Differences between the Upper Extremity and the Lower Extremity in Reconstruction Using an Anterolateral Thigh Perforator Flap

이상현,서정탁,안태영,홍성민,이효열 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.3

Background: While reconstruction of soft tissue defects is the common purpose, surgical reconstructions of upper extremities and lower extremities have different goals in terms of functional and aesthetic outcomes. The purpose of the current study was to compare and analyze differences between reconstructions of upper extremities and lower extremities using an anterolateral thigh (ALT) flap. Methods: We analyzed 74 patients who underwent reconstructions of upper extremities and lower extremities using an ALT flap from October 2006 to August 2012 (upper extremities, 45 cases; lower extremities, 29 cases). The study focused on the statistical analysis of patient satisfaction according to the donor site of the ALT flap and the timing of a debulking procedure. Results: On the choice of donor site, in the upper extremity reconstruction, flap elevation from the opposite side of the recipient limb was preferred (p = 0.019) because it causes less inconvenience while walking. In the lower extremity reconstruction, flap elevation from the same side of the recipient limb (p = 0.002) was preferred. The debulking procedure performed on the upper extremities at 4 weeks after reconstruction led to better functional results and enhanced patient satisfaction (p = 0.022). In the case of lower extremities, enhanced satisfaction was noted in patients who underwent the procedure at 6 months after reconstruction (p < 0.001). Conclusions: Elevation of the flap in reconstruction reduced inconvenience when performed on the same side of the recipient limb for lower extremities and on the opposite side for upper extremities. In addition, debulking resulted in better satisfaction when performed 4 weeks postoperatively in the upper extremities and 6 months postoperatively in the lower extremities.

Brachial Plexopathy Due to Upper-Extremity Deep Vein Thrombosis: A Case Report

Ju Yeon Woo,Kim Sodam,Choi Byung Chan,최은석,이상지,이숙정,이정수 대한근전도전기진단의학회 2022 대한근전도 전기진단의학회지 Vol.24 No.1

Upper-extremity deep vein thrombosis (DVT) accounts for 1% to 4% of DVT cases. Brachial plexus injury can result from venous distention due to thrombosis in the upper extremity, leading to neurologic deficits. We report a patient diagnosed with brachial plexopathy caused by venous thrombosis in the upper extremity. A 66-year-old female patient with a medical history of Parkinson disease and dementia presented to the emergency department with drowsy mental status. She was diagnosed with pre-renal acute kidney injury with multi-organ dysfunction. On the second hospital day, right upper extremity edema and muscle weakness were observed. On the sixth hospital day, the patient’s overall medical condition improved after conservative treatment, but severe edema was noticed, and muscle weakness did not show significant improvement in the right upper extremity. Computed tomography showed multifocal pulmonary thromboembolism and DVT in the pulmonary arteries, superior vena cava, and popliteal veins. After anticoagulant administration, the swelling subsided, but the weakness in the entire right upper extremity did not improve. Electromyography demonstrated right brachial pan-plexopathy involving the upper, middle, and lower trunks. A follow-up examination showed no significant improvement of muscle strength and function in the right upper extremity at 3 months after the first hospital day.

Effect of robot arm reach training on upper extremity functional movement in chronic stroke survivors: a preliminary study

Ki Hun Cho,Won-Kyung Song 물리치료재활과학회 2019 Physical therapy rehabilitation science Vol.8 No.2

Objective: The purpose of this study was to investigate the effect of robot arm reach training on upper extremity functional movement in chronic stroke survivors. Design: One group pretest-posttest design. Methods: Thirteen chronic stroke survivors participated in this study. Robot arm reach training was performed with a Whole Arm Manipulator (WAM) and a 120-inch projective display to provide visual and auditory feedback. During the robotic arm reach training, WAM provided gravity compensation and assist-as-needed (AAN) force according to the robot control mode. When a participant could not move the arm toward the target for more than 2 seconds, WAM provided AAN force to reach the desired targets. All patients participated in the training for 40 minutes per day, 3 times a week, for 4 weeks. Main outcome measures were the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT) and Box and Block Test (BBT) to assess upper extremity functional movement. Results: After 4 weeks, significant improvement was observed in upper extremity functional movement (FMA: 42.15 to 46.23, BBT: 12.23 to 14.00, p<0.05). In the subscore analysis of the FMA upper extremity motor function domains, significant improvement was observed in upper extremity and coordination/speed units (p<0.05). However, there were no significant differences in the ARAT. Conclusions: This study showed the positive effects of robot arm reach training on upper extremity functional movement in chronic stroke survivors. In particular, we confirmed that robot arm reach training could have a positive influence by leading to improvement of motor recovery of the proximal upper extremity.

Effect of robot arm reach training on upper extremity functional movement in chronic stroke survivors: a preliminary study

Cho, Ki Hun,Song, Won-Kyung korean Academy of Physical Therapy Rehabilitation 2019 Physical therapy rehabilitation science Vol.8 No.2

Objective: The purpose of this study was to investigate the effect of robot arm reach training on upper extremity functional movement in chronic stroke survivors. Design: One group pretest-posttest design. Methods: Thirteen chronic stroke survivors participated in this study. Robot arm reach training was performed with a Whole Arm Manipulator (WAM) and a 120-inch projective display to provide visual and auditory feedback. During the robotic arm reach training, WAM provided gravity compensation and assist-as-needed (AAN) force according to the robot control mode. When a participant could not move the arm toward the target for more than 2 seconds, WAM provided AAN force to reach the desired targets. All patients participated in the training for 40 minutes per day, 3 times a week, for 4 weeks. Main outcome measures were the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT) and Box and Block Test (BBT) to assess upper extremity functional movement. Results: After 4 weeks, significant improvement was observed in upper extremity functional movement (FMA: 42.15 to 46.23, BBT: 12.23 to 14.00, p<0.05). In the subscore analysis of the FMA upper extremity motor function domains, significant improvement was observed in upper extremity and coordination/speed units (p<0.05). However, there were no significant differences in the ARAT. Conclusions: This study showed the positive effects of robot arm reach training on upper extremity functional movement in chronic stroke survivors. In particular, we confirmed that robot arm reach training could have a positive influence by leading to improvement of motor recovery of the proximal upper extremity.

가상현실훈련과 위팔 기능적 전기자극이 만성 뇌졸중 환자의 위팔 근력, 능동관절운동과 기능에 미치는 효과

김동훈,김경훈 대한통합의학회 2020 대한통합의학회지 Vol.8 No.2

Purpose : The purpose of the present study is to examine the effects of VR training with FES on improving the muscle strength, AROM, and function of the upper limb joints in patients with chronic stroke. Methods : The present study makes use of a pre-post control group design. Thirty patients with chronic stroke were randomly assigned to two groups according to treatment method – the VRFES group and the control group. The VRFES group received 15 minutes of VR training and 15 minutes of FES treatment. The control group received 15 minutes of conservative physical therapy and 15 minutes of VR training. All subjects received 30 minutes of treatment, three times a week, for eight weeks, which amounted to 24 sessions of training. The muscle strength, AROM, and function of the upper extremities were measured before the training and eight weeks after. Upper limb muscle strength was tested using the Digital Manual Muscle Tester while AROM was measured using the Digital Dual Inclinometer. The clinical assessment tools for upper extremity function included the use of the Manual Function Test and the Jebsen-Taylor Hand Function Test. Result : Both groups exhibited great improvements in muscle strength and upper extremity function during the intervention period. The VRFES group exhibited a significant difference in muscle strength, AROM, and function of the upper extremities in comparison with the control group(p<.05). Our results reveal that VRFES is more effective for the muscle strength, AROM, and function of the upper extremities in patients with chronic stroke. Conclusion : VRFES treatment will be used as an important intervention for improving the muscle strength, AROM, and function of the upper extremities in patients with chronic stroke and achieving the functional recovery of the upper extremities.

Original Article : Relationships between upper extremity performance and unified Parkinson`s disease rating scale-motor exam

( Won Jeong Hwang ),( Su Jin Hwang ),( Kyoungsuk Lee ),( Yi Jung Chung ) 물리치료재활과학회 2013 Physical therapy rehabilitation science Vol.2 No.2

Objective: Clinical measures that quantify upper extremity function are needed for the accurate evaluation of patients and to plan an intervention strategy. The purpose of this study was to examine the relationship between the Unified Parkinson`s Disease Rating Scale (UPDRS)-Motor Exam and upper extremity performance as a quantifying clinical tool of upper extremity function in persons with Parkinson`s disease. Design: Cross-sectional study. Methods: Thirty-two idiopathic Parkinson`s Disease persons participated in this study. To investigate the relationship between the UPDRS-motor exam, Box and Block test (BBT), and Action Research Arm Test (ARAT) by two physical therapists. The examination took up to 1 hour, and the participants were invited to rest between each clinical measure in order to minimize the effects of fatigue. Clinical measures were assessed while the subjects were in the “on” phase of their medication cycle, generally 1-3 hour after taking their anti-Parkinson`s medications. Results: In more affected side, the UPDRS-motor exam was significantly negative correlated with the BBT (p<0.05) but it was not significantly correlated with the ARAT. In less affected side, only positively correlation was significantly shown between BBT and ARAT (p<0.05). On the other hand, between BBT and ARAT were not significantly correlated with the UPDRS-motor exam. Conclusions: The UPDRS-motor exam is effective tool which was significantly correlated with manual dexterity in more affected upper extremity. But The UPDRS-motor exam is not effective tool in less affected upper extremity.

Action observation training enhances upper extremity function in subacute stroke survivor with moderate impairment: a double-blind, randomized controlled pilot trial

( Chang Heon Kim ),( Dae Hyouk Bang ) 대한물리의학회 2016 대한물리의학회지 Vol.11 No.1

PURPOSE: This study’s aim was to investigate the effects of an action observational training in subactue stroke patients with moderate impairment. METHODS: 22 participants (men=13, women=9) with hemiparesis were randomly assigned to action observation training group or task-oriented training group. Patients in both group underwent a patient-specific multidisciplinary rehabilitation program. Participants in the action observation group (mean age, 62.78±9.85) were asked to watch the video scene, in the knowledge that they would then attempt to perform the same movement task after watching. The control group (mean age, 61.49±8.64) practiced the same tasks, without watching the video. To evaluate upper limb function, the upper extremity part of the Fugl-Meyer Assessment upper extremity and the Box and Block Test were used. The modified Barthel index was used to assess ADLs, and the modified Ashworth scale were used to assess spasticity in the upper extremity. RESULTS: The action observational training group exhibited greater changes in the Fugl-Meyer assessment upper extremity (P<0.05; 95% CI, 0.929 - 6.403), the Box and Block test (P<0.05; 95% CI, 0.086 - 5.913), and the modified Barthel index (P<0.01; 95% CI, 2.483 - 12.627) between groups. And the modified Ashworth scale (P>0.05; 95% CI, -0.402 to 0.624) did not show significantly different between groups. CONCLUSION: These findings suggest that action observational training may be more helpful to improve upper-extremity function than physical training only in subactue patients with moderate impairment after stroke.

초기 뇌졸중 환자에서 체간 제한과 결합된 로봇 보조 상지 훈련의 효과: 무작위 대조 예비 연구

정경만 ( Kyeoung-man Jung ),정유진 ( Yu-jin Jung ) 대한신경치료학회 2017 신경치료 Vol.21 No.3

Purpose This study was to determine the effect of robot-assisted upper limb training combined with trunk restraint in early stroke patient. Methods Sixteen inpatients were randomly allocated into the experimental group (n=8), who received robot-assisted upper limb training combined with trunk restraint, and the control group (n=8), who received a robot-assisted upper limb training. Each intervention consisted of a 30 min session once a day, five times a week, for four weeks. To measure the functions of the upper limbs and performance capacities in the activities of daily living, the Fugl-Meyer assessment-upper extremity (FMA-UE), Manual function test (MFT), Korean-modified Barthel index (K-MBI) were used before after the intervention. Results The robot-assisted upper limb training combined with trunk restraint group and control group improved more significantly after intervention in FMA, MFT, K-MBI (p<.05). However, robot-assisted upper limb training combined with trunk restraint group was more effective than control group in increasing the FMA, MFT, K-MBI (p<.05). Conclusion These results suggest that robot-assisted upper limb training combined with trunk restraint is more helpful to improve upper-extremity function than robot-assisted upper limb training only early stroke patients.

뇌졸중 환자군을 대상으로 한 작업대 높이가 수행도에 미치는 영향에 대한 연구

유영열(Young?Yul Yu),김희수(Hee?Soo Kim) 대한인간공학회 2009 大韓人間工學會誌 Vol.28 No.4

Our study goal is to find out how the table height influences functional ability of upper extremity to patients with stroke when they are having therapy. In this study, we tested forty patients with stroke at the age of over sixty-five who do not have visual, auditory disability and have no difficulty in communicating and moving things by using upper extremity. And they were able to pinch grip in hospital. We used occupational table for occupational therapy as Lab Materials. We also used cube and pegs board to test upper extremity functional ability. We used occupational table for occupational therapy as Lab Materials and we used cube and pegs board to test upper extremity functional ability. The method is that we measured the recommended table height that takes the subjects' size into consideration and patients' preferred table height and therapists' preferred table height and we applied them and then we have done a comparative analysis and set significance level(p<0.05). As the result, we found the Statistically significant between the recommended height and the other two, which are patients' preferred height and therapists' preferred height. We also discovered that functional ability of upper extremity varies significantly depending on each table height. We came to a conclusion that the table height had effects on the upper extremity functional ability of patients with stroke who are over sixty-five years old. It is therefore considered that the proper table height is important to improve upper extremity functional ability of patients with stroke for their physical therapy.

강제유도운동치료가 뇌졸중 환자의 상지 기능 및 일상생활활동에 미치는 영향

최유임,정민예,정보인,유은영 대한작업치료학회 2009 대한작업치료학회지 Vol.17 No.1

목적 : 강제유도운동치료가 뇌졸중 환자의 상지 기능 및 일상생활활동의 수행 능력에 미치는 효과를 알아보는 것이었다.연구방법 : 연구 대상은 뇌졸중으로 인한 편마비 진단을 받은 3인이었으며 개별실험 연구방법(single-subject experimental research design) 중 ABA 설계를 사용하였다. 강제유도운동치료는 12일 동안 팔걸이와 보조기로 건측을 깨어있는 시간의 84.9% 동안 억제하고, 6시간 동안 환측을 집중적으로 치료하는 방법으로 실시하였다. 대상자의 상지 기능은 기초선 과정(5회)과 치료 과정(12회), 기초선 회귀 과정(5회) 동안 상자와 나무토막 검사 그리고 수직선 그리기 검사를 사용하여 측정하였다. 일상생활활동의 수행 능력은 강제유도운동치료 전․후에 Assessment of Motor and Process Skills(AMPS)를 사용하여 측정하였다. 결과 : 대상자의 상지 기능은 기초선 기간보다 치료 기간 동안에 현저히 향상되었으며 이 향상은 기초선 회귀 과정 동안에도 계속 지속되었다. 일상생활활동의 수행 능력은 대상자 3인 중 2인에서 유의하게 향상되었다. 결론 : 강제유도운동치료는 뇌졸중으로 인한 편마비 환자의 환측 상지 기능을 향상시키는데 효과적이며, 우세손이 환측인 대상자들의 일상생활활동의 수행 능력을 향상시키는 것으로 나타났다. 앞으로의 연구에서는 많은 뇌졸중 환자를 대상으로 강제유도운동치료가 일상생활활동에 미치는 영향에 대하여 우세측과 비우세측에 따른 환측 부위를 고려한 분석이 이루어져야 할 것이며, 강제유도운동치료 효과의 지속성에 대해서 연구되어야 할 것이다. Objective : The purpose of this study was to investigate the effect of constraint-induced movement therapy (CIT) on the affected upper extremity function and activities of daily living (ADL) for three stroke patients who were admitted into a university affiliated general hospital.Methods : This study was a single-subject experimental research with ABA design, ʻAʼ being the baseline phase and 'B' the experimental phase. The CIT consisted of a restraint of movement of the unaffected upper extremity by placing it in a sling and resting splint for 84.9% of walking hours for 12 consecutive days, combined with 6 hours/day of intensive training of the affected upper extremity. The motor function of each subject's upper extremity was assessed using a Box and Block Test and a Vertical Line Drawing Test. Assessment of each subjectʼs Motor and Process Skills (AMPS) was applied for evaluation of ADL perform-ance ability and took place during the intial and second baseline phases.Results : The average of each of the three subjects' upper extremity function tests improved during the ex-perimental phase more than in the initial baseline phase. Also the test averages of each subject during the second baseline phase improved more than during the initial baseline phase. There was also a significant im-provement in the AMPS motor skills of subject 1 and 3, whose affected areas were their dominant hands before their illness. However, the AMPS motor skills of subject 2, whose unaffected area was the subjectʼs dominant hand, did not show significant changes. Conclusion : The results of this study indicate that the CIT had a positive effect on improving the affected upper extremity function in stroke patients. Also, the improved motor functions led to an increase in per-formance ability of ADL in the subjects whose affected sides were their premorbid dominant upper extremity.