Tesla MRI, and volume change of the grey matter was assessed using VBM. The corticospinal tract (CST) and superior longitudinal fasciculus (SLF) were analyzed by DTT. MEPs were recorded in the first dorsal interossei, the biceps brachii and the deltoid muscles.

Results: Mean BADS was 16.4±5.0 in ambulatory group (GMFCS levels I, II, and III; n=11) and 21.3±3.9 in non-ambulatory group (GMFCS levels IV and V; n=12). Twelve patients showed normal MRI findings, and eleven patients showed abnormal MRI findings (grade I, n=5; grade II, n=2; grade III, n=4). About half of patients with dyskinetic CP showed putamen and thalamus lesions on MRI. Mean BADS was 20.3±5.7 in normal MRI group and 17.5±4.0 in abnormal MRI group. VBM showed reduced volume of the hippocampus and parahippocampal gyrus. In DTT, no abnormality was observed in CST, but not in SLF. In MEPs, most patients showed normal central motor conduction time.

Conclusion: These results support that extrapyramidal tract, related with basal ganglia circuitry, may be responsible for the pathophysiology of dyskinetic CP rather than CST abnormality.
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http://dx.doi.org/10.5535/arm.2014.38.2.189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026605PMC
April 2014

Reliability and Validity of the Korean Version VISA-P Questionnaire for Patellar Tendinopathy in Adolescent Elite Volleyball Athletes.

Ann Rehabil Med 2013 Oct 29;37(5):698-705. Epub 2013 Oct 29.

Department of Physical Medicine and Rehabilitation, Institute for Medical Sciences, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

Objective: To translate the English Victorian Institute of Sport Assessment for patellar tendinopathy (VISA-P) questionnaire into a Korean version and to determine the reliability and validity of the Korean version.

Methods: The English VISA-P questionnaire was translated into Korean according to the internationally recommended guidelines. Then, 28 adolescent elite volleyball athletes (average age, 16 years; range, 14 to 19 years) were asked to complete the questionnaire three times (before examination, after examination, and 1 week later) for reliability. They were evaluated through a physical examination and ultrasonography to diagnosis patellar tendinopathy.

Results: The internal consistency of the VISA-P questionnaire by Cronbach's alpha was 0.80 for the first, 0.78 for the second, and 0.79 for the third assessment. The intraclass correlation coefficient (ICC) between the first and second assessments was 0.97. The ICC between the second and third assessments was 0.96. The mean VISA-P scores were 67.6±15.7 for the patellar tendinopathy group (n=23) and 92.6±8.6 for the normal group (n=5). There were significantly lower VISA-P scores in the patellar tendinopathy group compared to the normal group.

Conclusion: The translated Korean version VISA-P questionnaire has good internal consistency, test-retest reliability and validity. In addition, this study indicated that most adolescent elite volleyball athletes had patellar tendon problems. Therefore, the Korean version VISA-P is a useful self-administered outcome score of athletes with patellar tendinopathy.
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http://dx.doi.org/10.5535/arm.2013.37.5.698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825947PMC
October 2013
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