Earticle

이 논문은 제임스 조이스의 『가슴 아픈 사건』을 스테이시 앨러이모의 “횡 단 신체성”을 통해 생태 비평적으로 분석해 나가고자 한다. 조이스가 『더블린 사람들』에 서 더블린의 정체성으로 간주한 “마비”는 본래 신체에 사용되는 용어이며, 더블린의 물 리적 환경과 불가분의 관계를 맺고 있다. 따라서 먼저 “마비의 중심지”로서 더블린의 정 체성을 역사적, 사회적, 도시 환경적 관점에서 논의한다. 이어서 『가슴 아픈 사건』의 주 인공 제임스 더피 씨와 비인간 환경과의 상호 관련성을 탐구하고자 한다.

This paper takes an ecocritical approach to James Joyce’s “A Painful Case” through the lens of Stacy Alaimo’s “trans-corporeality” theory. Paralysis, which Joyce regards as Dublin’s identity in Dubliners, is a term often used for human bodies, and the term forms an inextricable relationship with Dublin’s urban environment. Therefore, this paper discusses Dublin’s identity as the center of paralysis through historical, social, and urban environmental perspectives. Then, the paper explores the interrelationship between the protagonist of “A Painful Case”, James Duffy, and nonhuman nature appearing in the short story.

This paper peers through the window at “The Sisters” to explore what the title means and how the young boy’s relationship with Father Flynn develops, keeping in mind the story’s functions as a prelude to the entire collection of James Joyce's Dubliners. The title seems at odds with the relationship between the boy and the priest, which stands out as a memorable feature of the story. However, the boy’s gaze up to the window is significant in that the boy’s narration draws the reader’s attention towards the revealing of the secret at the window in the same way “The Sisters” serves as a window to the general paralysis of Dubliners. Joyce’s narrative technique interrelates with the thematic concerns as the window motifs manifest the paralysis theme. “The Sisters” deploys the general theme of paralysis by employing a boy’s memory, combining the “main” male narration with the “marginal” female narration. As Joyce subtly reveals the deadly secret of paralysis screened from the boy’s ears, he succeeds in keeping the reader’s attention until the end, at which point the sisters offer an epiphany. The window motif acts on two levels regarding the first-person narrative. The boy undergoes a process of initiation as a hero and, as a story-teller, he shares the writer’s own concern with storytelling. The balance is maintained between two pairs, male and female, while there is also a parallel to the way the title and the story interact. “The Sisters” is placed before and after the story of the dead priest, so that the narrative form takes precedence over content on this border. In that way, the reader’s attention returns to “The Sisters” as a gnomon.

It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient’s symptoms and signs, including the paralysis, resolved after surgery.

Hypokalemic paralysis is a cause of acute paralysis that can be classified as primary (familial) or secondary according to its etiology. Routine electrodiagnostic examinations can be normal between attacks, potentially interfering with the diagnosis. We report two cases of hypokalemic paralysis with different etiologies. The first case involved secondary hypokalemic paralysis due to pharmacologic potassium shift, which was diagnosed by an electrodiagnostic study within the symptomatic period. The second case provides information on the diagnostic approach to primary hypokalemic periodic paralysis during the inter-attack period, as the diagnosis was made using the long exercise test. This case report highlights the need for a proper combination of routine electrodiagnostic studies and special techniques, such as the long exercise test, in patients suspected of hypokalemic paralysis to evaluate the disease state and exclude other possible causes of paralysis.

Diaphragm dysfunction can originate from various etiologies, and bilaterality of the dysfunction depends on the cause. Symptoms of diaphragm dysfunction vary depending on the degree of phrenic nerve denervation, spinal cord lesion, and involvement of the diaphragm. Several infectious diaphragmatic dysfunctions have been reported, including the human immunodeficiency virus, poliovirus, West Nile virus, and dengue virus. Here, we report a case of unilateral diaphragm paralysis in a 34-year-old man with neurosyphilis.

We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.

Objective To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke. Methods We recruited 75 patients with subacute hemiplegic stroke. Patients were divided into two groups according to the location of the lesion and the side of the dominant hand. Group 1 consisted of patients whose strokes affected the dominant hand (i.e., right hemiplegia and right dominant hand or left hemiplegia and left dominant hand). Group 2 consisted of patients whose strokes affected the non-dominant hand (i.e., left hemiplegia and right dominant hand or right hemiplegia and left dominant hand). The primary outcome measure was the Short-Form 36-Item Health Survey (SF-36), which was used to evaluate health-related QOL. Secondary outcomes were scores on the Modified Barthel Index (MBI) and Beck Depression Inventory (BDI).Results We did not find any statistically significant differences between the groups in any SF-36 domain including the summaries of physical and mental component. Similarly, the MBI and BDI scores were not significantly different between the groups. Conclusion The effect of paralysis on the dominant hand and QOL in patients with subacute stroke was not significantly different from the effect of paralysis on the non-dominant hand.

A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic. Six days after the radiofrequency procedure, she noticed a facial asymmetry during smiling. Physical examination revealed immobility of the mouth drawing upward and laterally on the left. Routine nerve conduction studies and needle electromyography (EMG) in facial muscles did not suggest electrodiagnostic abnormalities. We assumed that the cause of facial asymmetry could be due to an injury of zygomaticus muscles, however, since defining the muscles through surface anatomy was difficult and it was not possible to identify the muscles with conventional electromyographic methods. Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition. Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion.

Progressive muscular atrophy (PMA) is a rare disease involving lower motor neuron degeneration. Hypokalemic periodic paralysis (HypoPP) is a genetic disorder that causes temporary muscle paralysis due to decreased serum potassium levels. Mutations in the CACNA1S gene cause HypoPP. An altered locus closely linked near the CACNA1S gene suggests the possibility of motor neuron degeneration. However, PMA with HypoPP is very rare worldwide because HypoPP usually causes progressive muscle weakness involving a form of myopathy without motor neuron disease. In this report, we describe the case of a 64-year-old man who initially complained of weakness in only the left lower extremity, which subsequently progressed bilaterally. Hence, the patient was diagnosed with PMA with HypoPP based on serial electromyography and the presence of a CACNA1S mutation. Therefore, serial electromyography is necessary for middle-aged patients with progressive muscle weakness and a history of HypoPP.

It is not common in rehabilitation situation to encounter patients exhibiting paralysis or other disabilities which have no apparent organic basis. Even without organic causes for their signs and symptoms these patients often require comprehensive treatment and management. Patients with conversion disorder often pose particular difficulties because of diagnostic confusion and the lack of therapeutic strategies for rehabilitation management. We feel that systematic functional rehabilitation is helpful in resolving symptom and recovering normal function in the patient suffering from conversion disorder since it provides motivation and reduces reinforcements which contribute to sustained disabled state. This report describes the patient with hysterical motor paralysis who is successfully treated with structured physical therapy. The objectives of this report are to provide therapeutic guidelines for physical therapy and to emphasize the role of physical therapist in the assessment and treatment of hysterical paralysis.

Objective: High vagal paralysis (HVP) is a type of vocal-fold paralysis, associated with discoordination of the pharyngeal musculature, and the failure of the cricopharyngeus muscle to relax, leading to swallowing disability. We evaluated the difference between the functional results of office-based injection laryngoplasty and medialization thyroplasty in patients with unilateral vocal cord paralysis caused by HVP. Methods: A retrospective review of 28 patients following laryngoplasty with HVP was performed. Pre- and posttreatment swallowing and voice functions were reviewed. Results: Seventeen patients underwent injection laryngoplasties, while 11 received medialization thyroplasties. In both groups, all except one patient who received medialization thyroplasty recovered their ability to swallow after appropriate procedures (100% vs. 91%). An acoustic analysis demonstrated significant changes in shimmer, noiseto- harmonic ratio, and maximum phonation time (MPT) in the injection laryngoplasty group, whereas significant changes in jitter and MPT were observed in the medialization thyroplasty group. Conclusion: Office-based injection laryngoplasty was found to be an effective and reliable therapy for improving swallowing and voice function in patients with HVP, compared to medialization thyroplasty.

Objective To investigate the relationship between motor evoked potential (MEP) response and the severity of motor paralysis, evaluated according to the Korean disability evaluation system in patients with spinal cord injury (SCI).Methods We analyzed 192 lower limbs of 96 SCI patients. Lower limbs were classified according to their motor scores, as determined by the International Standards for Neurological Classification of Spinal Cord Injury: motor score <10 (group 1); ≥10 and <15 (group 2); ≥15 and <20 (group 3); and ≥20 (group 4). MEP responses were classified as ‘normal’, ‘delayed’ or ‘absent’, based on their onset latency, which was compared between the different motor score groups.Results MEP responses and limb motor scores were highly correlated (p<0.001). There was a significant difference of MEP responses between the motor score groups (p<0.001). MEP response was markedly poorer in motor group 1 (limb motor score <10) than in the other three groups (p<0.0001). However, there were no differences between the three groups with motor scores of 10 or above. Conclusion Clinical utility of MEP as a complimentary tool to manual muscle tests could be limited to discriminating motor score groups with severe paralysis, i.e., single lower limb motor power grades of 0 or 1, and from grade 2, 3, and 4, or above, in the Korean disability evaluation system.

A 74-year-old female patient was diagnosed with unilateral vocal fold paralysis without any brain lesions, but with a history of influenza infection 1 week ago. No significant manifestations were observed in the oral phase in the Video Fluoroscopic Swallowing Study (VFSS). However, during swallowing aspiration, 50% of the residue after swal-lowing was measured as semisolid, and aspiration was observed when swallowing in the liquid form. The Penetration Aspiration Scale (PAS) score was 6 points, and the Functional Dysphagia Scale (FDS) was 46 points. Vocal-fold adduction was performed by injecting hyaluronic acid. Four days after the vocal fold injection, VFSS showed no aspiration during the swallowing of semisolids. Moreover, compared to the initial test, 10% of the resi-due measured after swallowing semisolids was decreased. No aspiration was observed when swallowing the liquid. Scores obtained for the Penetration Aspiration Scale (PAS) and the Functional Dysphagia Scale (FDS) were 4 and 26, respectively. Taken together, our results indicate that in a situation where upper respiratory infections are increas-ing due to the COVID-19 pandemic, hyaluronic acid injections have the potential to improve dysphagia in patients with unilateral vocal fold paralysis due to a viral infection.

Purpose: Bell’s palsy is a nerve paralysis disease that causes functional impairments and affects psychological and aesthetical parts. This study aimed to examine whether acupressure massage had positive effects on facial paralysis, subjective symptoms, and depression in Bell’s palsy patients. Methods: This study was conducted by a nonequivalent control group pretest-posttest design. Participants were 60 patients with Bell’s palsy. 30 patients were assigned to the experimental group and the remaining 30 patients were assigned to the control group. The period of the study was from October 1, 2008 to July 30, 2009. Acupressure massage was offered to the experimental group for 20 minutes per day for two weeks (a total of six times). A SPSS/Win 12.0 program was used for data analysis. Results: A difference in Digital Infrared Thermographic Imaging (DITI) between affected and unaffected sides was less in the experimental group having acupressure massage than in the control group and the score of the recovery of facial paralysis was also increased in the experimental group. The Facial Nerve Grade Systems by Brackmann score that is a more objective index showed a significant difference between two groups (F=26.81, p<.001). Subjective symptom and depression scores were more decreased in the acupressure massage group than in the control group. Conclusion: Based on the results, it is considered that acupressure massage can be applied to Bell’s palsy patients as an alternativ

This paper reports a case of a female patient aged 48 years diagnosed with a right lateral medullary infarction anddysphagia after the onset period. In a video fluoroscopic swallowing study (VFSS), significant manifestations werenot observed in the oral phase, but during swallowing aspiration, a larger amount of post-swallowing residue wereobserved on the test of swallowing of semisolid and liquid. After the VFSS, a laryngoscopy was performed, whichindicated paralysis and para-median fixation in the right vocal fold. In this case, swallowing with rightward headrotation was adopted as a compensation technique to reduce the aspiration caused by the para-median fixation ofthe right vocal fold, but it was not enough to improve the dysphagia in this case. To medialize the right vocalfold, hyaluronic acid was injected with laryngoscopic guidance. In a VFSS conducted after the injection, aspirationwas not observed on the test of swallowing a semisolid and liquid. The injection of hyaluronic acid is less invasivethan surgical operations, does not require general anesthesia, and makes the recovery time shorter. Therefore, it isexpected to be an alternative to the treatment of unilateral vocal fold paralysis (UVFP) accompanied withdysphagia.

Type 2 superior labral anterior to posterior (SLAP) lesion is a common cause of shoulder pain requiring surgical operation. SLAP tears are often associated with paralabral cysts, but they rarely cause nerve compression. However, we experienced two cases of type 2 SLAP-related paralabral cysts at the spinoglenoid notch which were confirmed as isolated nerve entrapment of the infraspinatus branch of the suprascapular nerve by electrodiagnostic assessment and magnetic resonance imaging. In these pathological conditions, comprehensive electrodiagnostic evaluation is warranted for confirmation of neuropathy, while surgical decompression of the paralabral cyst combined with SLAP repair is recommended.

Objective To analyze the relationship of the change in fat mass percentage (FMP) and body mass index (BMI) with the change in obesity rate according to gender, extent of spinal cord injury (SCI) and the duration.Methods The retrospective study was conducted with medical records of 915 patients. FMP was calculated with BMI and bioelectrical impedance analysis (BIA). Statistical analysis of the relationship between FMP and gender, extent of SCI and the duration after SCI was done.Results FMP increased in relation to the duration. The mean FMP was higher in the motor complete tetraplegia group, as compared to the motor incomplete group. The rate of obesity was 69.8% with cutoff FMP values of over 22% and 35% for male and female patients, respectively. Rate of obesity was correlated with the duration after SCI and degree of paralysis. The rate of obesity was 17.1% with a cutoff value of BMI 25 kg/m2 and 51.3% with a cutoff value of 22 kg/m2. For evaluation of the diagnostic value of BMI to predict obesity according to FMP standards, a cutoff value of 25 kg/m2 showed a sensitivity level of 22.3% and specificity level of 94.9%. When the cutoff level for BMI was set at 22 kg/m2, the sensitivity and specificity were 59.3% and 67.0%, respectively.Conclusion In Korean SCI patients, FMP showed good correlation with the duration of SCI and the extent of SCI, while BMI did not. Especially in the motor complete tetraplegia group, the diagnostic value of BMI decreased as the duration after SCI increased. This study suggested that FMP could be used complementarily when evaluating the obesity of SCI patients.

This study investigates a unique case of trauma-induced abducens nerve paralysis resulting from a rare clivus fracture in a 60-year-old patient. Following a 5-meter fall, the patient presented with symptoms including headache, contralateral limb weakness, and intense vertigo. Imaging revealed epidural and subdural hematomas, along with a right clivus fracture. Post-cranial surgery, exclusive impairment of the sixth cranial nerve was identified, manifested by the inability to abduct the right eye. Magnetic resonance imaging ruled out neoplastic and infectious causes, establishing a link to the clivus fracture. Consistent application of eye patches, except during sleep, led to significant symptomatic relief within six months, including improved lateral gaze in the right eye. This case deviates from the commonly reported bilateral damage, emphasizing the impact of severe head injuries on the abducens nerve's path through the clivus. The notable improvement post-rehabilitation with eye patches underscores the efficacy of targeted rehabilitation methods for such nerve injuries. The discussion explores various causes of abducens nerve palsy, presenting a compilation of case reports to underscore diverse etiological factors and patient demographics.