• Journal of Yeungnam Medical Science
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• v.22 no.2
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• pp.119-130
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• 2005

Stroke is a leading cause of chronic physical disability. The recent randomized controlled trials have that motor function of chronic stroke survivors could be improved through physical or pharmacologic intervention in the stroke rehabilitation setting. In addition, several functional neuroimaging techniques have recently developed, it is available to study the functional topography of sensorimotor area of the brain. However, the mechanisms involved in motor recovery after stroke, are still poorly understood. Four motor recovery mechanisms have been suggested, such as reorganization into areas adjacent to the injured primary motor cortex (M1), unmasking of the motor pathway from the unaffected motor cortex to the affected hand, attribution of secondary motor areas, and recovery of the damaged contralateral corticospinal tract. Understanding the motor recovery mechanisms would provide neurorehabilitation specialists with more information to allow for precise prognosis and therapeutic strategies based on the scientific evidence; this may help promote recovery of motor function. This review introduces several methodologies for neuroimaging techniques and discusses theoretical issues that impact interpretation of functional imaging studies of motor recovery after stroke. Perspectives, for future research are presented.

• Physical Therapy Korea
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• v.2 no.2
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• pp.98-107
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• 1995

Physical therapists use assumptions about motor control in every aspect of their work in treating stroke patients. An understanding of the recovery process after stroke, some neural mechanism of recovery and therapeutic model is critical factor for physical therapist to evaluate and obtain a higher final stage of recovery. The purpose of this article was to review the recovery process after stroke, some neural mechanism of recovery, the role of rehabilitation in the process of recovery, therapeutic model and its limitation. This article will help understanding of recovery process. evaluation, and treatment of the stroke patients. Each therapeutic method consists of a different set of assumptions and they are not completely independent of one another. Therefore specializing in any techniques of physical therapy will not be enough to treat stroke, so we are in need of integrated approach and objective measurement instrument to adequately evaluate and treat stroke patients.

• The Korea Journal of Herbology
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• v.24 no.1
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• pp.179-189
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• 2009

Objectives : Coptidis Rhizoma (Coptis japonica MAKINO; CR) is a well known crude drug as antimicrobial, antibacterial, anti-inflammatory, antioxidant activity. However, there is no study of the effect of CR on brain infarction and it's mechanism. The aim of this study was to investigate the effects on ischemic stroke induced by photothrombotic infarction by evaluating the functional & neuronal recovery after brain infarction. Materials & Methods : Male Sprague-Dawley rats (250-300 g) were induced photothrombotic brain infarction on sensorimotor cortex, and brain infarction volume by image J software (NIH, USA) after Nissl stain, also single pellet reaching task as a functional motor recovery were observed. After orally pretreated by CR (500 mg/kg) or normal saline as a sham control before 7 days from the time of photothrombotic infarction, rats were sacrificed. After then we analysed anti-inflammatory cytokines (TNF-$\alpha$, IL-6, IL-1$\beta$), by RT-PCR and ELISA method, and immunohistochemistry (GFAP, connexin-43) as a marker of neural plasticity. Results : CR (100, 250, 500 mg/kg) decreased the infarction volume dose-dependently, however the effect of 500mg/kg of CR (CR 500) showed the best (P=0.051). Also, CR 500 decreased the infarction volume time-dependently, the most effective time was 3-7 days after stroke. Photothrombosis increased inflammatory cytokines after infarction, CR 500 suppressed significantly mRNA expression of IL-1$\beta$, IL-6 and TNF-$\alpha$. In serum, CR 500 decreased the amount of IL-1$\beta$, 12h, 24h and 48h respectively (p < 0.05), also decreased that of IL-6 and TNF-$\alpha$, 12h respectively (p < 0.05) after infarction. The more astrocytes were observed and neural plasticity was facilitated in the rat brain of CR 500 than that of sham control in immunohistochemistry. Conclusions : This results suggest that CR decrease infarction volume and improve functional motor recovery in acute stage in photothrombotic ischemic infarction model in the mechanism of anti-inflammation and promoting neural plasticity.

• Therapeutic Science for Rehabilitation
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• v.2 no.1
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• pp.24-35
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• 2013

The Purpose of this study was to determine the clinical effectiveness of mirror therapy for stroke. Moreover, this paper was designed to summarize clarified information of neurological plasticity by mirror therapy to finally define the neurological mechanism. Mirror therapy improves the stroke patients' hand and arm motor function. It also has a positive influence on recovering performance of activities of daily living and relieving pain. However, it is not evident that mirror therapy restores visual neglect. There are various ways of recovering stroke. Fundamentally, all the theories are on a bases of restoration of premotor area. Premotor area which is associated with motor control increases the activation of primary motor area and finally improves patients' motor function. If primary motor area is completely damaged, premotor area and supplementary motor substitute for primary motor area. In summary of literature survey, there are not enough evidence to verify the effectiveness and neurological mechanism of mirror therapy. In future, more researches should be conducted to verify the neurological recovery through mirror therapy. Then, mirror therapy will be acknowledged as a clinically effective treatment.

• PNF and Movement
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• v.12 no.3
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• pp.143-150
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• 2014

Purpose: The corticospinal tract (CST) is known to be an important pyramidal tract for walking and motor function. However, very little is known about the functional role of the CST in the recovery of motor function. In the current study, we investigated the relation between the CST and motor function in chronic hemiparetic stroke patients. Methods: Fifty-four patients and 20 normal subjects were recruited. The Functional Ambulation Category (FAC) was used in measurement of the walking ability. We classified patients into three groups according to the ability to walk independently: group A, patients who could not walk independently (FAC: 0-2); group B, patients who could walk independently (FAC: 3); and group C, patd walk functionally (stairs and uneven surfaces, FAC 4-5). The Motricity Index (MI) was used to measure the motor function of the affected upper and lower extremities (maximum score: 100). The fractional anisotropy (FA) value, apparent diffusion coefficient (ADC) value, and fiber volume of the CST were used for the diffusion tensor imaging (DTI) parameters. Results: In terms of the CST of the unaffected hemisphere, the FA value of group A was significantly lower than that of normal controls (p <0.05). The fiber volume of group C was significantly higher than that of normal controls (p <0.05). In contrast, the ADC values of all patient groups and the control group did not show any difference (p >0.05). In terms of lower MI and total MI, significant differences were observed between all patient groups (p <0.05). In addition, significant differences in terms of the upper MI scores were observed between groups A and C and between groups B and C (p <0.05); however, no significant difference was observed between groups A and B (p>0.05). Conclusion: The increased fiber volume of the CST in the unaffected hemisphere appears to be related to functional walking ability in chronic stroke patients. This result would be useful for elucidation of the neural recovery mechanism of walking and the investigation of new modalities for the recovery of walking following a stroke with CST injury.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.143-150
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• 2009

Objective : The purpose of this study was to investigate the reliable factors influencing the surgical outcome of the patients with traumatic acute subdural hematoma (ASDH) and to improve the functional outcome of these patients. Methods : A total of 256 consecutive patients who underwent surgical intervention for traumatic ASDH between March 1998 and March 2008 were reviewed. We evaluated the influence of perioperative variables on functional recovery and mortality using multivariate logistic regression analysis. Results : Functional recovery was achieved in 42.2% of patients and the overall mortality was 39.8%. Age (OR=4.91, p=0.002), mechanism of injury (OR=3.66, p=0.003), pupillary abnormality (OR=3.73, p=0.003), GCS score on admission (OR=5.64, p=0.000), and intraoperative acute brain swelling (ABS) (OR=3.71, p=0.009) were independent predictors for functional recovery. And preoperative pupillary abnormality (OR=2.60, p=0.023), GCS score (OR=4.66, p=0.000), and intraoperative ABS (OR=4.16, p=0.001) were independent predictors for mortality. Midline shift, thickness and volume of hematoma, type of surgery, and time to surgery showed no independent association with functional recovery, although these variables were correlated with functional recovery in univariate analyses. Conclusion : Functional recovery was more likely to be achieved in patients who were under 40 years of age, victims of motor vehicle collision and having preoperative reactive pupils, higher GCS score and the absence of ABS during surgery. These results would be helpful for neurosurgeon to improve outcomes from traumatic acute subdural hematomas.

• Journal of Power System Engineering
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• v.16 no.3
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• pp.5-9
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• 2012

Novel mechanisms for Energy Recovery Devices are proposed to diminish the pressure loss in the high-pressure reverse-osmosis system. In the beginning, the state-of-the-art in the design of Energy Recovery Devices is reviewed and the features of each model are investigated. The direct-coupled axial piston pump(APP) and axial piston motor(APM) showed 39% energy recovery at operating pressure of reverse osmosis desalination systems, 60 bar. Meanwhile, the developed PM2D model, in which APM pistons are arranged parallel to those of APP, is more compact and showed higher efficiency in a preliminary test. Loss-reduction mechanisms employing rod piston and double raw valve port are additionally proposed to enhance the efficiency and durability of the device.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2002.10a
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• pp.1066-1069
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• 2002

Dynamic postural control varies with the environmental context, specific task and intentions of the subject. In this paper, dynamic postural control against forward-backward perturbations of a platform was estimated using tri-axial accelerometers and a force plate. Ten young healthy volunteers stood upright in comfortable condition on the perturbation system which was controlled by an AC servo motor. With anterior-posterior perturbations, movements of ankle, knee and hip Joints were obtained by tri-axial accelerometers. and ground reaction forces with corresponding displacements of the center of pressure(CoP) by the force plate. The result showed that the ankle moved first and the trunk forward, which implies that the mechanism of the dynamic postural control in forward-backward perturbations, occurred in the procedure of the ankle, the knee and the hip. Knee flexion and hip extension in the period of acceleration, constant velocity and deceleration phase is very important fur the balance recovery. These responses depends on the magnitude and timing of the perturbation. From the present study the accelerometry-system appears to be a promising tool for understanding kinematic accelerative In response to a transient platform perturbation. A more through understanding of balance recovery mechanism may aid in designing methods for reducing falls and the resulting injuries.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2004.10a
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• pp.246-249
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• 2004

The purpose of this study was to investigate the characteristics between EMG timing of muscle contraction and motor impairment in chronic hemiplegic stroke patients. Delay time and co-contraction of 4 patients who had stroke less than 3 years were measured during isometric wrist flexion and extension along the 3 seconds beep signal. Onset and offset of muscle contraction were significantly delayed on the more affected sides than control sides. Offset was significantly delayed than the onset on the affected sides in wrist flexion. Also, recruitment of antagonist was larger than agonist on the affected sides. Co-contraction ratio on the affected side was significantly smaller than control sides in wrist flexion. In affected sides, Fugl-Meyer motor assessment(FMA) shows the correlation of onset delay in wrist flexion and extension. However, co-contraction ratio correlated with FMA in wrist flexion. EMG assessment is likely to be useful outcome measure and provide insights into mechanism for motor recovery in stroke patients.

• Physical Therapy Korea
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• v.9 no.3
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• pp.125-135
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• 2002

In most of the medical literature that discusses the common problem of movement in patients with cerebral lesions. This critical problem is ascribed to a mechanism involving uninhibited neural activity. The goals of neurological physical therapy are focus on reduce of muscle hypertonicity, facilitates muscle activities, and improve of performance in living environment. A variety of studies suggest that spasticity is a distinct problem and separate from the muscle weakness. It has become increasingly recognized that the major functional deficits following brain damage are largely due to negative features such as muscle weakness and loss of performance rather than spasticity. Adequate recruitment of prime mover, not release was able to carry out the movement tasks well. The strengthening exercise of spastic limbs on changes in muscle properties and performance skill, the repeated motor practice has been identified as crucial for motor recovery. This article support the concept that strengthening is an appropriate intervention to improve the quality of physical function in patients with central nervous system lesions. Further studies and therapeutic approaches should be efforts at improving motor neuron recruitment in agonist rather than reducing activity in antagonists while retraining muscle strengthening.