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Biomedical subjects

K H Kong

Publications and source records attributed to K H Kong.

At least 19 recordsLinked to original sources
PubMed2006

Complete semimembranosus rupture following therapeutic stretching after a traumatic brain injury.

Acute hamstring rupture is an uncommon event often occurring during high impact sports. Such events have not been previously reported during neurological rehabilitation. This case report describes a 30 year-old Chinese male presenting in a minimally responsive state 5 years after a severe traumatic brain injury. He was tetraplegic and bed-bound with spasticity involving all four limbs and flexion contracture of the right knee. During an episode of inpatient rehabilitation, he developed acute swelling and bruising of the posterior proximal thigh region associated with fever, tachycardia and diaphoresis. MRI showed a large soft tissue rim-enhancing mass in the right proximal hamstring muscle. During surgical exploration, complete rupture of the right semi-membranosus muscle was found without evidence of pus. The possible causative factors of hamstring rupture in this subject and a brief literature review are discussed. To the authors' knowledge, this is the first such reported case.

Acute Disease↗
PubMed2006

Health-related quality of life among chronic stroke survivors attending a rehabilitation clinic.

INTRODUCTION: To assess health-related quality of life (HRQOL) among chronic stroke survivors and factors associated with it. METHODS: Cross-sectional survey study of patients who had survived one year or more after a stroke. Subjects consisted of stroke patients attending the outpatient clinic of a rehabilitation centre. HRQOL was assessed using the Medical Outcomes 36-Item Short-Form Health Survey (SF-36), functional status using the Modified Barthel Index (MBI), and mood using the Beck's Depression Inventory (BDI). RESULTS: A total of 100 patients (63 men and 37 women, mean age 60.7 +/-10.8 years) were interviewed at an average of 22.2 +/-14.5 months post-stroke. The mean MBI was 88.9 +/-17.9, and the prevalence of depression 24%. 50 percent of patients needed varying degrees of care for their activities of daily living. The SF-36 scores of the patients were comparable to that of the general population except for the domain of physical function, which was much lower (23.9 versus 83.4). Age, sex, post-stroke duration, MBI score and side of hemiplegia were not associated with HRQOL. Depressed patients however had significantly lower SF-36 scores across all domains except for that of physical function and bodily pain (p-value is less than 0.001). CONCLUSION: A significant proportion of chronic stroke survivors attending the rehabilitation clinic continue to face limitations in their physical activities. In addition, almost 30 percent of these survivors have depression that affects their HRQOL adversely.

Activities of Daily Living↗
PubMed2003

Acquired heterotopic ossification in the settings of cerebral anoxia and alternative therapy: two cases.

Acquired Heterotopic Ossification (HO) has been well described in the literature as a recognized complication following spinal cord injury, traumatic brain injury and joint arthroplasty. Commonly, large proximal limb joints are affected. The underlying mechanisms for ectopic bone formation remain poorly elucidated. Post-stroke hemiplegia as a cause of neurogenic HO is rare, and no published reports of HO occurring after anoxic brain injury in adults have been documented. This study reports two unusual cases of acquired HO: (1) Polyarticular HO involving the ankle joint in a 24-year-old Chinese female who suffered severe anoxic encephalopathy following near drowning which resulted in persistent vegetative state; and (2) Elbow HO in chronic post-stroke hemiplegia occurring as a complication of alternative therapy following repeated forceful manipulation by a traditional practitioner in a 46 year-old male.

Adult↗
PubMed2003

Urinary incontinence after traumatic brain injury: incidence, outcomes and correlates.

OBJECTIVES: To document the incidence and outcome of urinary incontinence (UI) and urinary retention (UR) during acute traumatic brain injury (TBI) rehabilitation and determine associated clinical variables. METHODS: Retrospective case series. RESULTS: Eighty-four patients (mean age 44.7 +/- 17.9 years; 66 males, 18 females) with first-ever TBI within 6 weeks of injury. On admission, UI was present in 52 (62%). UR defined as post-void residual urine volumes of > 100 mls was present in eight (9.5%). Forty-six (54.8%) needed external collecting devices and six (7.1%) used indwelling catheters. Bilateral lesions, diabetes mellitus and faecal impaction were present in 70.2, 10.7 and 6.0%, respectively. UI was associated with poorer functional status (measured by the modified Barthel index) and presence of bilateral lesions (p < 0.01). UR was associated with diabetes mellitus and faecal impaction (p < 0.01). On discharge, 31 (36.9%) remained incontinent. CONCLUSION: UI is common after acute TBI and is associated with poorer functional outcome.

Adolescent↗
PubMed2003

Pain during in-patient rehabilitation after traumatic spinal cord injury.

In this prospective study, we surveyed the pain experience of 40 participants during the in-patient rehabilitation period following traumatic spinal cord injury (SCI). Twenty-eight patients (70% of the study population) had musculoskeletal (MS) pain or neuropathic (NP) pain. Pain responded positively to physical therapy and analgesics. A numerical pain scale decreased from a mean of 6.36+/-1.7 on admission to 3.2+/-1.94 on discharge (P<0.001). Paraplegic patients were more likely to have MS pain (P=0.001) and NP pain (P=0.046). There was no relationship between completeness of injury, or spinal surgery, and type of pain encountered. There was also no significant difference in the modified Barthel index between patients with and without pain on admission and discharge. We conclude that pain is a common experience in SCI patients and that it can be reduced significantly by the end of in-patient rehabilitation.

Adult↗
PubMed2002

Intramuscular neurolysis with alcohol to treat post-stroke finger flexor spasticity.

OBJECTIVE: To evaluate the effectiveness of intramuscular neurolysis with alcohol for the treatment of finger flexor spasticity in individuals with stroke. DESIGN: Case series. SETTING: Outpatient clinic of a tertiary rehabilitation facility. SUBJECTS: Thirty patients with a mean age of 60.2 years and post-stroke duration of 8.3 months with finger flexor spasticity. INTERVENTIONS: Intramuscular neurolysis or motor point blocks of the finger flexors of the hemiplegic upper extremity with 50% ethyl alcohol. MAIN OUTCOME MEASURES: The severity of spasticity as measured by the Modified Ashworth Scale (MAS) and the passive range of motion of the proximal interphalangeal joints of the second to fifth digits. RESULTS: The mean baseline MAS score was 4.0 +/- 0.5 and this improved to 2.0 +/- 0.6, 2.2 +/- 0.6 and 2.6 +/- 0.6 at four weeks, three months and six months post neurolysis respectively. The gains in range of motion were 18.5 +/- 6.7, 17.5 +/- 6.4 and 14.9 +/- 4.8 degrees at four weeks, three months and six months post neurolysis respectively. These improvements were statistically significant (p < 0.05). Two subjects developed temporary dysesthetic pain of the forearm and palm. CONCLUSION: Intramuscular neurolysis with alcohol provides good relief of finger flexor spasticity in hemiplegic individuals.

Ethanol↗
PubMed2001

Clinical and functional outcome after alcohol neurolysis of the tibial nerve for ankle-foot spasticity.

PURPOSE: To report one's experience of using 50-100% alcohol for neurolysis of the tibial nerve in chronic ankle-foot spasticity. METHODS: The records of patients who received alcohol neurolysis of the tibial nerve were retrospectively reviewed. Repetitive monopolar nerve stimulation was used to localize the tibial nerve. Outcome measures included muscle tone as measured by the Modified Ashworth Score (MAS), passive ankle range of motion (PROM), effect on clonus, plantar flexor motor strength, visual gait analysis and use of orthoses. RESULTS: A total of 21 tibial nerves were neurolysed in 18 patients (mean age 38.9 +/- 15.8 years, 12 males, six females). Mean duration post-event was 14.8 +/- 3.9 months. The mean pre-neurolysis MAS was 2.50 +/- 0.77 and this improved to 0.97 +/- 0.88 (p < 0.001) and 0.93 +/- 0.85 (p < 0.001) at 1 and 6 months post-procedure, respectively. Average duration of effect was 10.5 +/- 8.9 months. Eleven out of 12 patients (91.7%) with sustained ankle clonus had complete abolishment lasting 6 months. Mean gain in PROM was 24.6 +/- 16.1 degrees and 32.6 +/- 19.0 degrees at 1 and 3 months post-neurolysis, respectively (p < 0.001, < 0.02). No decrease in motor strength was seen post-neurolysis. All 13 ambulant patients had visible improvements in gait. Complications were transient and included dysesthetic pain (4), sensory loss (1) and distal limb oedema (1). CONCLUSION: Alcohol neurolysis (50-100%) of the tibial nerves is an effective and safe method of managing ankle-foot spasticity.

Adolescent↗
PubMed2000

Expression and characterization of human tyrosinase from a bacterial expression system.

To carry out biochemical characterizations of human tyrosinase and to provide an unlimited source of the enzyme for further study, an expression plasmid, pHis-Tyrosinase, which contains the entire coding sequence except the signal sequence of a human tyrosinase was constructed and expressed in Escherichia coli. The expressed enzyme was simply purified by an immobilized metal affinity chromatography. The recombinant enzyme had the same electrophoretic mobility as the native enzyme from human melanoma cell and cross-reacted with the polyclonal antibody raised against the native enzyme. The recombinant enzyme retained its catalytic function with both hydroxylating and oxidative activities. Km values for L-tyrosine and L-3,4-dihydroxy-phenylalanine of the recombinant enzyme were 0.17 and 0.36 mM, respectively. The activity of the recombinant enzyme was optimal at pH 7.5. Glutathione notably inhibited the enzymatic activity. This work is a further enzymatic characterization of human tyrosinase.

Dihydroxyphenylalanine↗
PubMed2000

Purification and characterization of a highly stable tyrosinase from Thermomicrobium roseum.

Tyrosinase, with an isoelectric point at pH 4.9, was purified to electrophoretic homogeneity from an extremely thermophilic bacterium, Thermomicrobium roseum. Gel filtration, N-terminal amino acid sequencing and SDS/PAGE analysis indicate that T. roseum tyrosinase is composed of two identical subunits, each with a molecular mass of 43000 Da. The enzyme exhibited high substrate specificity towards catechol, chlorogenic acid, L-3-(3,4-dihydroxyphenyl)-L-alanine (L-DOPA) and pyrogallol. The K(m) value of the enzyme for L-DOPA was 0.18 mM. beta-Mercaptoethanol and sodium diethyldithiocarbamate notably inhibited the enzymic activity. The activity of the enzyme was optimal at pH 9.5 and 70 degrees C, and was increased by addition of 1 mM Mg(2+), K(+) or Cu(2+). The enzyme was highly stable against high temperature and guanidine hydrochloride. The N-terminal amino acid sequence of the enzyme was determined to be Asp-Ile-Asn-Gly-Gly-Gly-Ala-Thr-Leu-Pro-Gln-Lys-Leu-Tyr. These facts indicate that T. roseum tyrosinase appears to be distinct from the tyrosinases so far purified from other sources.

Amino Acid Sequence↗
PubMed2000

Alcohol neurolysis of the sciatic nerve in the treatment of hemiplegic knee flexor spasticity: clinical outcomes.

OBJECTIVE: To study clinical outcomes after 50% to 100% alcohol neurolysis of the sciatic nerve in the treatment of chronic hemiplegic knee flexor spasticity. DESIGN: Case series using a convenience sample. SETTING: Rehabilitation teaching hospital. PATIENTS: Eight patients (mean age, 55.1 +/- 12.1 yr; mean duration to block, 4.4 +/- 3.7 mo) with chronic hemiplegia and severe spasticity (modified Ashworth scale [MAS] score < 2) secondary to cerebrovascular accidents (n = 5) and traumatic brain injuries (n = 3). Two patients were ambulant, 6 were wheelchair-bound. INTERVENTIONS: Fifty percent to 100% alcohol neurolysis of the sciatic nerve using repetitive electric stimulation to localize the sciatic nerve. MAIN OUTCOME MEASURES: MAS score, gain in knee range of motion (ROM), and visual inspection of gait at 0, 1, and 6 months postneurolysis. Nonparametric tests were used in statistical analysis. RESULTS: The mean preinjection MAS score was 2.8 +/- 0.7, which improved to 1.4 +/- 0.7 at 1 month (p = .005), and 1.8 +/- 0.9 (p = .01) and 1.9 +/- 1.1 (p = .02) at 3 and 6 months postinjection, respectively. The mean gain in knee ROM was 34.4 degrees +/- 15.7 degrees at 1 month postinjection and was maintained at 6 months postinjection. Improvements in gait were noted in both ambulant patients, and improved positioning in 3 of 6 wheelchair-bound patients. The incidence of dysesthetic pain was 0%. CONCLUSION: Fifty percent to 100% alcohol neurolysis of the sciatic nerve is a safe and effective method for treatment of hemiplegic knee flexor spasticity, with therapeutic effects lasting 6 months.

Adult↗
PubMed2000

Incidence and outcome of poststroke urinary retention: a prospective study.

OBJECTIVE: To document the incidence and outcome of poststroke urinary retention, and to determine clinical variables associated with it. DESIGN: Cohort of 80 consecutive patients. SETTING: Inpatient setting of a tertiary rehabilitation center. PARTICIPANTS: Eighty patients (48 men, 32 women; mean age, 65.4 yr) with a first ischemic stroke, admitted for rehabilitation within 4 weeks of the stroke. MAIN OUTCOME MEASURES: Patients had their postvoid residuals (PVR) assessed via a bladder scanner within 72 hours of admission. Urinary retention was defined by a PVR of more than 100mL on 2 consecutive occasions. RESULTS: Urinary retention was present in 23 (29%) patients. Cognitive impairment, aphasia, diabetes mellitus, and cortical stroke were present in 30%, 29%, 31%, and 41% of patients, respectively. Fifteen (19%) patients developed urinary tract infection during rehabilitation. Urinary retention was significantly associated (p < .05) with cognitive impairment, diabetes mellitus, aphasia, a lower admission functional status (as measured on the modified Barthel index), and urinary tract infection, but not with the use of anticholinergic medications. On discharge, 4 patients still had urinary retention (3 were voiding spontaneously and the other used intermittent catheterization). CONCLUSION: Urinary retention was common in patients with ischemic stroke. It should be strongly suspected in patients with aphasia, cognitive impairment, poor functional status, and diabetes mellitus.

Age Distribution↗
PubMed2000

Phenytoin-induced asterixis--uncommon or under-diagnozed?

Asterixis is a recognized but uncommon clinical sign of phenytoin toxicity. A case is presented in which asterixis and acute cerebellar dysfunction occurred when the phenytoin levels reached the toxic range. It disappeared when the drug levels normalized. Asterixis is now classified as a form of negative myoclonus, which is characterized by irregular myoclonic lapses of posture. The neurochemistry and physiology of phenytoin causing asterixis has yet to be elucidated.

Aged↗
PubMed2000

Botulinum toxin A in the treatment of hemiplegic spastic foot drop--clinical and functional outcomes.

PURPOSE OF STUDY: This study investigated the effects of intramuscular Botulinum toxin A (BTX-A) in 7 ambulatory chronic hemiplegic subjects (5 male, 2 female) who had spastic hemiplegic foot drop. BASIC PROCEDURES: An open label study involving intramuscular injections of Botulinum toxin A (dilution 10 U/0.1 ml) was performed in ambulatory chronic hemiplegics. Tone as measured by the Modified Ashworth Scale (MAS), passive ankle joint range of motion (PROM), briskness of ankle reflexes, gait velocity, motor functional status and effects on the use of walking aids were measured at baseline, 3 and 12 weeks post-injection. MAIN FINDINGS: All subjects except I showed a significant decrease in MAS from 3.43 +/- 0.54 at baseline to 2.0 +/- 1.15 at 3 weeks post-injection, which was maintained during the 3 month study duration. The median change in PROM was 17.0 degrees (SD 12.1 degrees) at 3 weeks and 5.0 degrees (SD 7.1 degrees) at 12 weeks (p = 0.25) Gait velocity and Modified Barthel Index mobility scores which measured motor functional status were not significantly altered post-injection. The injections were generally well-tolerated and there were no serious adverse side effects. PRINCIPAL CONCLUSIONS: Although significant decreases in muscle tone were observed and maintained after intramuscular Botulinum toxin A during the 3 month study period, this regional intervention did not significantly influence functional status, gait velocity and the use of ambulatory aids.

Adult↗
PubMed1999

Neurolysis of the musculocutaneous nerve with alcohol to treat poststroke elbow flexor spasticity.

OBJECTIVE: To evaluate the effectiveness of alcohol in neurolysis of the musculocutaneous nerve for the treatment of elbow flexor spasticity in individuals with a stroke. DESIGN: Case series. SETTING: Outpatient clinic of a tertiary rehabilitation facility. PARTICIPANTS: Twenty patients with a mean age of 62.8 years and poststroke duration of 12.3 months with elbow flexor spasticity. INTERVENTION: Musculocutaneous nerve block of the hemiplegic upper extremity with 50% ethyl alcohol. OUTCOME MEASURES: The severity of spasticity as assessed by the modified Ashworth scale (MAS) score and the elbow passive range of motion (PROM). RESULTS: The mean baseline MAS score was 3.7 +/- 0.6, and this improved to 1.7 +/- 1.0, 2.0 +/- 0.8, and 2.1 +/- 0.8 at 4 weeks, 3 months, and 6 months postneurolysis, respectively. The elbow PROM was 87.3 degrees +/- 20.2 degrees, 104.3 degrees +/- 20.1 degrees, 103.8 degrees +/- 18.9 degrees, and 101.6 degrees +/- 19.7 degrees, respectively. These improvements were statistically significant (p < .05). Four subjects had concomitant improvement of finger flexor spasticity and another four had relief of shoulder pain. Three subjects developed temporary dysesthetic pain over the lateral forearm. CONCLUSION: Neurolysis of the musculocutaneous nerve with alcohol provides good relief of elbow flexion spasticity in hemiplegic individuals.

Elbow Joint↗
PubMed1999

Rehabilitation outcome following traumatic brain injury--the Singapore experience.

The objectives of this study were to define (1) demographic and injury characteristics for acute traumatic brain injury (TBI) patients admitted to rehabilitation; (2) admission and discharge functional status; (3) discharge disposition and vocation status at follow-up. The charts of 80 consecutive TBI admissions (64 males, 16 females) were reviewed. Outcome measures included admission and discharge Modified Barthel Index (MBI) scores, length of rehabilitation stay, discharge disposition and return-to-work status at 1 year post-injury. Fifty-seven (71.3%) of patients were aged 40 years or less. Motor vehicle accidents accounted for 70.0% (56) of injuries. Sixty-one (76.3%) had severe head injuries. Diffuse cerebral oedema was present in 41.3% (33) and 52.5% (42) had intracranial haematoma. Admission and discharge MBI scores were 49.6 +/- 33.7 and 76.9 +/- 25.6 respectively. This difference was significant (P < 0.001). Memory and planning/organization deficits were present in 68.6% and 70.5% of patients (51 tested). Multiple regression analysis showed that admission MBI score had significant influence on discharge functional outcome (Multiple R 0.66, R2 0.40, P < 0.001). Seventy-two (90%) were discharge home and 25% (20) returned to work at 1 year post-injury. We conclude that this cohort of TBI patients showed significant improvement in functional status after rehabilitation, and admission functional status had the most impact on discharge functional outcome.

Activities of Daily Living↗
PubMed1998

Clinical characteristics and functional outcome of stroke patients 75 years old and older.

OBJECTIVE: To examine the demographic and clinical characteristics of stroke patients 75 years old and older admitted for rehabilitation, to study medical complications that occurred during rehabilitation, and to document functional outcome and possible factors influencing outcome. DESIGN AND SETTING: A case series of 59 consecutive inpatients admitted to a rehabilitation facility with confirmed strokes over a 2-year period. MEASURES: Patients were selected by rehabilitation physicians for admission into the rehabilitation program. Measures for outcome include the Modified Barthel Index (MBI) and the patient's discharge disposition. RESULTS: The mean age of this cohort was 80.4+/-3.2 years, and mean lengths of stay in the acute and rehabilitation facilities were 15.2 and 37.4 days. Twelve patients had three or more medical illnesses; hypertension and diabetes were the most common. Cognitive impairment, urinary incontinence, and dysphagia requiring tube feeding were present in 45.1%, 33.9%, and 11.9% of patients, respectively. Nineteen patients (32.2%) developed medical complications, and urinary tract infection was the most common. Improvements in functional status, motor power, continence, and dysphagia were noted after rehabilitation. Fifty-three patients (89.8%) were successfully discharged home, 28.8% of whom employed domestic maids as caregivers. The discharge MBI score was strongly predicted by the admission MBI and cognition scores. CONCLUSION: Despite their age, significant functional improvements were documented in this cohort of aged stroke patients, and the majority were discharged home. Admission MBI and cognition scores strongly predicted functional outcome.

Activities of Daily Living↗
PubMed1998

Infectious disease of the spine: outcome of rehabilitation.

Infectious disease of the spine is infrequently seen in the rehabilitation setting. We examined retrospectively 26 patients with spinal infections admitted to the rehabilitation centre over a 6-year period to determine the demographic characteristics, clinical features and outcome after rehabilitation. Their ages ranged from 24 to 83 years (mean = 56.4); 65.4% were males. The infection was due to pyogenic bacteria in 14 patients (53.8%) and Mycobacterium tuberculosis in 12 (46.2%). Staphylococcus aureus was the causative agent in 69% of those with pyogenic infections. A history of diabetes mellitus was present in 35.7% of the pyogenic group but in only 8.3% of the tuberculous group. Localised back pain, fever and neurological deficits were the typical clinical manifestations. The most common site of infection was the thoracic region. Surgery was performed on 24 patients and all received prolonged courses of antibiotics. All but three patients completed the rehabilitation programme. The motor score for the lower limbs and the modified Barthel scores for activities of daily living (ADL) and mobility improved significantly (P < 0.05) for both pyogenic and tuberculous groups. The amounts of improvement achieved were not significantly different between the pyogenic and tuberculous groups except for ADL. Age, gender and the presence of diabetes mellitus did not appear to significantly affect the neurological or functional outcome in our study population. The majority of patients (87.5%) were discharged to their own homes.

Activities of Daily Living↗