• Title/Summary/Keyword: Motor Function recovery

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Altered Peripheral Nerve Excitability Properties in Acute and Subacute Supratentorial Ischemic Stroke (급성 및 아급성 천막상 허혈성 뇌졸중에서 발생하는 말초신경 흥분성 변화)

  • Seo, Jung Hwa;Ji, Ki Whan;Chung, Eun Joo;Kim, Sang Gin;Kim, Oeung Kyu;Paeing, Sung Hwa;Bae, Jong Seok
    • Annals of Clinical Neurophysiology
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    • v.14 no.2
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    • pp.64-71
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    • 2012
  • Background: It is generally accepted that upper motor neuron (UMN) lesion can alter lower motor neuron (LMN) function by the plasticity of neural circuit. However there have been only few researches regarding the axonal excitability of LMN after UMN injury especially during the acute stage. The aim of this study was to investigate the nerve excitability properties of the LMNs following an acute to subacute supratentorial corticospinal tract lesion. Methods: An automated nerve excitability test (NET) using the threshold tracking technique was utilized to measure multiple excitability indices in median motor axons of 15 stroke patients and 20 controls. Testing of both paretic and non-paretic side was repeated twice, during the acute stage and subacute stage. The protocols calculated the strength-duration time constant from the duration-charge curve, parameters of threshold electrotonus (TE), the current-threshold relationship from sequential sub-threshold current, and the recovery cycle from sequential supra-threshold stimulation. Results: On the paretic side, compared with the control group, significant decline of superexcitablity and increase in the relative refractory period were observed during the subacute stage of stroke. Additionally, despite the absence of statistical significance, a mildly collapsing in ('fanning in') of the TE was found. Conclusions: Our results suggest that supratentorial brain lesions can affect peripheral axonal excitability even during the early stage. The NET pattern probably suggests background membrane depolarization of LMNs. These features could be associated with trans-synaptic regulation of UMNs to LMNs as one of the "neural plasticity" mechanisms in acute brain injury.

Effects of Melatonin on Improvement of Neurological Function in Focal Cerebral Ischemic Rats

  • Lee, Seung-Hoon;Shin, Jin-Hee;Lee, Min-Kyung;Lee, Sang-Kil;Lee, Sang-Rae;Chang, Kyu-Tae;Hong, Yong-Geun
    • Reproductive and Developmental Biology
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    • v.35 no.2
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    • pp.167-174
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    • 2011
  • Acute ischemic stroke results from sudden decrease or loss of blood supply to an area of the brain, resulting in a coinciding loss of neurological function. The antioxidant action of melatonin is an important mechanism among its known effects to protective activity during ischemic/reperfusion injury. The focus of this research, therapeutic efficacy of melatonin on recovery of neurological function following long term treatment in ischemic brain injured rats. Male Sprague-Dawley rats (n=40; 8 weeks old) were divided into the control group, and MCAo groups (Vehicle, MT7 : MCAo+ melatonin injection at 7:00, MT19 : MCAo+melatonin injection at 19:00, and MT7,19 : MCAo+melatonin injection at 7:00 and 19:00). Rat body weight and neurological function were measured every week for 8 weeks. After 8 weeks, the rats were anesthetized with a mixture of zoletil (40 mg/kg) and xylazine (10 mg/kg) and sacrificed for further analysis. Tissues were then collected for RNA isolation from brain tissue. Also, brain tissues were analyzed by histological procedures. We elucidated that melatonin was not toxic in vital organs. MT7,19 was the most rapidly got back to mild symptom on test of neurological parameter. Also, exogenous melatonin induces both the down-regulation of detrimental genes, such as NOSs and the up-regulation of beneficial gene, including BDNF during long term administration after focal cerebral ischemia. Melatonin treatment reduced the loss of primary motor cortex. Therefore, we suggest that melatonin could be act as prophylactic as well as therapeutic agent for neurorehabilitative intervention.

The Effect of EMG-stim on Upper Limb Function in Chronic Stroke Patients (근전도 유발 신경근 전기자극치료가 뇌졸중 환자의 상지기능에 미치는 효과)

  • Cho, In-Sul;Chang, Jong-Sung;Kim, Kyoung;Kim, Wook-Ro;Park, Rae-Joon
    • The Journal of Korean Physical Therapy
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    • v.21 no.2
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    • pp.1-8
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    • 2009
  • Purpose: This study examined the effect of EMG-stim related to the functional recovery of the upper extremity in chronic stroke patients with an intensive massed practice protocol. Methods: The subjects were assigned randomly to either the EMG-stim group (n=10) or sham treatment group (n=10). Both groups received conventional physical therapy, occupational therapy and FES, five times per week over a four week period. In the EMG-stim group, EMG-stim was applied to the hemiplegic wrist and finger extensors for 2 sessions for 30 minutes per day, 5 times per week over a 4 week period. As the pre- and the post-test, the following four motor tests were assessed as the function of the upper extremity clinical functional test: extensor digitorum strength test, Box and Block test, Fugl-Mayer Assessment, and Jebson-Taylor Hand Function Test. Results: In the Box and Block test and Fugl-Mayer Assessment, there were statistically significant differences between both groups as well as between pre- and post-test. The extensor digitorum and wrist extensor strength were similar in both groups. In the Jebson-Taylor Hand Function Test, there was a significant difference in simulated page turning but not in the other subtests. Conclusion: Intensive massed practice with EMG-stim intervention applied to the hemiplegic upper extremity is an effective therapeutic method for chronic stroke patients. However, a variety of intervention methods designed for stroke patients in clinical settings are needed.

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Comparision of cardiovascular and analgesic effects of epidural administration of medetomidine, medetomidine-buprenorphine and medetomidine-fentanyl in dogs anesthetized with isoflurane (Isofourane으로 마취된 개에 medetomidine, medetomidine-buprenorphine, medetomidine-fentanyl의 경막외 투여 시 심혈관계 반응과 진통효과의 비교)

  • Chang, Hwa-Seok;Kim, Hye-Jin;Choi, Chi-Bong;Lee, Jung-Sun;Kim, Hwi-Yool
    • Korean Journal of Veterinary Research
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    • v.47 no.1
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    • pp.103-115
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    • 2007
  • The aim of this study was to compare the reaction of the cardiovascular system, and the anesthetic effect among 3 experimental groups, epidural administration of medetomidine as a single agent, the combination of buprenorphine and medetomidine, and the combination of fentanyl and medetomidine. Twenty one dogs were anesthetized with isoflurane and allowed to breathe spontaneously. Epidural, arterial, and venous catheters were inserted. The tip of epidural catheter was positioned at the level of the space between the sixth and seventh lumbar vertebra. After a stable plane of anesthesia was achieved, these dogs were each administered one of the following treatments epidurally : medetomidine $10{\mu}g/kg$ (Group M), a combination of medetomidine $5{\mu}g/kg$ and buprenorphine $10{\mu}g/kg$ (Group M/B), and a combination of medetomidine $5{\mu}g/kg$ and fentanyl $10{\mu}g/kg$ (Group M/F). Heart rate (HR), Respiratory rate (RR), End-tidal carbon dioxide (EtCO2), and arterial blood pressure were measured before drug administration (base line) and 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min postinjection. Blood gas analysis was performed before injection and 5, 15, 25, 35, 45, 60 min postinjection. Isoflurane was discontinued 80 min postinjection and pain/motor function were evaluated up to 260 min postinjection every 15 min. At the early stage of drug introduction (until 5 min), the HR was decreased significantly in all 3 groups compared with base line. In Group M, HR was significantly decreased compared with the other 2 groups. With time (starting 20 min after drug introduction), the HR was decreased significantly in Group M/B in respect to base line. However, no significant difference was seen number-wise in all 3 groups. During 60 min after drug introduction, the systolic, diastolic and mean arterial pressures were highest in Group M and lowest in Group M/F. Among 3 groups, drug action and motor loss duration were longest in Group M/F. Analgesic effect observed in the M/F group was the most prominent and long-lasting, compared to those seen in the other 2 groups. Given the fact that the recovery of motor function takes place in a short period of time after analgesic effects disappeared, additional use of M/F depending on the patient's condition would be a good way to achieve effective pain management. However, proper care should be taken to ensure the function of cardiovascular system in the patient because the administration of M/F under isoflurane anesthesia results in a significant decline in arterial blood pressure ($65{\pm}10mmHg$).

The Effect of the Swimming Exercise by Load on Concentration of BDNF in Serum and Behavioral Change of CNS Injury in the Rats (부하유무에 따른 수영운동이 중추신경계 손상 흰쥐의 혈청 BDNF 농도 및 행동변화에 미치는 영향)

  • Ha, Mi-Sook;Hyong, In-Hyouk
    • The Journal of the Korea Contents Association
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    • v.9 no.12
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    • pp.391-399
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    • 2009
  • The purposes of the present investigation was to evaluate the effects of loaded and unloaded swimming stimulation after central nerve system injury in the rats. SCI model rats were damaged in L1-L2 injected with 6-OHDA. The twenty one Sprague-Dawley adult male rats weights($200\pm10g$) were randomly divided into control group and 2 swimming groups and then swimming groups divided into 15 minute unloaded swimming group and 15 minute loaded swimming group by swimming intensity. Behavioral Change was evaluated by the BBB(Basso, Brestti, Brenahan) scales test and the maximal angles of the inclined board on which the rat could maintain its intial position for the progressive locomotor recovery. Using enzyme-linked immunosolbent assays(ELISA), we measured concentrations of brain-delived growth factor(BDNF) in serum after swimming. There was significant change of BBB scores in control group as compared to unloaded swimming group and loaded swimming group(p<.05), and unloaded swimming group were significantly higher than loaded swimming group(p<.05). The maximal angles of the inclined plane test were higher in the unloaded swimming group and loaded swimming group than the control group(p<.05), and loaded swimming group were significantly lower than unloaded swimming group(p<.05). There were singnificant difference of concentration of BDNF in serum change in each group(p<.05). The results suggest that swimming applied from the early phase after spinal cord injury may be beneficial in the early recovery of motor function.

Correlation Study between the Changes of the Fire- and Heat- Related Symptoms and Motor Function Recovery in Acute Cerebral Infarction Patients (급성기 뇌경색 환자의 화열증상 변화와 기능회복도간의 상관관계에 대한 연구)

  • Hyun, Sang-Ho;Min, Kyung-Dong;Yei, Young-Chul;Kang, Ah-Reum;Lee, Eun-Chan;Moon, Sang-Kwan;Cho, Ki-Ho;Jung, Woo-Sang;Park, Sung-Wook;Ko, Chang-Nam
    • The Journal of Internal Korean Medicine
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    • v.34 no.4
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    • pp.428-437
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    • 2013
  • Objectives : The aim of this study was to examine if there is a significant correlation between the changes of Fire- and Heat- related symptoms and motor function recovery in acute cerebral infarction patients. Methods : We studied inpatients within a month after the onset of cerebral infarction who were admitted at Kyunghee University Medical Center from May 2011 to January 2013. We executed correlation analysis between Fire-heat pattern score and motricity index score at visit 1 and visit 2, and checked if there was a significant correlation between the changes of Fire-heat pattern score and changes of motricity index score. Also, we compared the changes of both scores in patients taking Fire-heat and non Fire-heat pattern prescriptions. Results : There was a significant correlation between the Fire-heat pattern score and Motricity index score at visit 1 and visit 2, and changes of Fire-heat pattern score showed significant correlation with changes of motricity index score. Patients taking Fire-heat pattern prescriptions showed significant change in Fire-heat pattern score after herb-medication treatment while patients taking non-Fire-heat prescriptions showed insignificant change in Fire-heat pattern score. Conclusions : This study provides evidence that taking a Fire-heat pattern prescription could be considered as a first line herb-medication treatment in acute cerebral infarction patients.

Effect of Physical Therapy on the Motor Function and Mental State Recovery in Stroke Patients (뇌졸중 환자에 있어서 물리치료가 운동기능과 인지기능의 회복에 미치는 영향)

  • Kim, Hee-Han;Kim, Yoo-Sup;Lee, Hye-Jin;Song, Myung-Soo
    • Journal of Korean Physical Therapy Science
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    • v.9 no.4
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    • pp.15-23
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    • 2002
  • In order to find the effects of physical therapy on the recovery of motor functions and mental state, a survey was conducted to 63 patients who, diagnosed as stroke by brain CT, had been hospitalized in a university medical center located in Jeonbuk provincial area from December 2000 to August 2001. The outcomes of the survey are as follows: 1. The subjects of the study were composed of 35 males(55.6%) and 28 females(44.4%), with 34(54.0%) below 60 in age and 29(46.0%) older than 60 years. 2. As to type of lesion, the surveyed patients were divided into 28(44.4%) with cerebral infarction, 24(38.1%) with cerebral hemorrhage, and 11(17.5%) with subarachnoid hemorrhage. In terms of size of lesion, they were divided into 29(46.0% with less than tan 1cm, 15 (23.8%) with $1{\sim}2cm$ and 19(30.2%) with longer than 2cm. Thirty-five patients(55.7%) reported paralysis in their right side, while 28(44.8%) complained paralysis in their left side. No recidivation was reported by 51(81.1%) while recidivation was asserted by 12(19%). Among them, 27(42.9%) had no past history but 36(57.1%) had such. 3. Regarding the time hour onset to admission to physical therapy, 46patients(73.0%) experienced it for less than one month, while 17(27.0%) for longer than one month. In terms of period of physical therapy, 30(47.6%) underwent the therapy for less than one month, 18(28.6%) for 1-2 months and 15(23.8%) for longer than 2 months. As is shown in the above study, the longer the period of physical therapy is, the more changes might occur in points of MMSE-K and MMAS. It may, therefore, be concluded that sufficiently longer period of physical therapy ensures the increased recovery of physical functions from stroke.

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The Effect of Transcranial Direct Current Stimulation over the Primary Somatosensory Cortex in Patients with Chronic Stroke on Somatosensory and Upper Limb Function for Improving Life Care (만성 뇌졸중 환자를 대상으로 한 일차 체성 감각 피질을 자극한 경두개 직류 전류 자극이 라이프 케어 증진을 위한 체성감각과 상지기능에 미치는 영향)

  • Kim, Sun-Ho
    • Journal of Korea Entertainment Industry Association
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    • v.14 no.6
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    • pp.269-277
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    • 2020
  • The purpose of this study is to investigate the recovery of sensation and the restoration of upper limb function according to transcranial direct current stimulation over the primary somatosensory cortex in patients with chronic stroke with sensory deficit. 20 patients with chronic stroke divided into 10 experimental groups and 10 control groups. Patients received transcranial direct current stimulations over the primary somatosensory cortex on the side of the stroke lesion, and The control group applied sham tDCS to the same location. Intervention was conducted 5 times a week, 20 minutes per session for a total of 2 weeks. Assessment was performed using the Erasmus MC modifications to the Nottingham Sensory Assessment(EmNSA), Semmes-Weinstein monofilament examination(SWME) for somatosensory, and Fugle-Meyer Assessment(FMA), Motor Activity Log(MAL), and accelerometer for upper extremity function. Assessment was conducted before and after the intervention. As a result of the study, the experimental group showed a significant improvement in the overall tactile sense, proprioception, cortical sense, and perception sensitivity than the control group, and showed a statistically significant difference in the usage amount of the upper limb. Based on the results of this study, it is thought that the possibility of effective clinical application of transcranial direct current stimulation for recovery of somatosensory and upper extremity function is thought to be increased.

Effect of Stem Cell Transplantation on Pain Behavior and Locomotor Function in Spinal Cord Contusion Model

  • Park, Hea-Woon;Kim, Su-Jeong;Cho, Yun-Woo;Hwang, Se-Jin;Lee, Won-Yub;Ahn, Sang-Ho;Jang, Sung-Ho
    • The Journal of Korean Physical Therapy
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    • v.22 no.3
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    • pp.79-85
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    • 2010
  • Purpose: Many trials for new therapeutic approaches such as stem cell-based transplantation have been conducted to improve the repair and regeneration of injured cord tissue and to restore functions following spinal cord injury (SCI) in animals and humans. Adipose tissue-derived stromal cells (ATSCs) have multi-lineage potential to differentiate into cells with neuron-like morphology. Most studies of stem cell transplantation therapy after SCI are focused on cellular regeneration and restoration of motor function, but not on unwanted effects after transplantation such as neuropathic pain. This study was focused on whether transplantation of ATSCs could facilitate or attenuate hindpaw pain responses to heat, cold and mechanical stimulation, as well as on improvement of locomotor function in a rat with SCI. Methods: A spinal cord injury rat model was produced using an NYU impactor by dropping a 10 g rod from a height of 25 mm on to the T9 segment. Human ATSCs (hATSCs; approximately $5{\times}10^5$ cells) or DMEM were injected into the perilesional area 9 days after the SCI. After transplantation, hindpaw withdrawal responses to heat, cold and mechanical allodynia were measured over 7 weeks. Motor recovery on the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale and on the inclined plane test were also evaluated. Results: The present study demonstrated that increased hindpaw withdrawal responses to cold allodynia was observed in both groups after transplantation, but the development of cold-induced allodynia in the hATSC transplantation group was significantly larger than in the control group. The difference between the two groups in locomotor functional improvement after SCI was also significant. Conclusion: Careful consideration not only of optimal functional benefits but also of unintended side effects such as neuropathic pain is necessary before stem cell transplantation therapy after SCI.

Evidence of Cortical Reorganization in a Monoparetic Patient with Cerebral Palsy Detected by Combined Functional MRI and TMS

  • Kwon, Yong-Hyun;Jang, Sung-Ho;Lee, Mi-Young;Byun, Woo-Mok;Cho, Yoon-Woo;Ahn, Sang-Ho
    • Journal of Yeungnam Medical Science
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    • v.22 no.1
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    • pp.96-103
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    • 2005
  • The motor recovery mechanism of a 21-year-old male monoparetic patient with cerebral palsy, who had complained of a mild weakness on his right hand since infancy, was examined using functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). The patient showed mild motor impairment on the right hand. MRI located the main lesion on the left precentral knob of the brain. fMRI was performed on this patient as well as 8 control subjects using the Blood Oxygen Level Dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexionextension exercises at 1 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was applied tangentially to the scalp at a 1.0 cm separation. Magnetic stimulation was carried out with the maximal output. The Motor Evoked Potentials (MEPs) from both Abductor Pollicis Brevis muscles (APB) were obtained simultaneously. fMRI revealed that the unaffected (right) primary sensori-motor cortex (SM1), which was centered on precentral knob, was activated by the hand movements of the control subjects as well as by the unaffected (left) hand movements of the patient. However, the affected(right) hand movements of the patient activated the medial portion of the injured precentral knob of the left SM1. The optimal scalp site for the affected (right) APB was located at 1 cm medial to that of the unaffected (left) APB. When the optimal scalp site was stimulated, the MEP characteristics from the affected (right) APB showed a delayed latency, lower amplitude, and a distorted figure compared with that of the unaffected (left) APB. Therefore, the motor function of the affected (right) hand was shown to be reorganized in the medial portion of the injured precentral knob.

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