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Objective To identify the prevalence and characteristics of neuropathic pain (NP) in patients with spinal cord injury (SCI) and to investigate associations between NP and demographic or disease-related variables.Methods We retrospectively reviewed medical records of patients with SCI whose pain was classified according to the International Spinal Cord Injury Pain classifications at a single hospital. Multiple statistical analyses were employed. Patients aged

Artificial intelligence (AI)-enhanced interventions show promise for improving the delivery of long-term care (LTC) services for older people. However, the research field is developmental and has yet to be systematically synthesised. This systematic review aimed to synthesise the literature on the acceptability and effectiveness of AI-enhanced interventions for older people receiving LTC services. We conducted a systematic search that identified 2720 records from Embase, Ovid, Global Health, PsycINFO, and Web of Science. 31 articles were included in the review that evaluated AI-enhanced social robots (n=22), environmental sensors (n=6), and wearable sensors (n=5) with older people receiving LTC services across 15 controlled and 14 non-controlled trials in high-income countries. Risk of bias was evaluated using the RoB 2, RoB 2 CRT, and ROBINS-I tools. Overall, AI-enhanced interventions were found to be somewhat acceptable to users with mixed evidence for their effectiveness across different health outcomes. The included studies were found to have high risk of bias which reduced confidence in the results. AI-enhanced interventions are promising innovations that could reshape the landscape of LTC globally. However, more trials are required to support their widespread implementation. Pathways are needed to support more high-quality trials, including in low-income and middle-income countries.

To reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC).A multistep expert consensus process.Multinational and multidisciplinary experts in LTC and ageing.The consensus process was composed of 3 stages: (1) a preconsultation round that built on an initial list of LTC interventions generated by a previous scoping review; (2) 2-round surveys to reach consensus on important, acceptable, and feasible interventions for LTC; (3) a panel meeting to finalize the consensus.The preconsultation round generated an initial list of 117 interventions. In round 1, 194 experts were contacted and 92 (47%) completed the survey. In round 2, the same experts contacted for round 1 were invited, and 115 (59%) completed the survey. Of the 115 respondents in round 2, 80 participated in round 1. Experts representing various disciplines (eg, geriatricians, family doctors, nurses, mental health, and rehabilitation professionals) participated in round 2, representing 42 countries. In round 1, 81 interventions achieved the predetermined threshold for importance, and in round 2, 41 interventions achieved the predetermined threshold for acceptability and feasibility. Nine conflicting interventions between rounds 1 and 2 were discussed in the panel meeting. The recommended list composed of 50 interventions were from 6 domains: unpaid and paid carers' support and training, person-centered assessment and care planning, prevention and management of intrinsic capacity decline, optimization of functional ability, interventions needing focused attention, and palliative care.An international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.

The WHO concept of Healthy Ageing (ie, the process of developing and maintaining the functional ability that enables well-being in older age) has initiated a global discussion about the need for shifting paradigms to reorient health and social services towards person-centred and coordinated models of care. In particular, the integration of health and social care services is critical to provide the basis for comprehensive information sharing and service delivery to support the evolution of the older person over time. The capability to monitor and respond to an older person’s changing health and social care needs will enable prompt and personalised health and social care plans to be implemented.The implementation of an integrated care approach involves all the settings where persons age, but also requires a concerted action among micro (clinical), meso (service delivery) and macro (system) level. The community is of particular relevance given the primary objective of "ageing in place". However, from the perspective of the continuum of care and services acting synergistically, all health and social care settings (including long-term care facilities and hospitals) need to evolve and embrace an integrated way of operating to support functional ability in older people, while maximising resource and information sharing efficiencies.In this paper, we explain that government actions to promote well-being in older age should be built on a seamless continuum of care starting from the assessment of the older person’s intrinsic capacity and functional ability with the final aim of providing care aligned with the individual’s needs and priorities.

ObjectiveThe global population is rapidly ageing. To tackle the increasing prevalence of older adults’ chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO’s public health framework of healthy ageing.DesignScoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community.Inclusion criteriaStudies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French.Results305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13).ConclusionThe identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.

A pilot randomized controlled trial.To evaluate the clinical efficacy of upper limb robotic therapy in people with tetraplegia.Inpatient rehabilitation hospital in Seoul, Korea.Participants were randomly allocated to a robotic therapy (RT) or occupational therapy (OT) group. Both groups received usual care plus 30 min of additional therapy per day for 4 weeks. The additional therapy provided to the OT group was OT, and the additional therapy provided to RT group was RT using the Armeo Power. Primary outcomes were the Medical Research Council scale of each key muscle and Upper Extremity Motor Score (UEMS) for the trained arm. Secondary outcomes were the Spinal Cord Independence Measurement version III (SCIM-III) subscale and total score. Evaluations were performed at baseline and 4 weeks.A total of 34 individuals with tetraplegia were included; 17 in each group. At 4 weeks, the median (IQR) change in UEMS in the RT group was 1/25 (0 to 3) points compared with 0/25 (-1 to 1) points in the OT group (p = 0.03). The median (IQR) change in total SCIM-III score in the RT group was 7/100 (1.5 to 11) points compared with 0/100 (-8 to 4) points in the OT group (p 0.01).There were small improvements in motor strength and SCIM-III scores in the RT group, but there were no statistically significant differences between the groups. Further studies are required for a better understanding of the effects of RT for people with tetraplegia.

Objective To evaluate the clinical features that could serve as predictive factors for improvement in gait speed after robotic treatment. Methods A total of 29 patients with motor incomplete spinal cord injury received 4-week robot-assisted gait training (RAGT) on the Lokomat (Hocoma AG, Volketswil, Switzerland) for 30 minutes, once a day, 5 times a week, for a total of 20 sessions. All subjects were evaluated for general characteristics, the 10-Meter Walk Test (10MWT), the Lower Extremity Motor Score (LEMS), the Functional Ambulatory Category (FAC), the Walking Index for Spinal Cord Injury version II (WISCI-II), the Berg Balance Scale (BBS), and the Spinal Cord Independence Measure version III (SCIM-III) every 0, and 4 weeks. After all the interventions, subjects were stratified using the 10MWT score at 4 weeks into improved group and non-improved group for statistical analysis. Results The improved group had younger age and shorter disease duration than the non-improved group. All subjects with the American Spinal Injury Association Impairment Scale level C (AIS-C) tetraplegia belonged to the non-improved group, while most subjects with AIS-C paraplegia, AIS-D tetraplegia, and AIS-D paraplegia belonged to the improved group. The improved group showed greater baseline lower extremity strength, balance, and daily living function than the non-improved group. Conclusion Assessment of SCIM-III, BBS, and trunk control, in addition to LEMS, have potential for predicting the effects of robotic treatment in patients with motor incomplete spinal cord injury.

OBJECTIVE Given the lack of a Korean version of the Spinal Cord Independence Measure III (KSCIM-III) that accurately reflects the contextual and cultural aspect of the assessment tool, the aims of the study were to develop a new Korean version of the Spinal Cord Independence Measure III and to investigate its reliability and validity. DESIGN Forty (N = 40) consecutive patients with spinal cord injury were included in this prospective study. Backward and forward translation of the Spinal Cord Independence Measure III was performed by fluent speakers in both languages. To measure the validity of Korean version of the Spinal Cord Independence Measure III, the scores were compared with the Modified Barthel Index. Each patient was examined by two occupational therapists. For test-retest reliability assessment, follow-up evaluation was repeated 1 mo after the initial assessment by the same evaluator. RESULTS Reliability between the Korean version of the Spinal Cord Independence Measure III evaluators showed values of 0.710-1.000, and test-retest reliability showed high values ranging from 0.295 to 0.664. The validity of Korean version of the Spinal Cord Independence Measure III was confirmed by the close correlation with Modified Barthel Index (r = 0.953, P < 0.001). CONCLUSIONS The results of this study showed high interrater and substantial test-retest reliability. The Korean version of the Spinal Cord Independence Measure III is an appropriate tool to assess the activities of daily living in terms of independence for patients with spinal cord injury.

In the original version of the article the authors incorrectly stated that: "One case study provided evidence of some improvements in motor performance and spasticity [19], while several other studies only provided evidence on the feasibility of UER as an assessment tool; however, the fact that the manufacturer funded these studies lessens their objectivity [15, 20-24]." This is not correct as the manufacturers did not fund the studies. The correct phrase therefore should have read: "One case study provided evidence of some improvements in motor performance and spasticity [19], while several other studies provided evidence focusing more on the feasibility of UER rather than the clinical efficacy [15, 20-24]." The authors would like to apologise for this error.This has been corrected in both the PDF and HTML versions of the Article.

Pain is one of the most common complications of spinal cord injury (SCI), and the prevalence rates of pain in patients with SCI ranges between 75 and 81%.1, 2, 3 The most common subtype of pain in patients with SCI is neuropathic pain, which is defined as “pain caused by a lesion or disease of the somatosensory system.”4, 5 Neuropathic pain is one of the most problematic complications, reducing quality of life and interfering with cognitive, emotional, and physical functioning following SCI.6, 7 In addition, neuropathic pain after SCI is generally severe, refractory to treatment, and persistent over time.1 Botulinum toxin (BTX) is commonly used to treat spasticity or dystonia. Recent studies have suggested that BTX type A (BTX‐A) is effective for the treatment of chronic pain conditions such as chronic migraine, postherpetic neuralgia, post‐traumatic neuralgia, or diabetic neuropathy.8, 9, 10, 11 It has been suggested that BTX‐A may inhibit neurogenic inflammation and the peripheral sensitization of nociceptive fibers by inhibiting the release of local neuropeptides such as substance P, calcitonin gene‐related peptide, or glutamate, thereby reducing pain.12, 13 In addition, a retrograde effect of BTX‐A on the spinal cord by axonal transport is proposed as the central mechanism of the antinociceptive effect of BTX‐A.14, 15, 16 We propose that BTX‐A may be effective for the treatment of intractable neuropathic pain in patients with SCI due to these mechanisms. To the best of our knowledge, the efficacy of BTX‐A on neuropathic pain in patients with spinal cord lesions has been suggested in only a few case reports.17, 18 This study is the first to evaluate the potential effects of BTX‐A on neuropathic pain in patients with SCI using a double‐blind, placebo‐controlled, parallel group design.

The purpose of this study was to investigate the effect of RAGT on the static balance ability of sitting posture in SCI. Changes in COP in the open eyes showed significant differences between groups in the anterior sway category. In both groups, there was a tendency for the front and back sway to decrease, suggesting that RAGT and upper body balance training may have an effect of reducing anterior sway for SCI patients. On the other hand, the static balance in the eyes closed state did not show the difference between the groups, but the lateral sway was significantly increased after the RAGT intervention in the experimental group.

The aim of this study was to determine the location of the motor points and the intramuscular branches of the wrist flexors in relation to bony landmarks.Sixteen limbs from eight adult cadavers were anatomically dissected. The motor branch points of the flexor carpi radialis and flexor carpi ulnaris muscles and the proximal limit points and the distal limit points in relation to a reference line connecting the medial epicondyle and the pisiform bone or one connecting the medial epicondyle and the base of the second metarcarpal bone were identified.For the flexor carpi radialis muscles, the motor branch points were located at a distance of 27% ± 6% of the reference line, whereas the proximal limit points and the distal limit points were located at a distance of 21% ± 5% and 37% ± 8% of the reference line. For the flexor carpi ulnaris muscles, the corresponding data were 32% ± 8%, 23% ± 6%, and 43% ± 9%.The results may assist in enhancing accuracy when localizing points for neuromuscular blockade of the wrist flexors. The optimal area for flexor carpi radialis muscle injection is at a quarter point and that for flexor carpi ulnaris muscle injection is at one-third point along each reference line from the medial epicondyle.

A one-year epidemiological survey.To compare bacterial strains and antimicrobial susceptibilities of urinary isolates from hospital and community spinal cord injury (SCI) patients.A specialized SCI unit in a freestanding rehabilitation hospital.From June 2012 through May 2013, urine cultures were obtained from all of the newly admitted patients. Bacterial strains and antimicrobial susceptibilities were compared between patients from community and hospital settings.The proportion of Enterobacteriaceae in the total urinary isolates from hospital-dwelling patients was smaller than that from community-dwelling patients (66.0 vs. 85.5%, P0.001), while the proportions of Pseudomonas, Acinetobacter and Enterococcus species were relatively larger (8.7%, 6.0% and 12.0% vs. 2.8%, 0.7% and 2.8%, respectively, P0.05). The isolates from hospital-dwelling patients showed lower susceptibility to ampicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole and all generations of cephalosporin (P0.05), and a higher prevalence of extended-spectrum beta-lactamase (ESBL)-producers (41.7 vs. 5.4%, P0.001), compared with those from community-dwelling patients. The susceptibility rates to levofloxacin were lower than 50% in both community and hospital-dwelling patients.Broader-spectrum antibiotics should be considered in treating nosocomial urinary tract infection (UTI) of SCI patients because of the relatively wide variety of organisms and higher frequency of antibiotic-resistant strains, including ESBL-producing Enterobacteriaceae in hospital-derived specimens. Furthermore, in areas with high prevalence of fluoroquinolone resistance, fluoroquinolones should be used with caution during empirical treatment for UTI in SCI patients.

It is generally thought that the corticobulbar tract descends through the genu of the internal capsule (IC). There have been several reports that genu lesions cause bulbar symptoms such as facial palsies, dysarthria, and dysphagia. However, the precise location of the corticobulbar tract in the IC remains controversial. The purpose of our study is to assess whether the corticobulbar tract passes through the IC genu. We reviewed 26 patients with selective IC infarction and located the sites related to bulbar symptoms. In addition, using diffusion tensor imaging, we reconstructed tracts passing through the IC in ten subjects without cerebral infarction. Patients with genu infarction, which extended to more than half of the posterior limb of the IC, showed bulbar symptoms. However, patients with genu infarction, which was limited to the genu, did not have bulbar symptoms. In contrast, patients with lesions limited to the posterior limb may show bulbar symptoms. According to statistical maps of the region of interest, the lesions related to bulbar symptoms were localized to areas that were beyond the midpoint of the posterior limb of the IC. In diffusion tensor imaging of subjects without cerebral infarctions, the corticobulbar and corticospinal tracts did not pass through the IC genu. Our data provide evidence that the corticobulbar tract does not pass through the IC genu. The proposed location of the corticobulbar tract in the level of the IC lies beyond the midpoint of the posterior limb.

The aim of this study was to report the characteristics of dysphagia in children with cerebral palsy (CP), related to gross motor function.Videofluoroscopic swallow study was performed in 29 children with CP, according to the manual of Logemann. Five questions about oromotor dysfunction were answered. Gross motor function level was classified by the Gross Motor Function Classification System Expanded and Revised.The results of the videofluoroscopic swallowing studies showed that reduced lip closure, inadequate bolus formation, residue in the oral cavity, delayed triggering of pharyngeal swallow, reduced larynx elevation, coating on the pharyngeal wall, delayed pharyngeal transit time, multiple swallow, and aspiration were significantly more common in the severe group (Gross Motor Function Classification System Expanded and Revised IV or V). As for aspiration, 50% of the children with severe CP had problems, but only 14.3% of them with moderate (Gross Motor Function Classification System Expanded and Revised III) CP and none of them with mild CP had abnormalities. In addition, five of the seven aspiration cases occurred silently.This study shows that dysphagia is closely related to gross motor function in children with CP. Silent aspiration was observed in the moderate to severe CP groups. Aspiration is an important cause of medical problems such as acute and chronic lung disease, and associated respiratory complications contribute significantly in increasing morbidity and mortality in these patient groups. Therefore, the authors suggest that early dysphagia evaluation including videofluoroscopic swallow study is necessary in managing feeding problems and may prevent chronic aspiration, malnutrition, and infections.

Intracranial stab wounds are low-velocity, penetrating injuries to the brain and fatality and outcome significantly depend on route, depth and location of cranial penetration. Due to the effective barrier provided by the adult calvarium, most injuries occur through the orbitae or temporal regions where bony layers are thin. Self-inflicted intracranial stab wounds are an even rarer form of traumatic brain injury, with common entry points being the orbital space and the nose. Intracranial brainstem injuries mostly result in death, with reported penetration areas being the pons or midbrain.The following report reviews a first reported case of self-inflicted intracranial stabbing via a trans-oral route with lesions to the medulla oblongata and cerebellum. Unlike previous cases of low velocity penetrating injuries to the brainstem, the patient underwent full neurologic recovery after manual knife removal and intensive rehabilitation.Self-inflicted transcranial injuries have been mentioned only briefly and sporadically in the literature. This article highlights a rare case of self-inflicted intracranial stabbing with a not yet reported entry route and brainstem lesion. Unlike the other fatal outcomes associated with such injuries, the patient underwent full neurological and functional recovery through a comprehensive approach that included intensive rehabilitation.

Objective To identify the pressure relieving effect of adding a pelvic well pad, a firm pad that is cut in the ischial area, to a wheelchair cushion on the ischium. Methods Medical records of 77 individuals with SCI, who underwent interface pressure mapping of the buttock-thigh area, were retrospectively reviewed. The pelvic well pad is a 2.5-cm thick firm pad and has a cut in the ischial area. Expecting additional pressure relief, it can be inserted under a wheelchair cushion. Subjects underwent interface pressure mapping in the subject's wheelchair utilizing the subject's pre-existing pressure relieving cushion and subsequently on a combination of a pelvic well pad and the cushion. The average pressure, peak pressure, and contact area of the buttock-thigh were evaluated. Results Adding a pelvic well pad, under the pressure relieving cushion, resulted in a decrease in the average and peak pressures and increase in the contact area of the buttock-thigh area when compared with applying only pressure relieving cushions (p

OBJECTIVE To identify the prevalence of multidrug-resistant (MDR) bacteria and identify their specific risk factors in routine urine specimens of spinal cord injury (SCI) patients. METHODS This study was designed in a retrospective manner, reviewing the medical records of SCI patients who were admitted to a specialized SCI unit between January 2001 and December 2013. Patients were investigated for age, gender, American Spinal Injury Association impairment scale, SCI level, duration after injury, bladder management method, and hospitalization history within four weeks prior to visiting our unit. The results of routine urine cultures including presence of MDR organisms were analyzed. RESULTS Among the total 2,629 urine samples from the newly admitted SCI patients, significant bacteriuria was identified in 1,929 (73.4%), and MDR organisms were isolated in 29 (1.1%) cultures. There was an increasing trend of MDR organism prevalence from 2001 to 2013 (p

To identify dermatological conditions following spinal cord injury (SCI) and analyze these conditions in relation to various characteristics of SCI.Retrospective chart review.National Health Insurance Corporation Ilsan Hospital of Korea, Rehabilitation Center, Spinal Cord Unit.Patients treated for SCI who were referred to dermatology for dermatological problems, 2000-2012.Of the 1408 SCI patients treated at the spinal cord unit, 253 patients with SCI were identified to have been referred to dermatology for skin problems and a total of 335 dermatological conditions were diagnosed. The most common dermatological finding was infectious (n = 123, 36.7%) followed by eczematous lesions (n = 109, 32.5%). Among the infectious lesions, fungal infection (n = 76, 61.8%) was the most common, followed by bacterial (n = 27, 21.9%) lesions. Seborrheic dermatitis (n = 59, 64.1%) was the most frequent eczematous lesion. Ingrown toenail occurred more frequently in tetraplegics whereas vascular skin lesions occurred more commonly in patients with paraplegia (P0.05). Xerotic dermatitis showed a higher occurrence within 12 months of injury rather than thereafter (P0.05). Of these, 72.4% of the infectious and 94.7% of the fungal skin lesions manifested below the neurological level of injury (NLI; P0.001) and 61.5% of the eczematous lesions and 94.9% of seborrheic dermatitis cases occurred above the NLI (P0.001). There was no significant difference in dermatological diagnoses between patients with neurologically complete and incomplete SCI.The most common dermatological condition in patients with SCI among those referred to dermatology was fungal infection, followed by seborrheic dermatitis. Although dermatological problems after SCI are not critical in SCI outcome, they negatively affect the quality of life. Patients and caregivers should be educated about appropriate skin care and routine dermatological examinations.

A 65-year-old man presented complaining of progressive inability to open his mouth and eyes and difficulty swallowing that had begun 20 days earlier. He had sustained a penetrating injury to his left foot caused by scissor tips approximately 6 weeks earlier. The foot injury was clean and had healed. His vital signs were stable without fever. The white blood cell count and C-reactive protein were within normal limits. His primary tetanus vaccination status was unclear. Magnetic resonance imaging and magnetic resonance angiography of the brain were normal. The patient was diagnosed with cephalic tetanus based on his history of penetrating injury, intense trismus, facial nerve paralysis, and exclusion of an alternative diagnoses. Treatment was initiated with tetanus immunoglobulin (HTIG, 500 U), metronidazole (500 mg q8h), and diazepam (10 mg q8h). Over the next 14 days, his rigidity improved slowly, and he was able to open his mouth (Fig. 1) and eyes (Fig. 2). Figure 1 The restricted jaw opening on day 1 had improved on day 15. Figure 2 The maximum eye opening on day 15 was markedly improved compared with that on day 1. Tetanospasmin, an exotoxin produced by Clostridium tetani, is the cause of tetanus. Cephalic tetanus is a rare form of localized tetanus and almost always occurs only following craniofacial injuries. This case developed after injury to an area remote from the head, which explains the relatively long incubation period. Treatment involves wound debridement, adequate active and passive immunization, antibiotics, benzodiazepines, and aggressive supportive care. Passive immunization with HTIG at a lower dose (500 U) appears to be as effective as a higher dose (10,000 U). About two-thirds of cephalic tetanus progress to generalized tetanus with a poor prognosis. When a patient presents with trismus and paralysis of one or more cranial nerves, cephalic tetanus should be included in the differential diagnosis. A remote, healed peripheral injury can be a source of cephalic tetanus.

OBJECTIVES To define the relationship between body indices of healthy adults and cross-sectional areas of the carpal tunnel and median nerve and to obtain the nerve/tunnel index, which represents a new standard for diagnosing carpal tunnel syndrome using sonography. METHODS Body indices (height, weight, and body mass index) were analyzed in 60 healthy adults, and electromyography and sonography were also performed. The cross-sectional areas of the proximal and distal median nerve and carpal tunnel were obtained by sonography. The proximal and distal nerve/tunnel indices were obtained by calculating the ratio between the proximal and distal cross-sectional areas of the median nerve to those of the carpal tunnel and multiplying the value by 100. RESULTS Although the proximal cross-sectional areas of the median nerve and body indices showed statistically significant relationships with weak positive correlations, the proximal and distal areas of the carpal tunnel showed relatively stronger correlations with body indices. Between sexes, there were significant differences in the proximal median nerve cross-sectional area (mean ± SD: male, 10.48 ± 3.21 mm(2); female, 8.81 ± 3.21 mm(2); P < .05) and proximal carpal tunnel area (male, 182.50 ± 21.15 mm(2); female, 151.23 ± 21.14 mm(2); P < .05). There was no difference in the proximal nerve/tunnel index (male, 5.80% ± 1.72%; female, 5.91% ± 1.63%). There was a statistically significant difference in the distal carpal tunnel cross-sectional area (male, 138.90 ± 20.95 mm(2); female, 121.50 ± 18.99 mm(2); P < .05) between sexes, but the distal median area (male, 9.99 ± 3.42 mm(2); female, 8.46 ± 1.84 mm(2)) and distal nerve/tunnel index (male, 7.15% ± 2.00%; female, 7.01% ± 1.38%) showed no significant differences. The proximal index was significantly higher than the distal index (proximal, 5.85% ± 1.66%; distal, 7.08% ± 1.71%). CONCLUSIONS The nerve/tunnel index is unaffected by body indices or sex and thus may be a useful and objective standard for diagnosing carpal tunnel syndrome.

Objective To perform an in depth evaluation of children, and thus provide a systematic method of managing children, who after infantile health screening, were categorized as suspected developmental delay. Method 78 children referred to the Developmental Delay Clinic of Ilsan Hospital after suspected development delay on infantile health examinations were enrolled. A team comprised of a physiatrist, pediatrician and pediatric psychiatrist examined the patients. Neurological examination, speech and cognitive evaluation were done. Hearing tests and chromosome studies were performed when needed clinically. All referred children completed K-ASQ questionnaires. Final diagnoses were categorized into specific language impairment (SLI), global developmental delay (GDD), intellectual disability (ID), cerebral palsy (CP), motor developmental delay (MD) or autism spectrum disorder (ASD). Results 72 of the 78 patients were abnormal in the fi nal diagnosis, with a positive predictive value of 92.3%. Th irty (38.4%) of the 78 subjects were diagnosed as GDD, 28 (35.8%) as SLI, 5 (6.4%) as ASD, 9 (12.5%) as MD, and 6 (7.6%) as normal. Forty fi ve of the 78 patients had risk factors related to development, and 18 had a positive family history for developmental delay and/or autistic disorders. Th e mean number of abnormal domains on the K-ASQ questionnaires were 3.6 for ASD, 2.7 for GDD, 1.8 for SLI and 0.6 for MD. Diff erences between these numbers were statistically signifi cant (p

Objective To investigate the intra- and inter-rater reliability of the Korean version of the ABILOCO questionnaire (K-ABILOCO). Methods The original ABILOCO questionnaire was translated into Korean and back-translated into English. Stroke patients (n=30) with hemiplegia were evaluated using the K-ABILOCO at one week interval. At each visit, the physiatrist also evaluated patient performance of the activities described in the K-ABILOCO, and the total logit scores were recorded. The total scores were used to evaluate intraclass correlation (ICC). Test-retest scores and each test scores were compared to obtain the intra- and inter-rater reliability. Results The K-ABILOCO showed good intra-rater correlation at one week interval in both patient and physiatrist evaluations (ICC=0.81, 0.91), respectively. It also showed a high inter-rater correlation between the patient and physiatrist at both the first and second visits (ICC=0.76, 0.84), respectively. Conclusion The K-ABILOCO is a useful tool that may reliably evaluate the locomotion ability in hemiplegic stroke patients.

Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

Objective To identify the clinical characteristics and investigate function related aspects of Korean children with Rett syndrome. Method A total of 26 patients diagnosed as Rett syndrome were clinically observed until the age of five or over. We surveyed past history, developmental history, and presence of typical clinical features of Rett syndrome. Furthermore, we investigated differences in clinical characteristics according to functional status and changes in clinical features related to growth. Results There were no problems related to gestational, perinatal or neonatal history. Only 12 patients had an ultimate head circumference of less than 3 percentile. Developmental regression was definite in all patients. At final assessment, only 14 patients were able to walk. Twenty patients had an epileptic history requiring medication. Sixteen patients with scoliosis showed progression during serial follow-up. The percentage of patients who were able to walk before 16 months was higher in the high function group than the low function group. The age of regression was 5.4 and 4.0 years in the high and low function group respectively, but the difference was not statistically significant. Scoliosis was more severe and seizure onset age was younger in the low function group. Conclusion We investigated 26 clinical characteristics in Korean children with Rett syndrome. Their clinical features change according to age, and we believe such knowledge could be utilized in rehabilitation to minimize their disabilities.