• Journal of Yeungnam Medical Science
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• v.39 no.3
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• pp.181-189
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• 2022

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative condition characterized by loss of motor neurons, resulting in motor weakness of the limbs and/or bulbar muscles. Pain is a prevalent but neglected symptom of ALS, and it has a significant negative impact on the quality of life of patients and their caregivers. This review outlines the epidemiology, clinical characteristics, underlying mechanisms, and management strategies of pain in ALS to improve clinical practice and patient outcomes related to pain. Pain is a prevalent symptom among patients with ALS, with a variable reported prevalence. It may occur at any stage of the disease and can involve any part of the body without a specific pattern. Primary pain includes neuropathic pain and pain from spasticity or cramps, while secondary pain is mainly nociceptive, occurring with the progression of muscle weakness and atrophy, prolonged immobility causing degenerative changes in joints and connective tissue, and long-term home mechanical ventilation. Prior to treatment, the exact patterns and causes of pain must first be identified, and the treatment should be tailored to each patient. Treatment options can be classified into pharmacological treatments, including nonsteroidal anti-inflammatory drugs, antiepileptic drugs, drugs for cramps or spasticity, and opioid; and nonpharmacological treatments, including positioning, splints, joint injections, and physical therapy. The development of standardized and specific assessment tools for pain-specific to ALS is required, as are further studies on treatments to reduce pain, diminish suffering, and improve the quality of life of patients with ALS.

• The Journal of Korean Physical Therapy
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• v.22 no.4
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• pp.29-33
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• 2010

Purpose: The purpose of this study was to assess and compare the reliability of the Modified Tardieu Scale (MTS) with the Modified Ashworth Scale (MAS) in patients with hemiplegia. Methods: Two experienced physical therapists examined twenty six patients (17 male and 9 female) with an age range of 19-83 years (mean=51.9 SD=15.2). They assessed the elbow flexor/extensor muscle spasticity in the affected side. Interand intra-rater reliability of the MAS and the MTS were calculated using kappa statistics. Intraclass correlation coefficient (ICC) was calculated to determine the inter- and intra-rater reliability of the angle of muscle reactions (R2-R1). Results: The intra-rater reliability of the MAS (K=0.39-0.55) and MTS (K=0.33-0.55) was fair to moderate. The inter-rater reliability was significantly higheras measured with MTS (K=0.54-0.66) in comparison with MAS (K=0.52). Intra-rater reliability of R2-R1 was moderate to almost perfect (ICC=0.52-0.86), and inter-rater reliability was substantial (ICC=0.74-0.76). Conclusion: The MTS provides higher inter-rater reliability compared with the MAS in hemiplegia patient analysis, but intra-rater reliability of both scales was not significantly different. Thus further research is needed to examine not only reliability, but also validity of these measurement systems.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.2
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• pp.105-108
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• 2021

Background : Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a rare, autosomal recessive metabolic disorder which is caused by genetic mutations that disrupt the urea cycle. It is characterized by variable clinical presentation and the age of onset. Patients may present with gait disturbance and progressive paraplegia and muscle tightness in the lower extremities. The use of botulinum toxin in metabolic disease has rarely been discussed. We describe a case of a 14-year-old-boy with HHH syndrome, who presented with a several - month history of gait disturbance and lower extremity weakness. Case presentation : A 14-year old male had a history of recurrent upper respiratory tract infections, occasional vomiting, loss of appetite, and general weakness, all of which started since he was 10 months old. He was diagnosed with HHH syndrome at one year of age. At the age of 14, he was referred for the assessment and treatment of his gait disturbance and aggravated weakness of the lower extremities. Brain MRI, electrodiagnostic study and blood test were performed to exclude any lesions related to neurologic dysfunction. Botulinum toxin type A were injected into muscles of adductor longus, adductor magnus, lateral and medial hamstring, and lateral and medial gastrocnemius muscle heads under needle electromyography guidance to reduce lower limb spasticity. Intensive physical therapy including gait training and stretching exercise of adductor and calf muscles were also provided. After intensive physical therapy and botulinum toxin injection to reduce lower limb spasticity, he was able to ambulate for 20 meters independently without any walking aids. There were no adverse events after the injection. Conclusion : Botulinum toxin injection is a safe and effective therapy for patients with HHH syndrome who suffer from gait disturbance.

• PNF and Movement
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• v.20 no.1
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• pp.31-39
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• 2022

Purpose: The purpose of this study was to identify the effects of general exercise after blood flow restriction on trunk muscles thickness in children with spastic cerebral palsy. Methods: Twenty children with cerebral palsy were assigned randomly to an experimental (n = 10) or a control (n = 10) group. The experimental group performed general exercise after blood flow restriction, while the control group performed general exercise alone. The study used an ultrasonic instrument to measure trunk muscles thickness. The Wilcoxon signed-rank test was used to determine differences before and after treatment, and the Mann-Whitney U test was used to determine differences between treatment groups. Results: From a comparison within the groups, the experimental and control groups showed significant difference in trunk muscle thickness after the experiment (p < 0.05). In a comparison between the two groups, the experimental group showed more significant difference in trunk muscle thickness than the control group (p < 0.05). Conclusion: Based on these results, general exercise after blood flow restriction effectively improves trunk muscle thickness in children with cerebral palsy.

• Journal of Biomedical Engineering Research
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• v.22 no.1
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• pp.49-58
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• 2001

A new scale named LCL(Logically Classified Level) has been developed to judge the status of the spasticity quantitatively implementing a pcndulum test in this study. Total 30 parameters have been used to develop the new scale. One representative parameter that can represent the dominant characteristics of spasticity has been chosen through statistical analysis. 20 parameters among 30 parameters uscd in the statistical analysis were newly developed and 10 parameters were from previous studies. The new 20 parametcrs were developed using combinations of pcndulum test characteristics. ie anglc, angular velocity. musclo midel. and EMG. 11 parameters among 30 parameters have showed strong correlations each other, Finally. L11 that showed consistency at every case has been chosen to be a representative parameter among the 11 parameters. 28 patients data were separated into 4 groups. A regression equation to predict the trend of patients of L11 has been made. The paramcter L11 was tested to prove its usabilitics for various cases of patients. The new LCL scale is expected to be a quantitative scale, and to replace the MAS(Modified Ashworth Scale) that is not a quantitative scale. Especially it is also expected that the new scale could be used to plan a treatmcnt period. methods, and intensity. as it can evaluate the status of patient's in detail.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.5 no.2
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• pp.61-72
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• 2007

INTRODUCTION: Local heat and cold application has been frequently used as means of muscle relaxation and blood circulation or reinforcing muscle strength, relaxing muscle tension in clinical situation. In particular, it has been known that long-term heat and cold application for relaxing muscle tension inhibits muscle spasticity or tension. But, it has been rarely reported that what influences of heat and cold application on activation of muscle action potential. Therefore, this study aims to analyze surface temperature and electromyography activities according to the heat and cold application. METHODE: Subjects of this research were 10 normal men and women (5 men, 5 women). Hot pack and cold pack was applied to vastus medialis muscle of thigh and rectus femoris muscle for 20 min. Surface temperature of vastus medialis muscle and rectus femoris muscle was measured, knee joint of subjects was in $45^{\circ}$ flexion, sitting on a chair, maximal isometric contraction was induced, surface electromyography (sEMG) signals were collected and root mean square (RMS) and median frequency (MOF) were analyzed. All measurements were conducted before and immediately after experiment, 10 min., 20 min. and 30 min. after experiment. Data were analyzed with SPSS 12.0 program, comparison of changes in superficial temperature and sEMG signals through repeated measurement was conducted with repeated measures ANOVA and significance level $\alpha$ was 0.05. RESULTS: Changes of surface temperature of vastus medialis muscle according to cold application were radically decreased immediately after application, but it was recovered after 30 min. of application and it showed significant difference (F4. 36=72.216, P<0.001). Surface temperature of rectus femoris also showed radical decrease immediately after application, but it was recovered after 30 min. of application and showed significant difference (F4. 36=88.930, P<0.001). Changes of surface temperature of vastus medialis muscle according to heat application were radically increased immediately after application, but it was recovered after 30 min. of application and it showed significant difference (F4. 36=27.267, P<0.001). Surface temperature of rectus femoris also showed radical decrease immediately after application, but it was recovered after 30 min. of application and showed significant difference (F4. 36=19.774, P<0.001). Changes of sEMG by heat and cold application were no statistical difference. Surface temperature of skeletal muscle after heat and cold application showed significant change for 30 min., but it was found that increase or decrease of surface temperature had not great influence on sEMG activities.

• The Korean Journal of Physiology
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• v.19 no.2
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• pp.155-160
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• 1985

Dantrolene sodium(DS) is a long acting skeletal muscle relaxant which has been successfully used to control muscle spasticity in patients with various neurological disorders. However, its use is associated with hepatotoxicity. Tissue sulfhydryl group has many important roles for cellular integration and glutathione serves as a substrate for the detoxification metabolism. The purpose of this study were to investigate the effect of DS on tissue sulfhydrl group and glutathione content. Foully albino rats were divided into two groups ; saline treated (control) and DS treated groups. DS dissolved in saline was administered orally. All rats were sacrificed after 7. 14. 21 and 28 days of DS ana saline treatment by dacapitation ana liver was removed for the enzyme preparation. Total and nonprotein sulfhydryl were measured by the method of Sedlak and Lindsay (1968). Total glutathione content was assayed according to the method described by Tietze (1969) and glutathione reductase was assayed according to the method of Racker (1955), The results obtained are summarized as follows : DS administration significantly depressed the total, protein and nonprotein sulfhydryl content in liver. There were significant reduction of both total glutathione content and glutathione reductase activity in liver. On the basis of the above results it may be speculated that the toxicity of DS are well correlated with tissue sulfhydryl content and glutathione reductase activity.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.236-239
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• 2010

Objective : The purpose of this study was to investigate the effectiveness and outcome of selective musculocutaneous neurotomy (SMcN) for spastic elbow. Methods : We retrospectively reviewed the medical records of 14 patients with spasticity of their elbows. The patients were selected using clinical and analytical scales, as well as nerve block tests, for assessment. Their mean age was 37.29 years (range, 19-63 years). SMcN was performed for these patients, and the mean follow-up period was 30.71 months (range, 19-54 months). Results : The modified Ashworth scale (MAS) scores recorded before and after the SMcN showed that the patients' mean preoperative MAS score of $3.28{\pm}0.12$ was improved to $1.71{\pm}0.12$, $1.78{\pm}0.18$, $1.92{\pm}0.16$ and $1.78{\pm}0.18$ at postoperative 3, 6, 12 months and last follow-up, respectively. On the basis of a visual analogue score ranging from 0-100, the patients' mean degree of satisfaction score was $65.00{\pm}16.52$ (range, 30-90). Conclusion : We believe that SMcN can be a good and effective treatment modality with low morbidity in appropriately selected patients who have localized spastic elbow with good antagonist muscles and without joint contracture.

• Journal of Korean Physical Therapy Science
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• v.1 no.1
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• pp.175-185
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• 1994

The purpose of this study was to evaluate and compare the biceps muscles activity at the different angle and direction of the base of support on sitting position in hemiplegic patients. The biceps muscles activity was measured at the $0^{\circ},\;10^{\circ}$ of posterior tilt, $10^{\circ}$ of anterior tilt, $10^{\circ}$ of affected side tilt and $10^{\circ}$ of sound side tilt of the base of support by EMG biofeedback (MYOMED 432. ENLAF NONIUS CO.) In this study, 24 out-patients were evaluated who were treated at Yonsei University Medical College Rhabilitation Hospital. This study was carried out from December 5. 1993 to March 30. 1994. In order to determine the statistical significance of result, the ANOVA, and t-test were applied at the 0.05 level of significance. The results were as follows : 1. The biceps muscles activity of the sound side was no significantly difference at the different angle and direction of the base of support on sitting position(p>0.05). 2. The biceps muscles activity of the affected side was significantly increased at the 100 of sound side tilt and $10^{\circ}$ of posterior tilt of the base of support on sitting position(p<0.05). 3. There was no significantly difference in the change of the biceps muscles activity of the affected side between the affected group and the intact group of propriocetive sense(p>0.05). 4. The change of the biceps muscles activity of the affected side was significantly higer in the group of G 2 spasticity compared to that of G 1, G 1+ spasticity(p<0.05). These results showed that the biceps muscles activity of affected side was significantly increased when the base of support was tilted toward the sounde side and posterior direction on sitting position. In order to prevent the increment of biceps muscle activity, the patients must avoid to sit toward sound side and posterior tilt.

• Biomolecules & Therapeutics
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• v.28 no.4
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• pp.302-310
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• 2020

Botulinum toxins are neurotoxic modular proteins composed of a heavy chain and a light chain connected by a disulfide bond and are produced by Clostridium botulinum. Although lethally toxic, botulinum toxin in low doses is clinically effective in numerous medical conditions, including muscle spasticity, strabismus, hyperactive urinary bladder, excessive sweating, and migraine. Globally, several companies are now producing products containing botulinum toxin for medical and cosmetic purposes, including the reduction of facial wrinkles. To test the efficacy and toxicity of botulinum toxin, animal tests have been solely and widely used, resulting in the inevitable sacrifice of hundreds of animals. Hence, alternative methods are urgently required to replace animals in botulinum toxin testing. Here, the various alternative methods developed to test the toxicity and efficacy of botulinum toxins have been briefly reviewed and future perspectives have been detailed.