Efficacy of Decompression and Fixation for Metastatic Spinal Cord Compression : Analysis of Factors Prognostic for Survival and Postoperative Ambulation

Park, Jin-Hoon,Rhim, Seung-Chul,Jeon, Sang-Ryong The Korean Neurosurgical Society 2011 Journal of Korean neurosurgical society Vol.50 No.5

Objective : The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC. Methods : We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo- or radiation therapy, were analyzed retrospectively. Results : Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) ($p$=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; $p$=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; $p$=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; $p$=0.038) were prognostic of postoperative ambulation. Conclusion : We found that postoperative ambulation and preoperative high Tokuhashi score were significantly associated with longer patient survival. In addition, preoperative hip flexion power greater than grade III was critical for postoperative ambulation.

이분 척추 환자들의 보행

방문석,한태륜,김진호,이경우,이인식 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.4

Assessment of Lower Limb Motor Function, Ambulation, and Balance After Stroke

Yoo Yeun Jie,임성훈 대한뇌신경재활학회 2022 뇌신경재활 Vol.15 No.2

Restoration of ambulation is important for stroke patients. Valid and reliable methods are required for the assessment of lower limb functional status. We reviewed the psychometric properties of methods employed to assess lower extremity motor function, ambulation, and balance, with a focus on stroke patients. We define “motor function” as the ability to produce bodily movements when the brain, motor neurons, and muscles interact. “Ambulation” is defined as the ability to walk with or without a personal assistive device, and “balance” as the ability to maintain stability (without falling) during various physical activities. The Motricity Index and Fugl-Meyer Assessment of Lower Extremities assess the motor function of the lower limbs. The Functional Ambulation Category, 10-m Walk Test, and 6-minute Walk Test assess ambulation. The Berg Balance Scale, Timed Up and Go Test, Functional Reach Test, and Trunk Impairment Scale explore balance. All these tests exhibit high-level validity and have good inter-rater and test-retest reliabilities. However, only 3 methods have been formally translated into Korean. The methods discussed here can be used for standardized assessment, personalized goal setting, rehabilitation planning, and estimation of therapeutic efficacy.

Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

Edward R. Mariano,Seshadri C. Mudumbai,Toni Ganaway,T. Edward Kim,Steven K. Howard,Nicholas J. Giori,Cynthia Shum 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.1

Background: Adductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients’ physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation. Methods: We conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status. Results: Data from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th–90th percentiles]) compared to femoral patients (0 [0–5] vs. 4 [0–10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = −2.6; 95% CI: −4.5, −0.8, P = 0.01) with R2 = 0.1. Conclusions: Adductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.

만성 편마비 환자의 modified Emory Functional Ambulation Profile의 임상 적용

김성렬 ( Seong Yeol Kim ),이제훈 ( Je Hoon Lee ),안승헌 ( Seung Heon An ) 대한물리의학회 2010 대한물리의학회지 Vol.5 No.4

Purpose:The examine the reliability and validity of the modified Emory Functional Ambulation Profile(mEFAP) for assessing gait function in chronic stroke patients. Methods:A total of 45 stroke patients, who had a stroke more than 6 months, participated in the study. Reliability was determined by Intra-class Correlation Coefficient (ICC3,1), including Bland and Altman method (Standard Error of Measurement: SEM, Small Real Differences: SRD). Validity was examined by correlating results to the gait ability(mEFAP, Modified Motor Assessment Scale-Gait(MMAS-G), Scandinavian Stroke Scale- Gait(SSS-G), Functional Ambulation Category(FAC), 10m Waking Test(10m WT)), and Fugl Meyer-Lower/ Extremity(FM-L/E), Berg Balance Scale(BBS). Results:Inter-rater reliability for the total mEFAP was High(ICC2,1=998), and absolute reliability were excellent (SEM: 1.75, SRD: 4.85). Subjects without assistance factor performed better on all tests than did subjects who had stroke. There were significant correlations between the mEFAP and MMAS-G, SSS-G, FAC(r=-.66∼-79), 10 m WT(r=-.86), and FM-L/E, BBS(r=-.72∼-78), indicating good validity. Increased times on the mEFAP correlated with poor performance on the gait ability, motor function of lower extremity, BBS and slow gait speeds on the 10 m WT in stroke patients. Conclusion:The mEFAP can be administered easily and comprehensively. It is a reliable gait assessment tool for patients with stroke and correlated with known of function, the mEFAP may be a clinically useful measure of ambulation.

만성 뇌졸중 환자의 지역사회 보행: 다섯 보행 조건의 비교

황은옥,오덕원,김선엽,Hwang, Eun-Ok,Oh, Duck-Won,Kim, Suhn-Yeop 대한물리치료과학회 2009 대한물리치료과학회지 Vol.16 No.1

Background: Community ambulation has been recently recognized as one of the most essential factors of activities of daily living in patients with post-stroke hemiparesis. This study aimed to compare walking velocity and step number in 5 community situations in patients with post-stroke hemiparesis. Methods: Ten chronic stroke patients volunteered for this study. The main variables analyzed were walking speed and step number, and these were measured in 5 different community situations: a physical therapy room, a parking lot, a bank, a crosswalk, and a hospital lobby. The measurements obtained for walking in the physical therapy room were measured using a 10m walk test and were used as baseline data for comparison with each option. The ambulation distance was set at 300m for the parking lot and the bank and 150m for the crosswalk and hospital lobby. For data analysis, walking speed and step number were standardized with the distance options of each ambulation. Results: Compared to the walking speed in the physical therapy room, those in the other situations, except for the parking lot, were significantly different (p<.05). Moreover, there were significant differences in the speeds between the bank and the parking lot and between the parking lot and the crosswalk (p<.05). Compared to the step number in the physical therapy room, those in all situations except for the crosswalk were significantly different (p<.05). Further, there was a significant difference in the step number between the bank and the crosswalk (p<.05). Conclusion: The walking ability of patients with hemiparesis in real environments within a community could be different from that in a physical therapy room. Therefore, the evaluation of walking should be performed in a variety of community situations.

Orthostatic Intolerance Ambulation in Patients Using Patient Controlled Analgesia

( Kwang Ok Park ),( Yoon Young Lee ) 대한통증학회 2013 The Korean Journal of Pain Vol.26 No.3

Background: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose. (Korean J Pain 2013; 26: 277-285)

Orthostatic Intolerance Ambulation in Patients Using Patient Controlled Analgesia

박광옥,이윤영 대한통증학회 2013 The Korean Journal of Pain Vol.26 No.3

Background:Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods:OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results:Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions:The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

Orthostatic Intolerance Ambulation in Patients Using Patient Controlled Analgesia

Park, Kwang Ok,Lee, Yoon Young The Korean Pain Society 2013 The Korean Journal of Pain Vol.26 No.3

Background: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

Relationship between straight and curved walking abilities among inpatients in the subacute phase according to walking independence level

Kazuya Fujii,Masaki Kobayashi,Miyuki Sato,Yasuyoshi Asakawa 물리치료재활과학회 2018 Physical therapy rehabilitation science Vol.7 No.2

Objective: This study was performed to examine differences in the association between straight and curved walking abilities of inpatients in the subacute phase and walking independence level. Design: Cross-sectional study. Methods: Subjects were divided into an independent group and a supervised group (n=10 each) by walking independence level within the ward decided by physical therapists. Inclusion criteria comprised the ability to ambulate independently within the ward, regardless of the use of walking aids. Straight walking abilities (walking velocity, stride length, and cadence) were evaluated using the 5-meter walk test. Curved walking abilities were evaluated using the Figure-of-8 Walk Test (F8W) and the 3-meter zigzag walk test (3ZW). Differences in associations between straight and curved walking abilities of inpatients were examined by calculating correlation coefficients between straight and curved walking abilities. Results: Age, walking velocity, stride length, F8W and 3ZW varied markedly between independent and supervised groups. In the independent group, F8W and 3ZW correlated significantly with walking velocity and cadence (p<0.05). In the supervised group, F8W correlated significantly with walking velocity and stride length (p<0.05), but 3ZW did not correlate significantly with straight walking abilities. Conclusions: The association between straight and curved walking abilities varied between inpatients who could ambulate independently and inpatients requiring supervision for ambulating. These differences may depend on skill on straight and curved walking abilities. There is a possibility that curved walking exercise is necessary for supervised group.