• International journal of advanced smart convergence
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• 제12권2호
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• pp.167-172
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• 2023

In this study, the absolute and relative strength of six upper extremity resistance exercises were measured by classifying resistance exercise experts and non-experts. As a result, the skilled group showed higher absolute and relative muscle strength than the unskilled group in the 6 upper extremity resistance exercises. These results are judged to be the hypertrophy of fast-twith muscles, the mobilization of motor units, and the increase in the speed of nerve conduction while the skilled person consistently performs resistance exercise. Experts use intermuscular coordination efficiently to stably perform the load according to the movement and exercise intensity performed during exercise, whereas the inexperienced person uses relatively large muscle groups rather than efficiently using intermuscular coordination. It is considered that exercise motion and load were performed by mobilizing. In addition, as a result of comparing the absolute and relative muscle strength between the 6 types of upper limb resistance exercises, there was a difference between the 6 types of upper limb resistance exercises in the two groups. It can be judged that greater muscle strength and endurance were created through liver coordination.

• Annals of Clinical Neurophysiology
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• 제12권1호
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• pp.11-15
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• 2010

Background: In belly-tendon (bipolar) montage, reference (R2) electrode placed on muscle's tendon has traditionally been considered to be electrically inactive. However, recent studies have revealed that R2 electrode is not simply referential, but actively contributes to compound muscle action potential (CMAP) waveform morphology. These findings suggest that CMAP onset latency and amplitude may also be influenced by the position of R2 electrode. This study was performed in order to evaluate the effect of R2 electrode position on CMAP onset latency and amplitude. Methods: We performed motor nerve conduction studies of median, ulnar, tibial and peroneal nerves on bilateral limbs of 20 normal subjects. We used traditional bipolar and monopolar montage and compared their CMAP onset latencies and amplitudes. In bipolar montage, recording (R1) electrode was placed on mid-belly of muscle with R2 electrode on the tendon of the muscle. In monopolar montage, R1 electrode was placed on the same site of bipolar montage, while R2 electrode was placed on the contralateral limb. Results: The mean CMAP onset latencies of median and peroneal nerves in bipolar montage were significantly different (p<0.05) with those in monopolar montage. And those of ulnar and tibial nerves were not significantly different (p>0.05). The mean CMAP amplitudes of all the tested nerves except ulnar nerve were significantly different (p<0.05). Conclusions: This study shows that change in R2 electrode position can affect the CMAP onset latency and amplitude, and these differences seem to be related to the generation of far field potential by CMAP.

• Archives of Reconstructive Microsurgery
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• 제21권2호
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• pp.86-91
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• 2012

Purpose: Mass can compress around tissue and cause deviation of normal anatomical structures. Often, mass grows toward neurovascular pedicle and encircles depending on the nature of mature mass. Neglecting neurovascular involvement of the mass is a serious problem not to be overlooked. Authors have performed microscopic approach regarding mass involving the neurovascular pedicle in the hand. Materials and Methods: From January 2007 through February 2012, retrospective analysis for nine cases of mass involving neurovascular pedicles was done. Patients were evaluated preoperatively by ultrasonography or MRI and checked intraoperative finding. Masses were evaluated by site, preoperative evaluation, involved neurovascular pedicle, histopathologic diagnosis, complication, and recurrence. Results: The site of mass involving neurovascular pedicles was 4 cases on the wrist, 2 cases on the palm, 2 cases on the finger, 1 case on the hand dorsum. Involved neurovascular pedicles were 3 radial arteries and nerves, 3 proper digital arteries and nerves, 1 radial artery, 1 superficial branch of radial nerve, 1 common digital artery and nerve. The histopathologic diagnosis of mass were 3 ganglions, 2 giant cell tumors, 2 epidermal cysts, 1 fibroma, and 1 benign spindle tumor. There were 2 cases of recurrence and secondary excisions were performed. Conclusion: Neurovascular pedicle injury can lead to serious complication like sensory and motor disorders, distal part ischemia, and so on. In case of mass suspected neurovascular invasion, accurate preoperative evaluation such as ultrasonography or MRI is necessary. To prevent any neurovascular related complication during mass excision, delicate surgical technique using a microscope becomes essential.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권1호
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• pp.12-20
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• 1994

Generally, the totally paralyzed face can never be made normal by any of the current methods of reconstruction. Careful selection of patients based on sound judgment of what can and cannot be achieved by the proposed surgical technique is paramount to a successful operation and a satisfied patient. The results are related to time of delayed between injury and repair ; the shorter the delay the better are the results. The objectives in correcting facial paralysis are to achieve normal appearance at rest ; symmetry with voluntary motion ; control of the ocular, oral, and nasal sphincter ; symmetry with involuntary emotion and controlled balance when expressing when expressing emotion ; and no significant functional deficit secondary to the reconstructive surgery. It must be employed a number of concepts, for treatment of the paralyzed face by surgeon, depending on the cause, time interval, and wound characteristics, as well as the availability of and necessity for neuromuscular substitution. Nerve grafts, crossovers, muscle transfers, free muscle and nerve-muscle grafts, micronuerovascular muscle transfers, and regional muscle transposition are the principal methods being developed. We applied the temporal musle transposition for reanimation of unilatrally paralyzed faces for long times on two patients. The results of muscle transposition can be enhanced by the patient's learning to activate the transposed muscle by voluntary effort, and are best in patients who are motivated to learn the necessary motor-sensory coordination techniques.

• Annals of Clinical Neurophysiology
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• 제6권1호
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• pp.26-30
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• 2004

Background: Electrophysiologic study accurately predicts the degree of degenerated motor axons but cannot give precise information on the type of injury that occurred in Bell's palsy. Because of these limitation for prognostic prediction in Bell's palsy, we evaluated divergence of electrophysiological time course for the purpose of presuming the type of injury in Bell's palsy. Methods: We did bilateral facial nerve conduction studies in 103 Bell's palsy patients, who visited to Han-Gang sacred heart hospital from 1998 to 2001. We compared the CMAP amplitude of disease site with that of normal site and suggested that decremental CMAP amplitude ratio (percentage) as a degree of denervation of affected facial nerve. Then we demonstrated the time course of denervation percentage. After defining normal range of CMAP amplitude difference from normal control group, we also evaluated if distinct time course of early minimal denervation is present. Results: Our results show that time course of the denervation in early stage of Bell's palsy reflect various injury type such as axonotmesis, neurotmesis or other unidentified type. We cannot identify the distinct time course of early minimal denervation. Conclusions: The time course as well as the maximal value of denervation are the best prognostic guidelines in Bell' s palsy. So repeated serial electrophysiologic test are inevitable to assess prognosis. As an another topic, early minimal denervation for prognostic prediction deserve to be evaluated as a future work up for prognostic prediction.

• 한국멀티미디어학회논문지
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• 제20권12호
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• pp.1980-1991
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• 2017

Many stroke patients undergoing rehabilitation therapy require a quantitative indicator for the evaluation of body function in paretic and non-paretic regions. In this study, the impedance parameters were acquired to assess the physical status in the upper extremity of thirty six stroke patients with hemiplegia caused by cerebral hemorrhage (10 patients) and cerebral infarction (26 patients), using bioelectrical impedance. Prediction marker (PM), phase angle (PA), PM/PA, and resistance (R) versus reactance ($X_c$) were utilized to evaluate the functional status of the paretic and non-paretic regions. In addition, the hand grip strength (HGS) and the pinch strength (lateral, palmer, tip) were measured on the upper extremity of hemiplegic stroke patients. PM was distributed in inversely proportional to HGS, but PA was distributed in proportional to HGS. However, there were a number of patients with HGS of 0, regardless of the impedance parameters (PM, PA, R vs. $X_c$). Paretic and non-paretic status in upper extremity of these patients could not be analyzed using impedance parameters. At the rehabilitation therapist's instructions, they were unable to move the hand and fingers of the paretic upper extremity by cranial nerve damage, motor nerve damage, and severe cognitive decline.

• Journal of Korean Neurosurgical Society
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• 제41권1호
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• pp.7-10
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• 2007

Objective : The aim of this study was to determine the efficacy of percutaneous radiofrequency neurotomy[RFN] of ramus communicans nerve in patients suffering from severe low back pain due to osteoporotic compression fracture. Methods : Twenty two patients with lumbar osteoporotic compression fracture who had intractable back pain for less than two weeks and were performed with RFN at L1-L4 from May 2004 to December 2005 were retrospectively analyzed. Clinical outcome using visual analogue scale[VAS] pain scores and modified MacNab's grade was tabulated. Complications related to the procedure were assessed. Results : Twenty-two female patients [age from 63 to 81 years old] were included in this study. The mean VAS score prior to RFN was 7.8, it improved to 2.6 within postoperative time of 48 hours, and the mean VAS score after 3 months was 2.8, which was significantly decreased. Eighteen of 22 patients were graded as excellent and good according to modified MacNab's criteria at final follow up. All patients recovered uneventfully, and the neurologic examination revealed no deficits. Two patients showing poor results worsened in symptom. Percutaneous was performed eventually resulting in symptom improvement. There were no significant complications related to the procedure such as sensory dysesthesia, numbness or permanent motor weakness. Conclusion : RFN is safe and effective in treating the painful osteoporotic compression fracture. in patients with intractable back pain due to lumbar osteoporotic compression fracture, RFN of gray ramus communicans nerve should be considered as a treatment option prior to vertebroplasty.

• Journal of Korean Neurosurgical Society
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• 제52권2호
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• pp.138-143
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• 2012

Objective : This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review. Methods : Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed. Results : Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient. Conclusion : Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor.

• Journal of Korean Neurosurgical Society
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• 제37권1호
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• pp.8-15
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• 2005

Objective: We evaluate temporal correlations between postoperative symptomatic and electrophysiological improvements, and assessed the recovery time required for patients with carpal tunnel syndrome(CTS) before returning to routine activities. Methods: 30 CTS patients were treated via the endoscopic monoportal approach, from March 2001 to September 2003. We assessed the symptoms (hyperesthesia in the finger tips, or abnormal sensations and painful numbness or night pain) and electrophysiological changes in the preoperative state, 1 month and 6 months after surgery. We marked the times at which patients became able to return to activities of daily living and work, after undergoing endoscopic carpal tunnel release. Results: At the end of the follow-up period, high levels of achievement and good outcomes were observed, with respect to both the symptoms and electrophysiological studies. We discovered significant differences between the preoperative and postoperative periods, especially in terms of motor nerve onset latency from $4.50{\pm}1.43$ to $3.97{\pm}0.69$ and sensory nerve conduction velocity, the wrist-to-finger from $19.81{\pm}10.03$ to $28.18{\pm}11.01$ and wrist-to-palm from $23.34{\pm}13.40$ to $31.79{\pm}13.38$(P<0.05 for each comparison). The average time interval required before return to activities of daily living was 26.4 days, and time interval required before return to work was 48.08 days. Conclusion: Electrophysiological improvements are largely consistent with symptomatic relief, but there is some disparity between electrophysiological and symptomatic improvement.

• Journal of Korean Neurosurgical Society
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• 제48권5호
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• pp.419-422
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• 2010

Objective : To analyze the clinical outcomes of computed tomography (CT) fluoroscopy-guided selective neve root block (SNRB) for severe arm pain caused by acute cervical disc herniation. Methods : The authors analyzed the data obtained from 25 consecutive patients who underwent CT fluoroscopy-guided SNRB for severe arm pain, i.e., a visual analogue scale (VAS) score of 8 points or more, caused by acute soft cervical disc herniation. Patients with chronic arm pain, motor weakness, and/or hard disc herniation were excluded. Results : The series comprised 19 men and 6 women whose mean age was 48.1 years (range 35-72 years). The mean symptom duration was 17.5 days (range 4-56 days) and the treated level was at C5-6 in 13 patients, C6-7 in 9, and both C5-6 and C6-7 in 3. Twenty-three patients underwent SNRB in 1 session and 2 underwent the procedure in 2 sessions. No complications related to the procedures occurred. At a mean follow-up duration of 11.5 months (range 6-22 months), the mean VAS score and NDI significantly improved from 9 and 58.2 to 3.4 and 28.1, respectively. Eighteen out of 25 patients (72%) showed successful clinical results. Seven patients (28%) did not improve after the procedure, and 5 of these 7 underwent subsequent anterior cervical discectomy and fusion. Conclusion : CT fluoroscopy-guided SNRB may play a role as a primary conservative treatment for severe arm pain caused by acute cervical disc herniation.