- Email: [email protected]
Abstract 18
A4 Abstract 15 H-Reflex Latencies and Sensory and Motor Nerve Action Potential Latencies Among Diabetic Patients Seen at the Outpatient Service of a Tertiary Hospital: A Correlative Study. Primavera B. Galinato, MD (University of the Philippines, Philippine General Hospital, Manila, Philippines); Teresita Joy Evangelista, MD; Iris I. Tan, MD; Michelle Anlacan, MD, e-mail: [email protected]. Disclosure: None. Objective: To determine the correlation between the H-reflex latencies and the sensory and motor nerve action potential latencies in detecting diabetic neuropathy. Design: Prospective, cross-sectional. Setting: Outpatient departments of neurology and rehabilitation medicine in a tertiary hospital. Participants: 41 subjects with diabetes. Interventions: Not applicable. Main Outcome Measures: H-reflex latencies of the tibial nerve and nerve conduction studies (median motor and sensory, peroneal motor, sural sensory latencies) of the upper and lower extremity of each patient. Results: The correlation between the nerve action potential latencies and the H-reflex latencies was studied using the canonical correlation analysis method. The computed canonical correlation coefficient was .8379 (P⫽.0001). Conclusions: The findings suggest that there is a strong correlation between H-reflex latencies and sensory and motor nerve action potential latencies among patients with diabetic neuropathy. Based on this study, use of H-reflex latencies is a promising alternative electrophysiologic technique in the investigation of peripheral neuropathy among patients with diabetes mellitus. Key Words: Diabetic neuropathies; Electrophysiology; H-Reflex; Rehabilitation.
Abstract 16 Effect of Chronic Occupational Organophosphate Exposure on Peripheral Nerves Among Filipino Ricefield Workers. Ofelia L. Reyes, MD (University of Santo Tomas, Manila, Philippines); Romil M. Martinez, MD; Ma.Arlene B. Lee, MD. Disclosure: None. Objectives: To investigate whether chronic occupational exposure to organophosphates among ricefield workers in a rice institute is related to electrodiagnostically detectable measures of multiple peripheral neuropathy, that is, to investigate whether rotation in areas of work would improve the conduction velocities of those workers found to have peripheral neuropathy, after being shifted from an exposed to a nonexposed status in their work. Design: A 2-year prospective research. Setting: Academic medical center. Participants: 24 male workers with exposure to organophosphates and a well-matched control group of 64 men from the general population who were not exposed to organophosphates. Interventions: All participants in the study and control groups were tested electrodiagnostically for peripheral neuropathy work-up. Those positive for peripheral neuropathy in the study (exposed) group were rotated from their field of work to a nonexposed status for 1 year. A repeated electromyographic nerve conduction velocity test was conducted after 1 year in all participants in the study group. Main Outcome Measures: The chi-square test was used to determine the association between exposure to organophosphate and multiple peripheral neuropathy. The Wilcoxon signed-rank test was used to test for differences in the electrodiagnostic data for the years 2001 and 2002. Results: 6 of 24 participants in the study group had multiple peripheral neuropathy, while 20 of 64 participants in the control group had multiple peripheral neuropathy (P⫽.707). Only 4 cases of those diagnosed with peripheral neuropathy in 2001 improved in nerve conduction velocities in their repeat testing in 2002 (P⫽.096). Level of statistical significance was set at .05. Conclusions: The results failed to show an association between chronic occupational organophosphate exposure and multiple peripheral neuropathy. Likewise, the nerve conduction velocities of those workers with peripheral neuropathy did not improve 1 year after being shifted from an exposed status to a nonexposed status. Key Word: Rehabilitation.
Abstract 17 A Novel Microanalytical Technique for Assaying Soft Tissue Demonstrates Significant Quantitative Biochemical Differences in 3 Clinically Distinct Groups: Normal, Latent, and Active. Jay P. Shah, MD (National Institutes of Health, Bethesda, MD); Terry Phillips, PhD, DSc; Jerome V. Danoff, PhD, PT; Lynn H. Gerber, MD, e-mail: [email protected]. Disclosure: None. Objectives: To determine (1) whether a novel microdialysis needle can successfully sample the biochemical milieu of trigger point 1 (TP1) in the upper trapezius muscle in healthy subjects and (2) whether there are measurable differences among those with symptoms and physical findings related to myofascial trigger points (MTrPs). Design: Prospective, controlled trial. Setting: Biomedical research hospital. Participants: 3 subjects were selected based on history and physical examination for 3 groups (N⫽9): group 1, normal (no neck pain, no MTrP); group 2, latent (no neck pain, MTrP present); and group 3, active (neck pain, MTrP present). Intervention: Pressure algometry was performed at TP1 to determine pain pressure threshold (PPT). Samples were obtained continuously with a microdialysis needle at regular intervals, starting with needle insertion, elicitation of a local twitch response, and then posttwitch. Main Outcome Measures: PPT and levels of pH, substance P, calcitonin gene-related peptide (CGRP), bradykinin, norepinephrine, tumor necrosis factor-alpha (TNF␣), and interleukin-1 (IL-1). Results: The active group had a lower PPT (P⬍.08). Overall, the amount of substance P, CGRP, bradykinin, norepinephrine, TNF␣, and IL-1 was significantly higher in the active group than in the other 2 groups (P⬍.01). Overall, pH was significantly lower in the active group than in the other 2 groups (P⬍.03). At 5 minutes, peak levels of substance P and CGRP differed significantly in all 3 groups (3⬎2⬎1, P⬍.02). Conclusions: This technique recovered extremely small quantities (⬍0.5L) of very small substances (molecular weight, ⬍100kd) directly from soft tissue. There were significant differences in the levels of pH, substance P, CGRP, bradykinin, norepinephrine, TNF␣, and IL-1 in those subjects with an active MTrP (symptoms, MTrP present) compared with subjects with a latent MTrP (no symptoms, MTrP present) and normal subjects (no symptoms, no MTrP). Key Words: Microdialysis; Myofascial pain; Myofascial trigger points; Rehabilitation.
Arch Phys Med Rehabil Vol 84, September 2003
Abstract 18 Plantar Fasciitis: A New Treatment Approach. Marta Imamura, MD, PhD (University of Sao Paulo School of Medicine, Sao Paulo, Brazil); Satiko Imamura, MD, PhD; Antonio Egydio de Carvalho Jr, MD, PhD; Renato A. Mazagao, MD; David A. Cassius, MD; Andrew A. Fischer, MD, PhD, e-mail: [email protected]. Disclosure: None. Objective: To evaluate the efficacy of a new approach that shortens the duration of plantar fasciitis treatment. Design: Randomized controlled study. Setting: Outpatient clinic. Participants: 64 patients were randomly assigned to intensive conventional physical therapy (PT) (n⫽34) or needling and infiltration of the myofascial trigger points at the proximal portion of the medial gastrocnemius muscle (n⫽30). Interventions: Patients in the PT group received ultrasound and electric stimulation at the origin of the plantar fascia followed by stretching exercises of the gastrocnemius muscle. The other group was treated by needling and infiltration (1% lidocaine) of the taut band at the proximal portion of the medial gastrocnemius muscle of the involved limb(s). Injections were performed at weekly intervals. PT was administered for 3 consecutive days after the injections. Patients were instructed to perform stretching of the gastrocnemius muscles and of the plantar fascia at home twice a day. Main Outcome Measures: Visual analog scale and hindfoot functional test (American Orthopaedic Foot and Ankle Society Hindfoot Questionnaire) were performed before and after treatment by an independent evaluator. Duration of treatment was compared between the 2 groups. Results: Statistically significant reduction of pain and improvement in function were observed in both groups, without any differences between them. The time required to achieve the same improvement was significantly less (80%) in the injected group than in the control group (P⬍.001). The number of PT sessions needed was also significantly reduced (P⬍.001). Postinjection soreness and local hematoma were found in 30% of the patients. No local infection or other major complications were noticed in any cases. Conclusions: Although treatment in both groups was equally successful, needling and infiltration of the medial gastrocnemius muscle provided faster pain relief and functional recovery in patients with plantar fasciitis. Key Words: Foot pain; Plantar fasciitis; Rehabilitation.
10:30
Saturday, October 11, 2003 Continental B–Lobby Level
AM–12:00 PM,
Neurologic Rehabilitation Abstract 19 Cortical Reorganization of Hand Motor Function to Primary Sensory Cortex in Hemiparetic Patients With a Primary Motor Cortex Infarct. Sung H. Jang, MD (School of Medicine, Yeungnam University, Daegu, Republic of Korea); Yoon-Woo Cho; Yun-Hee Kim; Sang-Ho Ahn; Jung-Sang Ha; Se-Jin Lee, e-mail: [email protected]. Disclosure: Jang, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology; Cho, Financial support from the Korean Brain Neuroinfomatics Research Progam, Korean Ministry of Science and Technology; Ahn, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology; Ha, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology; Lee, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology. Objective: To demonstrate cortical reorganization in hemiparetic patients with a primary motor cortex (M1) infarct using functional magnetic resonance imaging (fMRI). Design: The hand motor function of 2 hemiparetic stroke patients and 20 control subjects was evaluated by fMRI. Setting: Academic medical center. Participants: 2 hemiparetic patients and 20 control subjects with no history of neurologic disease. Interventions: fMRI was performed using the blood oxygen level– dependent technique at 1.5T. For the motor task paradigm, hand grasp-release movements were performed at a frequency of 1Hz for stimulation, guided with a metronome, over a repeated cycle of 15 seconds of control and 15 seconds of stimulus. Each task paradigm of alternating controlstimulus (30s) was repeated 3 times. Main Outcome Measures: fMRI data were analyzed using SPM-99 software running under the Matlab environment. The images were then smoothed with an 8mm isotropic gaussian kernel. Statistical parametric maps were obtained and voxels were considered significant at P⬍.001, uncorrected, with the additional requirement of a cluster size of 5 voxels. Results: The contralateral primary sensorimotor cortex was activated by the hand movements of control subjects and of the unaffected side of the 2 patients. Only the contralateral (infarct side) primary sensory cortex (S1) was activated by the affected hand movements of the 2 patients, a result that was not observed in control subjects or the unaffected hand of stroke patients. Conclusions: We believe that the hand motor function of the infarcted M1 of these patients was reorganized into S1. It seems that cortical reorganization took place in patients with an M1 infarct. Key Words: Brain; Magnetic resonance imaging; Motor skills; Rehabilitation; Stroke. Abstract 20 Rehabilitation Outcome for Patients Requiring Percutaneous Endoscopic Gastrostomy After Stroke: A Case-Matched Control Study. Masayuki Iizuka (Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY); Mike Reding, e-mail: [email protected]. Disclosure: None. Objective: To test the hypothesis that percutaneous endoscopic gastrostomy (PEG) placement, while signaling an increased risk of medical complications and death, allows survivors to achieve functional recovery and home discharge rates similar to those of case-matched controls. Design: Retrospective case-matched control study. Setting: Acute stroke rehabilitation inpatient unit. Participants: 364 patients admitted for stroke rehabilitation, 182 with PEG tubes in place and 182 case controls without PEG were matched at the time of admission for sex, age, FIM™ instrument score (mean, 2.5), and interval poststroke (mean, 1.5d). Interventions: Not applicable. Main Outcome Measures: Outcomes of interest were change in FIM scores, length of rehabilitation
Abstract 16 Effect of Chronic Occupational Organophosphate Exposure on Peripheral Nerves Among Filipino Ricefield Workers. Ofelia L. Reyes, MD (University of Santo Tomas, Manila, Philippines); Romil M. Martinez, MD; Ma.Arlene B. Lee, MD. Disclosure: None. Objectives: To investigate whether chronic occupational exposure to organophosphates among ricefield workers in a rice institute is related to electrodiagnostically detectable measures of multiple peripheral neuropathy, that is, to investigate whether rotation in areas of work would improve the conduction velocities of those workers found to have peripheral neuropathy, after being shifted from an exposed to a nonexposed status in their work. Design: A 2-year prospective research. Setting: Academic medical center. Participants: 24 male workers with exposure to organophosphates and a well-matched control group of 64 men from the general population who were not exposed to organophosphates. Interventions: All participants in the study and control groups were tested electrodiagnostically for peripheral neuropathy work-up. Those positive for peripheral neuropathy in the study (exposed) group were rotated from their field of work to a nonexposed status for 1 year. A repeated electromyographic nerve conduction velocity test was conducted after 1 year in all participants in the study group. Main Outcome Measures: The chi-square test was used to determine the association between exposure to organophosphate and multiple peripheral neuropathy. The Wilcoxon signed-rank test was used to test for differences in the electrodiagnostic data for the years 2001 and 2002. Results: 6 of 24 participants in the study group had multiple peripheral neuropathy, while 20 of 64 participants in the control group had multiple peripheral neuropathy (P⫽.707). Only 4 cases of those diagnosed with peripheral neuropathy in 2001 improved in nerve conduction velocities in their repeat testing in 2002 (P⫽.096). Level of statistical significance was set at .05. Conclusions: The results failed to show an association between chronic occupational organophosphate exposure and multiple peripheral neuropathy. Likewise, the nerve conduction velocities of those workers with peripheral neuropathy did not improve 1 year after being shifted from an exposed status to a nonexposed status. Key Word: Rehabilitation.
Abstract 17 A Novel Microanalytical Technique for Assaying Soft Tissue Demonstrates Significant Quantitative Biochemical Differences in 3 Clinically Distinct Groups: Normal, Latent, and Active. Jay P. Shah, MD (National Institutes of Health, Bethesda, MD); Terry Phillips, PhD, DSc; Jerome V. Danoff, PhD, PT; Lynn H. Gerber, MD, e-mail: [email protected]. Disclosure: None. Objectives: To determine (1) whether a novel microdialysis needle can successfully sample the biochemical milieu of trigger point 1 (TP1) in the upper trapezius muscle in healthy subjects and (2) whether there are measurable differences among those with symptoms and physical findings related to myofascial trigger points (MTrPs). Design: Prospective, controlled trial. Setting: Biomedical research hospital. Participants: 3 subjects were selected based on history and physical examination for 3 groups (N⫽9): group 1, normal (no neck pain, no MTrP); group 2, latent (no neck pain, MTrP present); and group 3, active (neck pain, MTrP present). Intervention: Pressure algometry was performed at TP1 to determine pain pressure threshold (PPT). Samples were obtained continuously with a microdialysis needle at regular intervals, starting with needle insertion, elicitation of a local twitch response, and then posttwitch. Main Outcome Measures: PPT and levels of pH, substance P, calcitonin gene-related peptide (CGRP), bradykinin, norepinephrine, tumor necrosis factor-alpha (TNF␣), and interleukin-1 (IL-1). Results: The active group had a lower PPT (P⬍.08). Overall, the amount of substance P, CGRP, bradykinin, norepinephrine, TNF␣, and IL-1 was significantly higher in the active group than in the other 2 groups (P⬍.01). Overall, pH was significantly lower in the active group than in the other 2 groups (P⬍.03). At 5 minutes, peak levels of substance P and CGRP differed significantly in all 3 groups (3⬎2⬎1, P⬍.02). Conclusions: This technique recovered extremely small quantities (⬍0.5L) of very small substances (molecular weight, ⬍100kd) directly from soft tissue. There were significant differences in the levels of pH, substance P, CGRP, bradykinin, norepinephrine, TNF␣, and IL-1 in those subjects with an active MTrP (symptoms, MTrP present) compared with subjects with a latent MTrP (no symptoms, MTrP present) and normal subjects (no symptoms, no MTrP). Key Words: Microdialysis; Myofascial pain; Myofascial trigger points; Rehabilitation.
Arch Phys Med Rehabil Vol 84, September 2003
Abstract 18 Plantar Fasciitis: A New Treatment Approach. Marta Imamura, MD, PhD (University of Sao Paulo School of Medicine, Sao Paulo, Brazil); Satiko Imamura, MD, PhD; Antonio Egydio de Carvalho Jr, MD, PhD; Renato A. Mazagao, MD; David A. Cassius, MD; Andrew A. Fischer, MD, PhD, e-mail: [email protected]. Disclosure: None. Objective: To evaluate the efficacy of a new approach that shortens the duration of plantar fasciitis treatment. Design: Randomized controlled study. Setting: Outpatient clinic. Participants: 64 patients were randomly assigned to intensive conventional physical therapy (PT) (n⫽34) or needling and infiltration of the myofascial trigger points at the proximal portion of the medial gastrocnemius muscle (n⫽30). Interventions: Patients in the PT group received ultrasound and electric stimulation at the origin of the plantar fascia followed by stretching exercises of the gastrocnemius muscle. The other group was treated by needling and infiltration (1% lidocaine) of the taut band at the proximal portion of the medial gastrocnemius muscle of the involved limb(s). Injections were performed at weekly intervals. PT was administered for 3 consecutive days after the injections. Patients were instructed to perform stretching of the gastrocnemius muscles and of the plantar fascia at home twice a day. Main Outcome Measures: Visual analog scale and hindfoot functional test (American Orthopaedic Foot and Ankle Society Hindfoot Questionnaire) were performed before and after treatment by an independent evaluator. Duration of treatment was compared between the 2 groups. Results: Statistically significant reduction of pain and improvement in function were observed in both groups, without any differences between them. The time required to achieve the same improvement was significantly less (80%) in the injected group than in the control group (P⬍.001). The number of PT sessions needed was also significantly reduced (P⬍.001). Postinjection soreness and local hematoma were found in 30% of the patients. No local infection or other major complications were noticed in any cases. Conclusions: Although treatment in both groups was equally successful, needling and infiltration of the medial gastrocnemius muscle provided faster pain relief and functional recovery in patients with plantar fasciitis. Key Words: Foot pain; Plantar fasciitis; Rehabilitation.
10:30
Saturday, October 11, 2003 Continental B–Lobby Level
AM–12:00 PM,
Neurologic Rehabilitation Abstract 19 Cortical Reorganization of Hand Motor Function to Primary Sensory Cortex in Hemiparetic Patients With a Primary Motor Cortex Infarct. Sung H. Jang, MD (School of Medicine, Yeungnam University, Daegu, Republic of Korea); Yoon-Woo Cho; Yun-Hee Kim; Sang-Ho Ahn; Jung-Sang Ha; Se-Jin Lee, e-mail: [email protected]. Disclosure: Jang, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology; Cho, Financial support from the Korean Brain Neuroinfomatics Research Progam, Korean Ministry of Science and Technology; Ahn, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology; Ha, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology; Lee, Financial support from the Korean Brain Neuroinfomatics Research Program, Korean Ministry of Science and Technology. Objective: To demonstrate cortical reorganization in hemiparetic patients with a primary motor cortex (M1) infarct using functional magnetic resonance imaging (fMRI). Design: The hand motor function of 2 hemiparetic stroke patients and 20 control subjects was evaluated by fMRI. Setting: Academic medical center. Participants: 2 hemiparetic patients and 20 control subjects with no history of neurologic disease. Interventions: fMRI was performed using the blood oxygen level– dependent technique at 1.5T. For the motor task paradigm, hand grasp-release movements were performed at a frequency of 1Hz for stimulation, guided with a metronome, over a repeated cycle of 15 seconds of control and 15 seconds of stimulus. Each task paradigm of alternating controlstimulus (30s) was repeated 3 times. Main Outcome Measures: fMRI data were analyzed using SPM-99 software running under the Matlab environment. The images were then smoothed with an 8mm isotropic gaussian kernel. Statistical parametric maps were obtained and voxels were considered significant at P⬍.001, uncorrected, with the additional requirement of a cluster size of 5 voxels. Results: The contralateral primary sensorimotor cortex was activated by the hand movements of control subjects and of the unaffected side of the 2 patients. Only the contralateral (infarct side) primary sensory cortex (S1) was activated by the affected hand movements of the 2 patients, a result that was not observed in control subjects or the unaffected hand of stroke patients. Conclusions: We believe that the hand motor function of the infarcted M1 of these patients was reorganized into S1. It seems that cortical reorganization took place in patients with an M1 infarct. Key Words: Brain; Magnetic resonance imaging; Motor skills; Rehabilitation; Stroke. Abstract 20 Rehabilitation Outcome for Patients Requiring Percutaneous Endoscopic Gastrostomy After Stroke: A Case-Matched Control Study. Masayuki Iizuka (Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY); Mike Reding, e-mail: [email protected]. Disclosure: None. Objective: To test the hypothesis that percutaneous endoscopic gastrostomy (PEG) placement, while signaling an increased risk of medical complications and death, allows survivors to achieve functional recovery and home discharge rates similar to those of case-matched controls. Design: Retrospective case-matched control study. Setting: Acute stroke rehabilitation inpatient unit. Participants: 364 patients admitted for stroke rehabilitation, 182 with PEG tubes in place and 182 case controls without PEG were matched at the time of admission for sex, age, FIM™ instrument score (mean, 2.5), and interval poststroke (mean, 1.5d). Interventions: Not applicable. Main Outcome Measures: Outcomes of interest were change in FIM scores, length of rehabilitation