Search

Brain-machine Interface (BMI) is a system that translates neuronal data into an output variable to control external devices such as a robotic arm. A robotic arm can be used as an assistive living device for individuals with tetraplegia. To reflect users' needs in the development process of the BMI robotic arm, our team followed an interactive approach to system development, human-centered design, and Human Activity Assistive Technology model. This study aims to explore the perspectives of people with tetraplegia about activities they want to participate in, their opinions, and the usability of the BMI robotic arm. Eight people with tetraplegia participated in a focus group interview in a semistructured interview format. A general inductive analysis method was used to analyze the qualitative data. The 3 overarching themes that emerged from this analysis were: 1) activities, 2) acceptance, and 3) usability. Activities that the users wanted to do using the robotic arm were categorized into the following 5 activity domains: activities of daily living (ADL), instrumental ADL, health management, education, and leisure. Participants provided their opinions on the needs and acceptance of the BMI technology. Participants answered usability and expected standards of the BMI robotic arm within 7 categories such as accuracy, setup, cost, etc. Participants with tetraplegia have a strong interest in the robotic arm and BMI technology to restore their mobility and independence. Creating BMI features appropriate to users' needs, such as safety and high accuracy, will be the key to acceptance. These findings from the perspectives of potential users should be taken into account when developing the BMI robotic arm.

Motor imagery (MI) for target-oriented movements, which is a basis for functional activities of daily living, can be more appropriate than non-target-oriented MI as tasks to promote motor recovery or brain-computer interface (BCI) applications. This study aimed to explore different characteristics of brain activation among target-oriented kinesthetic imagery (KI) and visual imagery (VI) in the first-person (VI-1) and third-person (VI-3) perspectives. Eighteen healthy volunteers were evaluated for MI ability, trained for the three types of target-oriented MIs, and scanned using 3 T functional magnetic resonance imaging (fMRI) under MI and perceptual control conditions, presented in a block design. Post-experimental questionnaires were administered after fMRI. Common brain regions activated during the three types of MI were the left premotor area and inferior parietal lobule, irrespective of the MI modalities or perspectives. Contrast analyses showed significantly increased brain activation only in the contrast of KI versus VI-1 and KI versus VI-3 for considerably extensive brain regions, including the supplementary motor area and insula. Neural activity in the orbitofrontal cortex and cerebellum during VI-1 and KI was significantly correlated with MI ability measured by mental chronometry and a self-reported questionnaire, respectively. These results can provide a basis in developing MI-based protocols for neurorehabilitation to improve motor recovery and BCI training in severely paralyzed individuals.

The partial weight-bearing protocol after lower limb fracture is an important issue in postoperative rehabilitation. Because it is difficult to quantify the actual weight load and provide a constant weight, the protocol is unestablished. By training with a lower-body positive-pressure treadmill and using an in-shoe pressure-measuring device, partial weight-bearing exercise can be performed with quantified loads. This case series illustrates the applicability of an early quantitative partial weight-bearing rehabilitation program using lower-body positive-pressure treadmill with an in-shoe pressure-measuring device after periarticular tibial fractures, which provides a quantitatively predetermined constant load.

BACKGROUND Despite the importance of understanding penetration-aspiration (PA) in patients with stroke, the pathophysiology of PA remains unclear. OBJECTIVES This study aimed to investigate the temporal characteristics of PA in post-stroke patients in terms of the timing of the PA event and hyolaryngeal incoordination. METHODS Fifty-eight swallows (38 stroke patients), showing PA when swallowing a thin liquid, were included. The timing of PA was classified kinematically as before or during the swallow. The movement sequence of vertical laryngeal elevation, horizontal hyoid excursion, and epiglottic rotation were compared with healthy controls. Spatiotemporal measurements, videofluoroscopic dysphagia scale parameters were compared between subgroups. RESULTS Thirteen swallows (22.4%) were classified as PA before the swallow and 45 were classified as PA during the swallow (77.6%). Among the PA during the swallow, 26 (57.8%) swallows exhibited abnormal sequences of hyolaryngeal movements and 19 (42.2%) swallows showed normal sequences of hyolaryngeal movements compared with healthy controls. The onset time of horizontal hyoid excursion (P = 0.028), the time to maximal horizontal hyoid excursion (P = 0.010), and maximal epiglottic rotation (P = 0.030) were significantly more delayed in the PA during the swallow group than in the PA before the swallow group. In the swallows with abnormal sequential movements, the onset of horizontal hyoid excursion occurred significantly later than the onset of epiglottic rotation (P

Spasticity is an important factor in designing wearable and lightweight exoskeleton neurorehabilitation robots. The proposed study evaluates biomechanical reactions of an exoskeleton robot to spasticity and establishes relevant guidelines for robot design. A two-axis exoskeleton robot is used to evaluate a group of 20 patients post-stroke with spastic elbow and/or wrist joints. All subjects are given isokinetic movements at various angular velocities within the capable range of motion for both joints. The resistance torque and corresponding angular position at each joint are recorded continuously. Maximal resistance torques caused by low (modified Ashworth scale (MAS) 0, 1), intermediate (MAS 1+), and high (MAS 2 and 3) grade spasticity were 3.68 ± 2.42, 5.94 ± 2.55, and 8.25 ± 3.35 Nm for the elbow flexor ( ${p} , between each grades) and 4.23 ± 1.75, 5.68 ± 1.96, and 5.44 ± 2.02 Nm for the wrist flexor ( ${p} , for low versus intermediate, low versus high grade spasticity). The angular velocity did not significantly influence maximal resistance torque in either joint. The catch occurred more quickly at higher velocities for low and intermediate elbow flexor spasticity ( ${p} ). Spasticity caused considerable resistance to the robots during mechanically actuated movements. The resistance range according to the degree of spasticity should be considered when designing practical neurorehabilitation robots.

The purpose of this study was to compare the swallowing function and kinematics in stroke patients with and without tracheostomies. In this retrospective matched case-control study, we compared stroke patients with (TRACH group, n = 24) and without (NO-TRACH group, n = 24) tracheostomies. Patients were matched for age, sex, and stroke-type. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) and functional oral intake scale (FOIS) obtained from videofluoroscopic swallow study (VFSS) images. Swallowing kinematics were evaluated using a two-dimensional kinematic analysis of the VFSS images. Mean duration of tracheostomy was 132.38 ± 150.46 days in the TRACH group. There was no significant difference in the total VDS score between the TRACH (35.17 ± 15.30) and NO-TRACH groups (29.25 ± 16.66, p = 0.247). FOIS was significantly lower in the TRACH group (2.33 ± 1.40) than in the NO-TRACH group (4.33 ± 1.79, p = 0.001). The TRACH group had a significantly lower maximum vertical displacement (15.23 ± 7.39 mm, p = 0.011) and velocity (54.99 ± 29.59 mm/s, p = 0.011), and two-dimensional velocity (61.07 ± 24.89 mm/s, p = 0.013) of the larynx than the NO-TRACH group (20.18 ± 5.70 mm, 82.23 ± 37.30 mm/s, and 84.40 ± 36.05 mm/s, respectively). Maximum horizontal velocity of the hyoid bone in the TRACH group (36.77 ± 16.97 mm/s) was also significantly lower than that in the NO-TRACH group (47.49 ± 15.73 mm/s, p = 0.032). This study demonstrated that stroke patients with tracheostomies had inferior swallowing function and kinematics than those without tracheostomies. A prospective longitudinal study is needed to elucidate the effect of a tracheostomy on swallowing recovery in stroke patients.

Background/aims This study aimed to evaluate the efficacy and safety of emergency variceal ligation for the prevention of rebleeding in cirrhotic patients who are found on initial endoscopy to have blood clots in the stomach but no actively bleeding esophageal and gastric varices or stigmata. Methods This study included 28 cirrhotic patients who underwent emergency prophylactic EVL and 41 who underwent an elective intervention between January 2009 and June 2014. Clinical outcomes were analyzed, including the rebleeding, 6-week mortality, and rebleeding-free survival rates. Results The rebleeding rate was higher in the emergency than in the elective group (28.6% vs. 7.3%, P=0.041). Multivariate analysis showed that emergency prophylactic EVL (odds ratio [OR] = 7.4, 95% confidence interval [CI]=1.634.8, P=0.012) and Child-Pugh score C (OR=10.6, 95% CI=1.4-80.8, P=0.022) were associated with rebleeding. In the emergency group, the gastric varices were associated with rebleeding (OR=12.0, 95% CI=1.7-83.5, P=0.012). Conclusion Emergency EVL may be associated with variceal rebleeding when blood clots are present in the stomach without active esophageal and gastric variceal bleeding or stigmata. Elective intervention should be considered as a safer strategy for preventing variceal rebleeding in this situation.

In the context of stroke rehabilitation, simple structures and user-intent driven actuation are relevant features to facilitate neuroplasticity as well as deliver a sufficient number of repetitions during a single therapy session. A novel robotic treatment device for distal upper limb rehabilitation in stroke patients was developed, and a usability test was performed to assess its clinical feasibility. The rehabilitation robot was designed as a two-axis exoskeleton actuated by electric motors, consisting of forearm supination/pronation and hand grasp/release, which were selected based on a kinematic analysis of essential daily activities. A vision-assisted algorithm was utilized for user-intent extraction in a human-in-the-loop concept. A usability test was performed on six physiatrists, five biomedical engineers, five rehabilitation therapists, two chronic stroke patients, and two caregivers of the patients. After sufficient instruction, all subjects tested the robot for a minimum of 10 min and completed the evaluation form using a 7-point Likert scale. The participants found the device interesting (5.7 &plusmn, 1.2), motivating (5.8 &plusmn, 0.9), and as having less possibility of causing injury or safety issues (6.1 &plusmn, 1.1), however, the appropriateness of difficulty (4.8 &plusmn, 1.9) and comfort level (4.9 &plusmn, 1.3) were found to be relatively low. Further development of the current device would provide a good treatment option as a simple, low-cost, and clinically feasible rehabilitation robot for stroke.

In practical rehabilitation robot development, it is imperative to pre-specify the critical workspace to prevent redundant structure. This study aimed to characterize the upper extremity motion during essential activities in daily living. An IMU-based wearable motion capture system was used to access arm movements. Ten healthy subjects performed the Action Research Arm Test (ARAT) and six pre-selected essential daily activities. The Euler angles of the major joints, and acceleration from wrist and hand sensors were acquired and analyzed. The size of the workspace for the ARAT was 0.53 (left-right) &times, 0.92 (front-back) &times, 0.89 (up-down) m for the dominant hand. For the daily activities, the workspace size was 0.71 &times, 0.70 &times, 0.86 m for the dominant hand, significantly larger than the non-dominant hand (p &le, 0.011). The average range of motion (RoM) during ARAT was 109.15 &plusmn, 18.82&deg, for elbow flexion/extension, 105.23 &plusmn, 5.38&deg, for forearm supination/pronation, 91.99 &plusmn, 0.98&deg, for shoulder internal/external rotation, and 82.90 &plusmn, 22.52&deg, for wrist dorsiflexion/volarflexion, whereas the corresponding range for daily activities were 120.61 &plusmn, 23.64&deg, 128.09 &plusmn, 22.04&deg, 111.56 &plusmn, 31.88&deg, and 113.70 &plusmn, 18.26&deg, The shoulder joint was more abducted and extended during pinching compared to grasping posture (p &lt, 0.001). Reaching from a grasping posture required approximately 70&deg, elbow extension and 36&deg, forearm supination from the initial position. The study results provide an important database for the workspace and RoM for essential arm movements.

Background While spontaneous robotic arm control using motor imagery has been reported, most previous successful cases have used invasive approaches with advantages in spatial resolution. However, still many researchers continue to investigate methods for robotic arm control with noninvasive neural signal. Most of noninvasive control of robotic arm utilizes P300, steady state visually evoked potential, N2pc, and mental tasks differentiation. Even though these approaches demonstrated successful accuracy, they are limited in time efficiency and user intuition, and mostly require visual stimulation. Ultimately, velocity vector construction using electroencephalography activated by motion-related motor imagery can be considered as a substitution. In this study, a vision-aided brain–machine interface training system for robotic arm control is proposed and developed. Methods The proposed system uses a Microsoft Kinect to detect and estimates the 3D positions of the possible target objects. The predicted velocity vector for robot arm input is compensated using the artificial potential to follow an intended one among the possible targets. Two participants with cervical spinal cord injury trained with the system to explore its possible effects. Results In a situation with four possible targets, the proposed system significantly improved the distance error to the intended target compared to the unintended ones (p

This study aimed to investigate spatiotemporal characteristics of the hyoid bone during swallowing in patients with Parkinson's disease (PD) and dysphagia. Spatiotemporal data of the hyoid bone was obtained from videofluoroscopic images of 69 subjects (23 patients with PD, 23 age- and sex-matched healthy elderly controls, and 23 healthy young controls). Normalized profiles of displacement/velocity were analyzed during different periods (percentile) of swallowing using functional regression analysis, and the maximal values were compared between the groups. Maximal horizontal displacement and velocity were significantly decreased during the initial backward (P = 0.006 and P 0.001, respectively) and forward (P = 0.008 and P 0.001, respectively) motions in PD patients compared to elderly controls. Maximal vertical velocity was significantly lower in PD patients than in elderly controls (P = 0.001). No significant difference was observed in maximal displacement and velocity in both horizontal and vertical planes between the healthy elderly and young controls, although horizontal displacement was significantly decreased during the forward motion (51st-57th percentiles) in the elderly controls. In conclusion, reduced horizontal displacement and velocity of the hyoid bone during the forward motion would be due to combined effects of disease and aging, whereas those over the initial backward motion may be considered specific to patients with PD.

BACKGROUND Optimal seatback angles for automobile drivers' seats have been investigated based on comfort and back muscle activities; however, radiology supported evidences are scarce. OBJECTIVE The aim of this study was to evaluate optimal range of the seatback reclining regarding torso angles for an automobile driver's seat to preserve lumbar lordosis. METHODS Thirty-one healthy volunteers were recruited among five body type categories. Lateral lumbar spine X-rays were obtained for the neutral sitting posture without seatback (reference), and with reclining angles of 23∘ to 33∘ by 2∘ intervals. The Cobb angles for the L1-L4, L4-S1, and L1-S1 segments were measured. RESULTS The Cobb angle for L4-S1 was nearest to the reference (18.74 ± 1.57∘, mean ± standard error mean) at reclining angles of 29∘ and 31∘ (14.51 ± 1.41∘ and 14.47 ± 1.43∘, respectively). The Cobb angle at L4-S1 between reclining angles of 27∘(12.02 ± 1.31∘) and 29∘ (14.51 ± 1.41∘) were significantly different (p< 0.001). Tall men showed relatively preserved lordosis angles at all reclining angles. Fat men and short women demonstrated prominent loss of lordosis with excessively kyphotic L1-L4 segment. CONCLUSIONS Reclining angles of 29∘ to 31∘ revealed to be optimal for preserving lordosis at the L4-S1 segment. Individualized healthcare-related guideline for driver's seat adjustment setting is necessary.

Botulinum toxin A is widely used in the clinics to reduce spasticity and improve upper limb function for post-stroke patients. Efficacy and safety of a new botulinum toxin type A, NABOTA (DWP450) in post-stroke upper limb spasticity was evaluated in comparison with Botox (onabotulinum toxin A). A total of 197 patients with post-stroke upper limb spasticity were included in this study and randomly assigned to NABOTA group (n=99) or Botox group (n=98). Wrist flexors with modified Ashworth Scale (MAS) grade 2 or greater, and elbow flexors, thumb flexors and finger flexors with MAS 1 or greater were injected with either drug. The primary outcome was the change of wrist flexor MAS between baseline and 4weeks post-injection. MAS of each injected muscle, Disability Assessment Scale (DAS), and Caregiver Burden Scale were also assessed at baseline and 4, 8, and 12weeks after the injection. Global Assessment Scale (GAS) was evaluated on the last visit at 12weeks. The change of MAS for wrist flexor between baseline and 4weeks post-injection was -1.44±0.72 in the NABOTA group and -1.46±0.77 in the Botox group. The difference of change between both groups was 0.0129 (95% confidence interval -0.2062-0.2319), within the non-inferiority margin of 0.45. Both groups showed significant improvements regarding MAS of all injected muscles, DAS, and Caregiver Burden Scale at all follow-up periods. There were no significant differences in all secondary outcome measures between the two groups. NABOTA demonstrated non-inferior efficacy and safety for improving upper limb spasticity in stroke patients compared to Botox.

Objectives/Hypothesis To evaluate the relationship between movements of hyolaryngeal structures and fluid bolus transition in normal swallowing using automatized kinematic analysis of the videofluoroscopic swallowing study (VFSS). Study Design A prospective, descriptive study. Methods Seventy-five healthy volunteers underwent VFSS with 2 mL of diluted barium. The timing and sequence of structural movements were measured for laryngeal elevation (LE), hyoid excursion (HE), epiglottic rotation (ER), and fluid bolus transition. Results The rapid movement of LE (reference time point) was initiated simultaneously with the fluid bolus head passing the mandibular angle (−0.05 s, P = .07), followed by rapid onset of HE with significant temporal difference (P

OBJECTIVE To investigate the accessibility of medical services for Korean people with spinal cord injury (SCI) compared to the control group (CG) and to evaluate significantly related factors. METHODS A total of 363 community dwelling people with chronic SCI were enrolled and 1,089 age- and sex-matched subjects were randomly selected from the general population as the CG. Self-reported access to medical services was measured by asking "Have you experienced the need for a hospital visit in the last year but could not?". This was followed up by asking the reasons for not receiving services when medically necessary. Variables, including lack of finances, difficulties making medical appointments, and lack of transportation were evaluated for accessibility to medical services. RESULTS Sixty subjects (16.5%) in the SCI group had difficulties receiving medical services due to a lack of accessibility, compared to 45 (4.1%) in the CG (p

Robotic devices that practically assist activities of daily living (ADL) are scarce. The aim of this study was to investigate practical demands of potential users of external robotic arms and upper limb exoskeletons for assistance in ADL. A survey was performed in rehabilitation clinics in individuals with functional impairments in the upper extremity, divided into unilateral (UIG, n = 24) and bilateral impairment groups (BIG, n = 24). Descriptive analyses were performed for current dependency, objective importance, and subjective necessity of the 18 ADLs by using a 5-point Likert scale. Overall, handling foods, dressing, and moving close items were highly necessary functions for both robot types. The UIG demonstrated a high demand for self-exercise using exoskeletons, whereas one-hand ADLs showed low necessity. In the UIG, the exoskeleton had significantly higher demands than the external robotic arm in washing face (p = 0.005) and brushing teeth (p = 0.007). The subjects in the BIG replied that cleaning desks and eating are highly necessary abilities for the external robotic arm, and transfer and wheelchair control, for exoskeletons. In the BIG, the exoskeleton showed significantly higher necessity than the external robotic arms in dressing (p = 0.010), making phone calls (p = 0.026), using a smartphone (p = 0.011), and writing (p = 0.005). The practical demands of potential users were affected by laterality and robot type. Further robot developments should involve essential functions based on the survey results to meet end-user needs.

The purpose of this study was to assess the effect of repeated sessions of electrical stimulation therapy (EST) on the neck muscles with respect to the stimulation site by using quantitative kinematic analysis of videofluoroscopic swallowing studies (VFSS) in dysphagia patients with acquired brain injury. We analyzed 50 patients in a tertiary hospital who were randomly assigned into two different treatment groups. One group received EST on the suprahyoid muscle only (SM), and the other group received stimulation with one pair of electrodes on the suprahyoid muscle and the other pair on the infrahyoid muscle (SI). All patients received 10-15 sessions of EST over 2-3 weeks. The VFSS was carried out before and after the treatment. Temporal and spatial parameters of the hyoid excursion and laryngeal elevation during swallowing were analyzed by two-dimensional motion analysis. The SM group (n = 25) revealed a significant increase in maximal anterior hyoid excursion distance (mean ± SEM = 1.56 ± 0.52 mm, p = 0.008) and velocity (8.76 ± 3.42 mm/s, p = 0.017), but there was no significant increase laryngeal elevation. The SI group (n = 25), however, showed a significant increase in maximal superior excursion distance (2.09 ± 0.78 mm, p = 0.013) and maximal absolute excursion distance (2.20 ± 0.82 mm, p = 0.013) of laryngeal elevation, but no significant increase in hyoid excursion. There were no significant differences between the two groups with respect to changes in maximal anterior hyoid excursion distance (p = 0.130) and velocity (p = 0.254), and maximal distance of superior laryngeal elevation (p = 0.525). EST on the suprahyoid muscle induced an increase in anterior hyoid excursion, and infrahyoid stimulation caused an increase in superior laryngeal elevation. Hyolaryngeal structural movements were increased in different aspects according to the stimulation sites. Targeted electrical stimulation based on pathophysiology is necessary.

Mirror therapy has been performed as effective occupational therapy in a clinical setting for functional recovery of a hemiplegic arm after stroke. It is conducted by eliciting an illusion through use of a mirror as if the hemiplegic arm is moving in real-time while moving the healthy arm. It can facilitate brain neuroplasticity through activation of the sensorimotor cortex. However, conventional mirror therapy has a critical limitation in that the hemiplegic arm is not actually moving. Thus, we developed a real-time 2-axis mirror robot system as a simple add-on module for conventional mirror therapy using a closed feedback mechanism, which enables real-time movement of the hemiplegic arm. We used 3 Attitude and Heading Reference System sensors, 2 brushless DC motors for elbow and wrist joints, and exoskeletal frames. In a feasibility study on 6 healthy subjects, robotic mirror therapy was safe and feasible. We further selected tasks useful for activities of daily living training through feedback from rehabilitation doctors. A chronic stroke patient showed improvement in the Fugl-Meyer assessment scale and elbow flexor spasticity after a 2-week application of the mirror robot system. Robotic mirror therapy may enhance proprioceptive input to the sensory cortex, which is considered to be important in neuroplasticity and functional recovery of hemiplegic arms. The mirror robot system presented herein can be easily developed and utilized effectively to advance occupational therapy.

OBJECTIVE To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. METHODS A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. RESULTS The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p

Pseudoachalasia secondary to primary squamous cell carcinoma (SCC) of the liver is extremely rare and has not been reported until now. Here, we report a unique case of primary SCC of the liver initially presenting with progressive dysphagia along with short periods of significant weight loss. A 58-year-old man initially presented with progressive dysphagia along with significant weight loss over brief periods of time. The radiographic and manometric findings were consistent with achalasia. Subsequent esophagogastroduodenoscopy revealed a moderately dilated esophagus without evidence of neoplasm or organic obstruction. However, firm resistance was encountered while traversing the esophagogastric junction (EGJ), although no mucosal lesion was identified. Due to the clinical suspicion of the presence of a malignant tumor, endoscopic ultrasonography (EUS) and computed tomography scans of the chest and abdomen were obtained. A huge hepatic mass with irregular margins extending to the EGJ was found. EUS-guided fine-needle aspiration was performed, and the mass was diagnosed as a primary SCC of the liver by immunohistochemical staining.

BACKGROUND/AIMS Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment. METHODS We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (≥ 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (≥ 50 vs. < 50%) on progression-free survival (PFS) and overall survival (OS). RESULTS During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months, respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp ≥ 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp ≥ 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp ≥ 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters. CONCLUSIONS Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.

A novel robotic mirror therapy system was recently developed to provide proprioceptive stimulus to the hemiplegic arm during a mirror therapy. Validation of the robotic mirror therapy system was performed to confirm its synchronicity prior to the clinical study. The mean error angle range between the intact arm and the robot was 1.97 to 4.59 degrees. A 56-year-old male who had right middle cerebral artery infarction 11 months ago received the robotic mirror therapy for ten 30-minute sessions during 2 weeks. Clinical evaluation and functional magnetic resonance imaging (fMRI) studies were performed before and after the intervention. At the follow-up evaluation, the thumb finding test score improved from 2 to 1 for eye level and from 3 to 1 for overhead level. The Albert's test score on the left side improved from 6 to 11. Improvements were sustained at 2-month follow-up. The fMRI during the passive motion revealed a considerable increase in brain activity at the lower part of the right superior parietal lobule, suggesting the possibility of proprioception enhancement. The robotic mirror therapy system may serve as a useful treatment method for patients with supratentorial stroke to facilitate recovery of proprioceptive deficit and hemineglect., Graphical Abstract

Cross-sectional survey. To investigate the prevalence of suicidal ideation and attempt in Korean persons with spinal cord injury (SCI) and the factors related with suicidal ideation in comparison with a control group (CG). Community-dwelling persons with chronic SCI in Korea. A total of 382 persons with chronic SCI and 1104 able-bodied persons randomly selected from the general population and matched for age, sex and education level were compared. Suicidal ideation and attempt were recorded positive if the subjects had that experience during the past year. Psychosocial variables and injury-related factors were also evaluated. Suicidal ideation was found in 34.8% (127/365) of SCI persons and 10.4% (115/1104) in the CG (P

Objective To evaluate the feasibility of the ICF for initial comprehensive evaluation of early post-acute spinal cord injury. Method A comprehensive evaluation of 62 early post-acute spinal cord injury (SCI) patients was conducted by rehabilitation team members, such as physicians, physical therapists, occupational therapists, nutritionists, medical social-workers, and nurses. They recorded each of their evaluation according to the ICF first level classification. The contents of the comprehensive evaluation were linked to the ICF second level categories, retrospectively. The linked codes were analyzed descriptively and were also compared with the brief ICF core set for early post-acute SCI. Results In the evaluation of early post-acute SCI patients based on the ICF first level categories, 19 items from the body functions domain, such as muscle power functions (b730) and urination functions (b620), 15 items from the body structures domain, including spinal cord and related structures (s120), 11 items from the activities and participation domain, such as transferring oneself (d420) and walking (d450), and 9 items from the environmental factors domain, e.g., health professionals (e355), were linked to the ICF second level categories. In total, 82.4% of all contents were linked to the brief ICF core set. Prognosis insight, a personal factor not linkable to an ICF code, was mentioned in 29.0% of all patients. Conclusion First level ICF categories can provide a structural base for a comprehensive evaluation in early post-acute spinal cord injury. However, frequently linked items, including the brief core set, as well as personal factors should be considered via a checklist in order to prevent the omission of significant contents.

□DOI: 10.4166/kjg.2010.56.4.268연락처: 김광하, 602-739, 부산시 서구 아미동 1가 10번지부산대학교 의학전문대학원 내과학교실Tel: (051) 240-7869, Fax: (051) 244-8180E-mail: doc0224@pusan.ac.krCorrespondence to: Gwang Ha Kim, M.D.Department of Internal Medicine, Pusan National University School of Medicine, 1-10, Ami-dong, Seo-gu, Busan 602- 739, KoreaTel: +82-51-240-7869, Fax: +82-51-244-8180E-mail: doc0224@pusan.ac.kr

어깨는 허리, 무릎과 함께 통증이 가장 많이 발생하는 관절의 하나로, 통증이 발생하는 원인 역시 매우 다양하다. 젊은 연령에서 갑자기 발생하는 회전근개전층파열과 같은 경우를 제외하면 비수술적인 치료를 먼저 시행하게 되는데, 단순히 관절강 내 스테로이드 주사를 시행하는 것보다는 통증의 해부학적, 병리학적 원인에 근거한 정확한 치료를 가능한 조기에 시행하는 것이 통증 경감 및 어깨기능 회복을 위해 반드시 필요하다. 본 논문에서는 어깨통증의 흔한 원인인 유착성견관절낭염(adhesive capsulitis), 어깨충돌증후군(impingement syndrome) 및 회전근개건증(rotator cuff tendinosis), 파열 및 석회화건염(calcific tendinitis) 수술의 보존적 치료방법에 대해 소개하고자 한다.

Objective To investigate the characteristics of community-dwelling spinal cord injury (SCI) persons with obesity, including diet, socioeconomic factors, weight reduction method, and frequency of body weight and abdominal circumference measurements. Methods We developed a questionnaire based on ‘the Fourth Korea National Health and Nutrition Examination Survey, 2009’ . A total of 371 community-dwelling SCI persons were enrolled in this study. Inclusion criteria were SCI persons older than 20 years with more than 1 year elapsed since the injury. Trained investigators visited SCI persons’ home to complete the questionnaire and measure abdominal obesity (AO) as defined by the waist circumference. Results Prevalence of AO was 29.2% in SCI persons and 27.4% in the general population (GP), showing no significant difference. Education showed correlation with AO in both SCI persons and the GP. The injury level, type of injury and income did not show any correlation with AO in SCI persons. Only 28.8% and 48.8% of SCI persons measured their waist circumference and body weight within the past year, respectively. Also, SCI persons with AO thought that their body was less obese compared to persons with AO in the GP (p

Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.