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Background: Musculoskeletal complaints influence general health status, but the relative contribution of concurrent upper and lower extremity disabilities on patient perceptions of general health is unclear. Questions/Purposes: We evaluated whether two regional instruments (DASH and WOMAC) reflect a patient's perception of general health measured using the SF-36 and determined whether general health components are explained by upper and lower extremity disabilities. Methods: We recruited 272 randomly chosen participants 65 years or older without a history of surgery for musculoskeletal disease or trauma who participated in the Korean Longitudinal Study on Health and Aging. Upper extremity disability was determined with the DASH score and lower extremity disability with the WOMAC; as a measure of general health, we obtained SF-36 scores. Multivariate regression modeling was used to assess the relative contributions made by upper and lower extremity disabilities to general health. Results: The DASH and WOMAC each was correlated with the physical component summary (PCS) scale and with the mental component summary (MCS) scale to differing extents. Multivariate regression analyses revealed that WOMAC alone, DASH alone, and WOMAC and DASH accounted for 24%, 19%, and 26% of the variance in the PCS scale. However, only the DASH was associated with the MCS scale but accounted for only 2% of the variance. Conclusions: We found that in a community-based elderly population, perceived general physical health is associated with upper and lower extremity disabilities, whereas perceived general mental health is associated with only upper extremity disabilities, but to a small extent. Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Interpreting the impact of hand osteoarthritis (OA) on hand function is complicated owing to the multiple digits and joints in the hand. Questions/purpose: We determined the impact of digit-related radiographic OA on hand function in patients 65 years or older. Methods: We evaluated hand radiographs in 196 men and 182 women older than 65 years without shoulder or elbow pain who participated in the Korean Longitudinal Study on Health and Aging. Using the Kellgren and Lawrence criteria, we graded the 15 joints in each hand from 0 to 4 for OA, and evaluated hand function by measuring DASH scores and grip and pinch strength of dominant hands. We performed multiple linear regression analyses to evaluate associations between hand functions and the sum of Kellgren and Lawrence grade of each digit. Results: The sums of Kellgren and Lawrence grades for thumbs and middle fingers were independently associated with grip strength, and the sums of the Kellgren and Lawrence grades for thumbs and index fingers were independently associated with pinch strength after controlling for age and sex. DASH scores were independently associated with OA of the thumb, or index or middle finger, but not with OA of the ring or small finger. Conclusions: This study revealed cumulative effects of joint involvement and Kellgren and Lawrence grades of thumb and middle finger OA on grip strength, and thumb and index finger OA on pinch strength. Furthermore, OA of either of three radial digits was associated with more severe upper extremity disabilities. Level of Evidence: Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested a high prevalence of carpal tunnel syndrome in patients seeking treatment for basal joint arthritis of the thumb. The purpose of this study was to compare the prevalence of carpal tunnel syndrome between individuals with and those without radiographic evidence of basal joint arthritis of the thumb in the general elderly Korean population, and to determine if there is a correlation between the severity of carpal tunnel syndrome shown by electrophysiological studies and the severity of basal joint arthritis as seen on radiographs.Methods: We evaluated hand radiographs and nerve conduction studies of 192 men and 176 women (more than sixty-five years of age) who participated in the Korean Longitudinal Study on Health and Aging. The basal joint of the thumb was assigned a grade for osteoarthritis of 0 to 4 on radiographs with use of the Kellgren and Lawrence criteria. The diagnosis of carpal tunnel syndrome was based on the combination of a positive response to survey questions and a positive nerve conduction study. Motor distal latency and motor conduction velocity were measured to assess the electrophysiological severity of carpal tunnel syndrome.Results: The prevalence of carpal tunnel syndrome was 16.7% in the group with basal joint arthritis and 10.9% in the group without basal joint arthritis, a difference that was not significant (p = 0.249). Neither motor distal latency nor motor conduction velocity was significantly correlated with the severity of the basal joint arthritis in the entire group of 368 study subjects (p = 0.154 and p = 0.662, respectively) or in those with carpal tunnel syndrome (p = 0.603 and p = 0.998, respectively).Conclusions: This study of Koreans who were more than sixty-five years of age showed that the prevalence of carpal tunnel syndrome is similar in patients with and those without radiographic findings of basal joint arthritis of the thumb. We found no correlation between the electrophysiological severity of carpal tunnel syndrome and the severity of basal joint arthritis. [ABSTRACT FROM AUTHOR]

Introduction: Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise., Methods and Analysis: This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome., Discussion: This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction., Trial Registration Number: This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.

Introduction: Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment., Methods and Analysis: We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index., Discussion: Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis., Ethics and Dissemination: The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.

Functional brain imaging studies have suggested that the superior temporal gyrus (STG) and the middle temporal gyrus (MTG) are involved in phonological and lexical-semantic processing, respectively. However, the precise role of the posterior temporal lobe is not fully understood. To clarify the functional relevance of the left posterior STG and MTG during language processing, we used neuronavigation-guided repetitive transcranial magnetic stimulation (rTMS). The reaction times and error rates for 12 healthy volunteers performing auditory repetition and lexical-semantic decision tasks were compared before and during rTMS stimulation. We applied 1 Hz rTMS over the left posterior STG or MTG or sham stimulation for 10 min in a random order. Stimulation of the left posterior MTG significantly slowed the response time for the lexical-semantic decision task from 478.9±56.5 to 583.1±80.0 ms. However, stimulation over the left posterior STG or MTG did not affect the response time or the error rate for the auditory repetition task. Our results suggest that the left posterior MTG might be involved in lexical decision making. Neuronavigation-guided rTMS virtual lesion studies could help determine the functional roles of specific brain areas in language processing, and our findings provide new evidence supporting the use of neuromodulation through rTMS for patients with aphasia.

Objective: To test the hypothesis that 10 sessions of transcranial direct current stimulation combined with occupational therapy elicit more improvement in motor function of the paretic upper limb than sham stimulation in patients with subacute stroke., Design: Eighteen patients with subacute stroke with hand motor impairment were randomly assigned to one of the three 10-day sessions of (a) anodal transcranial direct current stimulation over the affected motor cortex, (b) cathodal transcranial direct current stimulation over the unaffected motor cortex, or (c) sham stimulation. Blinded evaluators assessed upper limb motor impairment and global functional state with the Fugl-Meyer Assessment score and the Modified Barthel Index at baseline, 1 day after stimulation, and 6 mos after stimulation., Results: Baseline scores for Fugl-Meyer Assessment and Modified Barthel Index were comparable in all groups (P > 0.05). At 6-mo follow-up, cathodal transcranial direct current stimulation led to a greater improvement in Fugl-Meyer Assessment than the sham procedure (P < 0.05). There was a significant inverse correlation between baseline Fugl-Meyer Assessment and Fugl-Meyer Assessment increase at 6 mos (r = -0.846; P < 0.01)., Conclusions: Our results suggest a potentially beneficial effect of noninvasive cortical stimulation during rehabilitative motor training of patients who have suffered from subacute strokes.

Objective: To evaluate the effect of botulinum toxin type A injections on dysphagia accompanied by upper esophageal sphincter dysfunction., Design: A preinjection and postinjection blinded retrospective review was performed using the videofluoroscopic swallowing study video clips of eight patients administered botulinum toxin type A because of dysphagia with accompanying upper esophageal sphincter dysfunction at a dysphagia clinic in a department of rehabilitation medicine at a university hospital. The outcome variables applied were a functional dysphagia scale that included assessments of food residues in vallecula and piriform sinuses, and bolus transit time, and physician's judgment regarding which videos (preinjection or postinjection) were functionally superior in terms of aspiration frequency and bolus transit time., Results: After botulinum toxin type A injection, residues in the piriform sinus significantly improved (P < 0.05), and the applied functional dysphagia scale showed a tendency toward improvement (P = 0.173). A blinded physician found postinjection to be superior to preinjection in terms of videofluoroscopic swallowing study results in six of eight cases., Conclusions: Botulinum toxin type A injection to the upper esophageal sphincter was found to improve swallowing function in patients with upper esophageal sphincter dysfunction and seems to offer a possible therapeutic option in these patients.