Search

Dysphagia has been reported to be associated with the descent of the hyolaryngeal complex. Further, suprahyoid muscles play a greater role than infrahyoid muscles in elevation of the hyolarngeal complex. Respiratory muscle training (RMT) can improve lung function, and expiratory muscle strength training can facilitate elevation of the hyoid bone and increase the motor unit recruitment of submental muscles during normal swallowing. This study aimed to investigate the surface electromyography (sEMG) of the swallowing muscles, bilaterally, and the effect of RMT on swallowing muscles in stroke patients with respiratory muscle weakness.Forty patients with first episode of unilateral stroke were included in this retrospective controlled trial. After exclusion of 11 patients with respiratory muscle strength stronger than 70% of the predicted value, 15 were allocated to the RMT group and 14 to the control group. However, eventually, 11 patients in RMT group and 11 patients in control group completed the study. The sEMG of the orbicularis oris, masseter, submental, and infrahyoid muscles were recorded during dry swallowing, water swallowing (2 mL), and forced exhalation against a threshold breathing trainer set at different intensities, at baseline and after 6-week RMT.Regarding the sEMG of submental muscles, there were significant between-group differences on the latency of the unaffected side (P = .048), significant change from baseline force on the unaffected side (P = .035), and significant between-side difference (P = .011) in the RMT group during dry swallowing. Significant change in the duration from baseline was observed on the affected side of the RMT group when blowing was set at 50% maximal expiratory pressure (MEP; P = .015), and on the unaffected side of the control group when blowing set at 15% MEP (P = .005). Significant difference was observed in the duration between 50% MEP and 15% MEP after 6-week program in the control group (P = .049).A 6-week RMT can improve the electric signal of the affected swallowing muscles with more effect on the unaffected side than on the affected side during dry swallowing. Furthermore, RMT with 50% MEP rather than 15% MEP can facilitate greater submental muscle activity on the affected side in stroke patients with respiratory muscle weakness.

Background Spasticity and impaired hand function are common complication in patients with stroke, and it pose negative impact on quality of life. Aim We aimed to assess the effect of the combined administration of kinesio taping (KT) and modified constraint-induced movement therapy (mCIMT) on upper extremity function and spasticity in hemiplegic patients with stroke. Design A randomized controlled pilot study. Setting A hospital center. Population Patient of stroke with hemiplegia for 3-12 months. Methods Thirty-five patients were enrolled and allocated into three groups, including the sham KT and mCIMT group, KT group, or KT and mCIMT group. The KT, sham KT, and mCIMT serve as additional therapies (5 days/week for 3 weeks) besides regular rehabilitation (5 days/week for 6 weeks). KT was applied over the dorsal side of the affected hand, while mCIMT was applied to restrain the unaffected upper extremity. The outcomes included the modified Tardieu scale (mTS), Brunnstrom stage, Box and Block Test (BBT), Fugl-Meyer assessment for the upper extremity (FMA-UE), and Stroke Impact Scale version 3.0. Measurements were taken at baseline, immediately after intervention (third week), and 3 weeks later (sixth week). Results Between baseline and the third week, within-group comparisons yielded significant improvement in the wrist and hand parts of the FMA and BBT of the Sham KT and mCIMT group (P=0.007-0.035); in the hand part of the FMA, BBT, and mTS degree (P=0.005-0.024) of the KT group; and in the Brunnstrom stage of the wrist, FMA-UE, BBT, and mTS degrees (P=0.005-0.032) of the KT and mCIMT group. Between baseline and the sixth week, there was significant difference in the proximal part of the FMA and mTS degree in groups with KT, but an additional improvement on the Brunnstrom stage of the wrist was noted in the KT and mCIMT group. Conclusions KT benefits patients with stroke in spasticity reduction and upper extremity function. The combination of KT and mCIMT provides extra benefit in motor performance with a more long-lasting effect. Clinical rehabilitation impact Kinesio taping could act as potential adjuvant therapy in patient of stroke with hemiplegia.

The purpose of this study was to investigate the effect of comprehensive postural instructions and range of motion (ROM) exercises via educational videos for shoulder injury prevention and functional improvement of the hemiplegic shoulder after acute stroke.In this prospective cohort study, 48 subacute stroke patients with hemiplegia were enrolled and divided into 2 groups (23 in experimental group and 25 in control group). In the control group (n = 25), the patients performed conventional rehabilitation for 5 days per week. In the experimental group (n = 23), the patients received not only conventional rehabilitation but also additional postural instructions and regular ROM exercises via educational videos for hemiplegic shoulders for 15 minutes twice per day for 5 days per week during their hospital stay. Main outcome measures, including the presence and severity of pain, motor function, and sonography on hemiplegic shoulder, were assessed.More motor recovery improvement was found in the experimental group (P.05). In the supraspinatus tendon, a significantly increased frequency in tendinopathy or tear was observed between admission (12%) and before discharge (40%) in the control group (P.05), but no difference was observed in the experimental group. In the subdeltoid bursa, effusion or bursitis was significantly reduced between admission (30.4%) and before discharge (8.7%) in the experimental group (P.05).These findings suggest that comprehensive postural instructions and ROM exercises via educational videos during inpatient rehabilitation for subacute stroke patients could improve motor recovery and limit shoulder injury in stroke patients with hemiplegia.

Physical therapy improves outcomes for patients with head and neck cancer (HNC) but home-based program (HBP) has not yet been investigated thoroughly. This study compared a HBP with outpatient physical therapy (OPT).This trial categorized patients with primary HNC into OPT and HBP groups. The patients in the HBP group received home-based therapy once a day for 5 days per week. By contrast, the OPT group received various physical therapies, including aerobic, anaerobic, and stretching therapies, twice per week, plus a thrice-weekly home-based therapy that similarly consisted of aerobic, anaerobic, and stretching exercises. The major outcome was the Functional Assessment of Cancer Therapy-Head and Neck (FACT HN), and secondary outcomes were the visual analog scale (VAS) of shoulder pain, 6-min walking test (6MWT), and shoulder range of motion (ROM), all of which were evaluated before, during, and after interventions.Significant improvements were found after 12 weeks of the HBP or OPT. The HBP was not inferior to OPT regarding FACT HN (p=.074), VAS of shoulder pain (p=.677), 6MWT (p = .677), and shoulder ROM (p=.145 for flexion; p=.383 for abduction).Both the HBP and OPT can improve shoulder abduction, shoulder flexion and functional capacity.

Background Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke. Aim The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance in patients with subacute stroke. Design A randomized controlled pilot study. Setting A hospital center. Population Participants with stroke within six months. Methods Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week). Results Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (P=0.037). Conclusions Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke. Clinical rehabilitation impact Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

The aim of this study is to investigate soft tissue disorders of affected shoulders after nerve-sparing selective neck dissection (SND) in patients with head and neck cancers (HNCs) by sonography. Eighteen HNCs patients with shoulder disability after SND were enrolled. Shoulder motions, pain, and the sonographic findings were measured and analyzed. Significantly decreased flexion, abduction, and increased pain were found on affected shoulders compared with normal shoulders. There were significant decrease in thickness of trapezius muscle (p=0.001), abnormal findings of supraspinatus tendon (p=0.022), and subdeltoid bursa (p=0.018) on surgical side. The ratio of trapezius muscle atrophy was related to shoulder pain (p=0.010). Patients with subdeltoid abnormalities had significant limitation on shoulder flexion and abduction. Abnormalities of supraspinatus tendon and subdeltoid bursa on sonography and trapezius muscle atrophy may play a key role in shoulder pain and shoulder flexion and abduction limitations.

Aim The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients. Background The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before. Design A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies. Data sources Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015. Review methods This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies. Results There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test. Conclusions This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients.

Background: Early detection and intervention for post-stroke dysphagia could reduce the incidence of pulmonary complications and mortality. The aims of this study were to investigate the benefits of swallowing therapy in swallowing function and brain neuro-plasticity and to explore the relationship between swallowing function recovery and neuroplasticity after swallowing therapy in cerebral and brainstem stroke patients with dysphagia. Methods: We collected 17 subacute stroke patients with dysphagia (11 cerebral stroke patients with a median age of 76 years and 6 brainstem stroke patients with a median age of 70 years). Each patient received swallowing therapies during hospitalization. For each patient, functional oral intake scale (FOIS), functional dysphagia scale (FDS) and 8-point penetration-aspiration scale (PAS) in videofluoroscopy swallowing study (VFSS), and brain functional magnetic resonance imaging (fMRI) were evaluated before and after treatment. Results: FOIS (p = 0.003 in hemispheric group and p = 0.039 in brainstem group) and FDS (p = 0.006 in hemispheric group and p = 0.028 in brainstem group) were both significantly improved after treatment in hemispheric and brainstem stroke patients. In hemispheric stroke patients, changes in FOIS were related to changes of functional brain connectivity in the ventral default mode network (vDMN) of the precuneus in brain functional MRI (fMRI). In brainstem stroke patients, changes in FOIS were related to changes of functional brain connectivity in the left sensorimotor network (LSMN) of the left postcentral region characterized by brain fMRI. Conclusion: Both hemispheric and brainstem stroke patients with different swallowing difficulties showed improvements after swallowing training. For these two dysphagic stroke groups with corresponding etiologies, swallowing therapy could contribute to different functional neuroplasticity.

Objective To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke. Design Prospective, randomized controlled trial. Setting Tertiary hospital. Participants The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups. Intervention Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks. Main outcome measures MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis. Results Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups. Conclusions Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.

Dysphagia after stroke is associated with mortality and increased pulmonary complications. Swallowing therapies may decrease pulmonary complications and improve patients' quality of life after stroke. This study used clinical swallowing assessments and videofluoroscopy (VFS) to assess the functional recovery of acute stroke patients with dysphagia after different swallowing therapies. We enrolled 29 acute stroke patients with dysphagia and randomly divided them into 3 therapy groups: traditional swallowing (TS), oropharyngeal neuromuscular electrical stimulation (NMES), and combined NMES/TS. All patients were assessed using the clinical functional oral intake scale (FOIS), 8-point penetration–aspiration scale (PAS), and functional dysphagia scale (FDS) of VFS before and after treatment. There were no differences in the clinical parameters and swallowing results of the FOIS and VFS before swallowing treatment among the 3 groups (P > .05). TS therapy and combined therapy both had significant swallowing improvement after therapy according to the FOIS and 8-point PAS (P < .05). When comparing the results of the VFS among the 3 groups, we found significant improvements in patients eating cookies and thick liquid after combined NMES/TS therapy (P

This study aims to compare donor-site morbidity between the traditional fibula osteocutaneous and chimeric fibula flaps for mandibular reconstruction. Twenty-three patients with head and neck cancer were recruited. Fifteen patients underwent the traditional fibula osteocutaneous flap. Eight patients received a chimeric fibula osteocutaneous flap with a sheet of soleus muscle. Subjective donor-site morbidities were evaluated by questionnaire. Objective isokinetic testing and 6-minute walking test (6MWT) were used to evaluate ankle strength and walking ability. The results revealed no significant difference was found in total average score of the questionnaire between the traditional (2.57) and the chimeric (2.75) groups (P > 0.05). There were no significant differences in peak torque/total work of ankle motions and in walking ability at 6MWT between the traditional and chimeric groups (P > 0.05). In conclusion, compared with the traditional fibula osteocutaneous flap, the chimeric fibula flap does not increase donor-site morbidity for reconstructive surgery.

Background:Hemiplegic shoulder pain (HSP) is one common complication after stroke. The interferes with the functionality of the affected shoulder in patients with stroke during rehabilitation. Hyaluronic acid (HA) could have positive effects on pain relief and shoulder motion in stroke patie

Purpose. To examine the hemiplegic shoulders for soft-tissue injury by musculoskeletal sonography and to determine the relationship between the motor functions of the upper extremity and these injuries, which play an important role in hemiplegic shoulder pain and may impede rehabilitation. Methods. The following characteristics of 34 acute stroke patients were recorded: age, gender, height, body weight, side of hemiplegia, type and duration of stroke, Brunnstrom stage, subluxation, and degree of spasticity of the upper extremity. On the basis of the Brunnstrom stage, the patients were divided into 2 groups. Patients with stages I, II, or III were categorized under the lower Brunnstrom stage (LBS) group (n = 21), and those with stages IV, V, or VI were allocated to the higher Brunnstrom stage (HBS) group (n = 13). Both shoulders of each patient were examined by musculoskeletal sonography with a 5–10-MHz linear transducer on 2 separate occasions (i.e., at admission and 2 weeks after rehabilitation). Results. With the exception of age, there were no significant differences in the demographic and clinical characteristics of the patients in the 2 groups. Shoulder musculoskeletal sonography revealed soft-tissue injury in 7 patients (33%) and 15 patients (71%) in the LBS group at admission and 2 weeks after rehabilitation, respectively (p < 0.05), and in 4 patients (31%) in the HBS group both at admission and 2 weeks after rehabilitation. Conclusions. Acute stroke patients with poor upper limb motor functions are more prone to soft-tissue injury of the shoulder during rehabilitation. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009.

Tang SF, Chen CP, Chen MJ, Pei Y-C, Lau Y-C, Leong C-P. Changes in sagittal ground reaction forces after intra-articular hyaluronate injections for knee osteoarthritis. Arch Phys Med Rehabil 2004;85:951–5. Objectives To examine the gait patterns and the sagittal ground reaction forces (GRFs) in persons with knee osteoarthritis (OA) after intra-articular injection of hyaluronate and to investigate the duration of its treatment effectiveness. Design Case-comparison study. Setting Gait laboratory in a tertiary care center. Participants Fifteen subjects (30 knees) with symptomatic knee OA (stage I or II, according to the Ahlback grading system), and 15 age-, mass-, and gender-matched non-OA control subjects (30 knees). Intervention After initial gait analysis, the group with knee OA received 5 weekly intra-articular injections of hyaluronate to bilateral knees. Gait analysis was performed again for the group with knee OA after the completion of hyaluronate injections. Main outcome measures Forceplate sagittal GRFs and gait parameters of velocity, cadence, step length, and stride time. Results The distinctive 2-peak force vector GRF was lost in persons with knee OA. The first peak rise time was significantly delayed ( P P Conclusions Gait patterns and GRFs improved significantly after intra-articular knee injection of hyaluronate in persons with Ahlback stages I and II knee OA. The clinical treatment effect was immediate and may last for 6 months or more.

OBJECTIVE To investigate the effect of orthotic insoles in heel injury patients who received reconstructive flap operations. DESIGN Motion analysis and force platform data were collected in able-bodied subjects and patients with heel injuries during walking without and with the use of the total contact insole. Gait kinetics were collected for the hip, knee, and ankle joints and then compared with Student's t tests. RESULTS Walking velocity and step length were decreased (P < 0.014 and P < 0.005) for patients not wearing the total contact insole. The affected limbs had longer double-support duration (14.8% of gait cycle, P < 0.037) and shorter single-support duration (34.5% of gait cycle, P < 0.045). Less hip power generation was noted for the affected limbs during both initial contact and preswing phases, 0.17 +/- 0.10 N-m/kg-m and 0.45 +/- 0.20 N-m/kg-m, as compared with that of the able-bodied subjects, 0.36 +/- 0.08 N-m/kg-m and 0.89 +/- 0.22 N-m/kg-m, respectively. Decreased ankle power generation was noted for the affected limbs (1.08 +/- 0.38 N-m/kg-m) during preswing phase as compared with the able-bodied subjects (2.24 +/- 0.33 N-m/kg-m). After fitting of the total contact insole, the affected limbs recovered to a gait pattern similar to that of the able-bodied subjects (P < 0.05). CONCLUSION Asymmetry of gait pattern after heel injury resulted in altered gait kinetics. Gait symmetry could be recovered in these patients as the total contact insole provides weight acceptance, shock absorption, and cushioning effect for the reconstructed heels.

To investigate the relationship of sit-to-stand and gait performance in hemiplegic stroke patients.A total of 40 chronic stroke patients with hemiplegia and 22 age-matched healthy subjects were included in this study. Data of a motion analysis system and three force platforms were collected in a rehabilitation unit of a medical center.Laboratory sit-to-stand measurement and gait analysis were evaluated in both groups via three AMTI (Advanced Mechanical Technology Inc.) force platforms and a Vicon 370 system (six high-resolution cameras and one AMTI force plate), respectively. The sit-to-stand and gait parameters of hemiplegic patients were correlated significantly, especially in rising speed and the maximal vertical force of both legs during rising.Hemiplegic stroke patients, who could stand up within 4.5 sec or who had a maximal vertical force difference of less than 30% of body weight between both legs, had better gait performance than the others did.

Tang SF, Chen CP, Pan J-L, Chen J-L, Leong C-P, Chu N-K. The effects of a new foot-toe orthosis in treating painful hallux valgus. Arch Phys Med Rehabil 2002;83:1792-5. Objective: To assess the effects of a new foot-toe orthosis on painful hallux valgus. Design: Uncontrolled intervention study. Setting: An outpatient clinic in a tertiary medical center with an orthotic laboratory in Taiwan. Participants: Seventeen patients with painful hallux valgus. Intervention: Application of a new total contact insole with fixed toe separator. Main Outcome Measures: The hallux valgus angle, an 11-point numeric rating scale (NRS-11) for pain assessment, and walking ability scale. Results: The average hallux valgus angle reduction ± standard deviation was 6.5°±3.8° after insole application ( P P P =.002) 3 months later for the 12 patients who completed the study. The walking ability scale improved at least 1 grade or more after the insole was worn for 3 months ( P =.002). All patients tolerated the insole well without any clinical evidence of skin ulcers or blisters. Conclusion: Our new total contact insole with fixed toe separator reduced pain, and improved walking ability and the hallux valgus angle. It is an effective alternative treatment for patients with painful hallux valgus. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Objective: To determine the wrist angle that produces the least compression to the median nerve and to evaluate the usefulness of sonography in determining the optimal position. Design: Seventeen wrists of 17 healthy volunteers received dynamic, high-frequency (8 MHz), high-resolution sonography with the wrist splinted at various positions: 15° of flexion, neutral position, and 15° and 30° of extension. The morphologic changes of the median nerve were evaluated with the wrist positioned at various angles. Results: The neutral position caused significantly lower compression of the median nerve than it did in the other positions. However, in some cases, the lowest pressure was found when the wrist was fixed in 15° of flexion or 15° of extension. Because median nerve compression may decrease the anteroposterior diameter, increase the transverse diameter, and decrease the cross-sectional area, greater anteroposterior diameter, lower flattening ratio (transverse diameter/anteroposterior diameter), and greater cross-sectional area were considered to indicate lower median nerve compression. Conclusions: Neutral position of the wrist is the best position with the least median nerve compression in most individuals. However, the optimal position may vary from person to person. Sonographic examination can help to determine the splint position that results in the lowest median nerve compression.

Background: After harvesting the fibula flap, pain, sensory disturbance, weakness of donor leg, reduced walking endurance, ankle instability, and lower walking speed had been reported. The aim of this study was to quantitatively assess functional outcome of regular home-based exercise on donor ankle strength, endurance, and walking ability after free fibula flap for mandibular reconstruction. Methods: Fourteen patients were recruited. Objective isokinetic testing and a 6-min walk test (6MWT) were used to evaluate ankle strength/endurance and walking ability, respectively. Results: There was a significant increase in the peak torque of ankle dorsiflexion/foot inversion of the healthy leg and ankle dorsiflexion/foot eversion of the donor leg after exercise (p < 0.05). After home-based exercise, there was reduced asymmetry in the peak torques of ankle dorsiflexion and foot eversion and the total work of foot eversion between the donor and healthy legs. In 6MWT, no significant difference was found between the walking distances before and after exercise. Conclusion: Regular home-based exercise could improve the strength of ankle dorsiflexion and foot eversion of the donor leg, and get more symmetric ankle motor function between the donor and healthy legs.

Objective Patients with osteoporotic vertebral compression fracture (OVCF) have postural changes and increased risk of falling. The aim of this study is to compare balance characteristics between patients with OVCF and healthy control subjects. Methods Patients with severe OVCF and control subjects underwent computerised dynamic posturography (CDP) in this case-control study. Results Forty-seven OVCF patients and 45 controls were recruited. Compared with the control group, the OVCF group had significantly decreased average stability; maximal stability under the `eye open with swayed support surface' (CDP subtest 4) and 'eye closed with swayed support surface' conditions (subtest 5); and decreased ankle strategy during subtests 4 and 5 and under the `swayed vision with swayed support surface' condition (subtest 6). The OVCF group fell more frequently during subtests 5 and 6 and had longer overall reaction time and longer reaction time when moving backward during the directional control test. Conclusion OVCF patients had poorer static and dynamic balance performance compared with normal control. They had decreased postural stability and ankle strategy with increased fall frequency on a swayed surface; they also had longer reaction times overall and in the backward direction. Therefore, we suggest balance rehabilitation for patients with OVCF to prevent fall.

Background Hemiplegic shoulder pain (HSP) is one of the most common comorbidities in stroke patients with flaccid shoulders. The pain limits functional motor recovery and affects the activities of daily living after acute stroke. This study investigated the effects of hyaluronic acid (HA) injection on pain reduction and motor function in subacute stroke patients with HSP and injury. Methods A randomized, double-blinded controlled trial was conducted in a medical center. Twenty-six subacute stroke patients were enrolled and randomly divided into 2 groups: the experimental group (n = 16) received ultrasound-guided, subacromial HA injections once per week for 3 weeks and conventional rehabilitation, whereas the control group (n = 10) received 0.9% sodium chloride injections once per week for 3 weeks and conventional rehabilitation. Shoulder pain and motor function were evaluated before and after the intervention using the visual analog scale (VAS) and the Fugl-Meyer assessment for the upper extremity (FMA-UE), respectively. Results In the experimental group, significant differences were found in VAS (P = 0.003), shoulder flexion (P = 0.03) and abduction (P = 0.02), and FMA-UE (P = 0.003) after treatment. In the control group, there were significant differences in VAS (P = 0.007), shoulder flexion (P = 0.035), and FMA-UE (P = 0.042) after treatment. The comparison of the changes in the parameters between the experimental and control groups, after each intervention, revealed a significant difference in VAS (P = 0.001). Conclusion Subacromial HA injection could result in positive effects on shoulder pain and shoulder abduction in subacute stroke patients with HSP and injury.

Objective: To investigate the correlation between hemiplegic shoulder pain factors during the acute and chronic stages of stroke recovery. Design: A prospective longitudinal study. Subjects: Seventy-six stroke patients with hemiplegic shoulders. Methods: Hemiplegic shoulder pain and clinical, physical, and sonography results were recorded at admission and during both acute (before discharge) and chronic stages (6 months after discharge). Results: During the acute stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level and range of motion limitations. During the chronic stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level, range of motion limitations, spasticity and abnormal sonographic findings. Higher incidence (p = 0.014) of hemiplegic shoulder pain and pain scores (p < 0.01) were noted and abnormal sonographic findings of the biceps tendon long head (p = 0.01) and subscapularis tendon (p = 0.01) were higher during the chronic stage. Effusion, tenosynovitis or tendinopathy of the biceps tendon long head, and supraspinatus tendinopathy were notable during both stages. Conclusion: Hemiplegic shoulder pain was correlated with lower motor function level and shoulder range of motion limitation in both stages. Shoulder spasticity and abnormal sonographic findings were correlated with hemiplegic shoulder pain during the chronic stage.

This study aims to compare donor-site morbidity between the traditional fibula osteocutaneous and chimeric fibula flaps for mandibular reconstruction. Twenty-three patients with head and neck cancer were recruited. Fifteen patients underwent the traditional fibula osteocutaneous flap. Eight patients received a chimeric fibula osteocutaneous flap with a sheet of soleus muscle. Subjective donor-site morbidities were evaluated by questionnaire. Objective isokinetic testing and 6-minute walking test (6MWT) were used to evaluate ankle strength and walking ability. The results revealed no significant difference was found in total average score of the questionnaire between the traditional (2.57) and the chimeric (2.75) groups (P0.05). There were no significant differences in peak torque/total work of ankle motions and in walking ability at 6MWT between the traditional and chimeric groups (P0.05). In conclusion, compared with the traditional fibula osteocutaneous flap, the chimeric fibula flap does not increase donor-site morbidity for reconstructive surgery.

Analysis of electromyographic (EMG) activities in the back during dynamic exercise is needed because more complex loading on the spine is created in comparison with that during static exercise. The purpose of this study is to investigate the difference in bilateral midback and low-back paraspinal muscle (PSM) activities during performance of different resistance isokinetic exercises in healthy subjects and those with scoliosis.Forty-one healthy subjects and thirty-three subjects with adolescent idiopathic scoliosis (AIS) were enrolled. An isokinetic back system in combination with quantitative surface EMG was used to evaluate the dominant and nondominant PSM activities by analyzing the root mean square (RMS) during isokinetic extension and flexion exercise at velocities of 30 degree/s and 90 degree/s.Significantly higher RMS of EMG were found in the dominant medial and lateral PSM of the lumbar region than the non-dominant muscles in the healthy control group and in those with AIS with smaller curves (20 degrees) during isokinetic flexion and extension exercises. In AIS patients with larger curves (20 to 50 degrees), shifting of muscle activities from the dominant to the non-dominant side occurred during isokinetic exercises, and the EMG activities of the thoracic muscle were significantly higher on the non-dominant (concave) side than on the dominant (convex) side.The bilateral PSM do not act symmetrically during isokinetic back exercises. The dominant lumbar PSM supply the major action in healthy subjects and patients with small curve scoliosis. For larger curve scoliosis, compensated muscle activity is needed in the midback when doing resistance exercises. More midback protection may be needed by scoliotic subjects with large curves during resistance exercise.

Severe dysphagia in a 54 year-old woman with Sjogren's syndrome with involvement of multiple cranial nerves significantly improved after treatment with neuromuscular electrical stimulation (NMES) in combination with a swallowing rehabilitation program. The swallowing response was assessed in real time using a videofluoroscope. Immediate improvement in the tongue retraction force, clearing of the valleculae, increase in laryngeal elevation and shortening of pharyngeal transit time were noted during stimulation. The patient returned to independent oral feeding after 46 sessions of NMES. After follow-up for 1 year, we found that the patient maintained adequate oral feeding and did not show signs of pulmonary complications.

Objective: Physical and sonographic evaluation of hemi­ plegic shoulder in patients after acute stroke and correlation between the physical/sonographic findings and early-onset hemiplegic shoulder pain. Design: Cross­sectional study. Subjects: Fifty­seven patients after stroke with hemiplegic shoulder. Methods: Subjects were assigned to poor motor function and good motor function groups according to the Brunnstrom motor recovery stages of hemiplegic shoulder. Physical find­ ings and sonography of hemiplegic shoulder at admission and before discharge were compared, and the relationship between the physical/sonographic findings of hemiplegic shoulder and hemiplegic shoulder pain was analysed. Results: The 2 groups differed significantly in propriocep­ tion, spasticity, subluxation, and shoulder rotation (p < 0.05). Frequency of abnormal sonographic findings and shoulder pain and visual analogue scale score of hemiplegic shoulder pain before discharge were significantly higher in the poor motor function group (p < 0.05) than in the good motor func­ tion group. Brunnstrom motor recovery stages, shoulder motion, subluxation, and abnormal sonographic findings of hemiplegic shoulder were moderately correlated with visual analogue scale scores of hemiplegic shoulder pain (γ = 0.34– 0.65; p < 0.01). Conclusion: The frequency of shoulder soft tissue injuries (85%) and hemiplegic shoulder pain (67%) was higher in patients with hemiplegic shoulder with impaired sensation, spasticity, subluxation, and restricted rotation. Brunnstrom motor recovery stages, limited rotation, subluxation, and abnormal sonographic findings of hemiplegic shoulder were associated with hemiplegic shoulder pain severity in patients

Body sway increases with age. The purpose of this study was to obtain baseline data and the characteristics of balance performance in different age groups for balance strategy management.Healthy individuals (n = 107) were divided into young, middle-aged, and elderly groups, and assessed by computerized dynamic posturography (CDP) on a Smart Balance Master. The 6 subtests in the sensory organization tests (SOT) for the CDP were as follows: subtest 1, eyes open, fixed support platform; subtest 2, eyes closed, fixed platform; subtest 3, eyes open, fixed platform; subtest 4, eyes open, swaying platform; subtest 5, eyes closed, swaying platform; subtest 6, swaying visual surround, swaying platform. Motor balance control tests included the limit of stability (LOS) test at 75% of LOS in 8 directions and the left/right and forward/backward rhythmic weight shift (RWS) test.In the SOT, the elderly group demonstrated significantly lower average stability and maximal stability scores in subtests 4-6. This group also demonstrated a relatively lower average percentage of ankle strategy in subtests 4-6. In the motor control tests, the elderly group demonstrated a significantly higher overall reactive time and lower overall directional control in the LOS test, lower on-axis velocity during the forward/backward and left/right motor control test and a lower average percentage of forward/backward directional control in the RWS test.The elderly had a higher degree of postural imbalance and used hip strategy to a greater extent to maintain their balance, especially when standing on a swaying support surface in the absence of visual surround or with conflicted visual surround. The elderly required a longer reaction time and demonstrated lower directional control in balance performance.

High-resolution ultrasonography (HRUS) has been used to diagnose carpal tunnel syndrome (CTS) in recent years. However, the best diagnostic criterion and optimal cut-off value for HRUS remain controversial.This study enrolled 37 patients with idiopathic CTS (61 CTS hands) and 20 healthy subjects (40 normal hands). The subjects underwent nerve conduction studies along with HRUS. Several ultrasonographic measurements with good reliability were compared, including the median nerve cross-sectional areas (CSA) at the pisiform and hook of hamate levels; the flattening ratios (FR) at the pisiform, hook of hamate, and distal radioulnar joint levels; retinacular bowing (RB); and the longitudinal compression sign (LCS). Receiver operating characteristic (ROC) curves were plotted for the optimal cut-off values as well as the sensitivity and specificity.There was a significant increase in the median nerve CSA at the pisiform and hook of hamate levels, RB, and LCS, but the FR was decreased at the hook of hamate level. The ROC curves demonstrated that the median nerve CSA at the pisiform level was most predictive of CTS; the optimal cut-off value wasor = 9.875 mm2, yielding 82% sensitivity and 87.5% specificity.CTS can be diagnosed by HRUS. The most useful diagnostic criterion is a median nerve CSA ofor = 9.875 mm2 at the pisiform level.

Despite increasing use of assistive devices (ADs) by physically disabled (PD) children, the use rate, number, effects and related services have seldom been studied. Understanding AD utilization is helpful in improving the related services. This study describes the usage of ADs by children with physical disabilities (PDs).This regional survey enrolled children with PDs. The children's parents or primary caregivers filled out structured questionnaires regarding the children's use of and need for ADs, the benefits and problems associated with the ADs and related services.In total, 224 ADs were used by 124 children (1.79 ADs per child). The most commonly used ADs were orthoses (n = 77, 62.10%), mobility aids (n = 51, 41.13%), and aids for therapy and training (n = 21, 16.94%). The degree of disability, age, gender, diagnosis and rehabilitation training location were not associated with the number of ADs used. Most children (n = 103, 83.06%) benefited from ADs, and 93 (75%) children had been evaluated prior to buying ADs. Eighty three (66.94%) parents paid for the Ads, and 108 (87.10%) parents acquired information from rehabilitation professionals. Forty one (40.20%) parents were satisfied with the services of local suppliers; 119 (95.97%) parents had applied to their local government for financial support; 82 (68.91%) parents were not satisfied with the application procedures or the amount of support they received.Although parents of PD children favored the usage of ADs, they needed additional information. We suggest that policies and strategies are needed to reduce barriers to ADs utilization, enhance insurance coverage and improve ease of using the services.

Betel pepper (Piper betle L.) cultivation is an important agricultural industry in Taitung, Taiwan, and culling leaves is very labor-intensive. This case study compares the proportion of cumulative trauma disorders (CTDs) between cullers and those with other occupations.Patients with musculoskeletal disorders in the rehabilitation clinic of a local hospital in Taitung were enrolled. This all female cohort was divided into a culler group (betel pepper cullers, n = 20), and a non-culler group (other occupations, n = 47). Three cullers were interviewed, and were also recorded to elucidate the related ergonomics. Patients were diagnosed using plain radiography and ultrasonography.The act of culling involves an overhead internal rotation of both shoulders with extended elbows while standing, followed by wrist flexion and forearm pronation. Flexing of the fingers is also required by the tools, 'iron nails' fitted onto both thumbs. The proportions of patients with shoulder impingement syndrome (SIS) and carpal tunnel syndrome (CTS) were significantly higher among cullers than non-cullers (0.45 vs. 0.15, p = 0.011 and 0.40 vs. 0.06, p = 0.002, respectively). Furthermore, the total frequency of CTDs displayed a positive linear correlation with employment duration (r = 0.618, p = 0.004).Proportions of occupational SIS and CTS were higher among betel pepper cullers than those with other occupations. These CTDs may have resulted from a prolonged static posture and repetitive motions during culling.

Knowing the types and frequency of medical complications of stroke patients during inpatient rehabilitation, together with the ability to identify high-risk patients, would be extremely helpful for providing the best possible physiologic environment for their recovery.A retrospective study was conducted. Charts of 346 stroke patients who were consecutively admitted or transferred for inpatient rehabilitation in a tertiary care hospital from October 1997 to September 1998 were reviewed. Demographic and stroke characteristics, preexisting neuromedical conditions, neurological deficits, disability level, medical complications occurring during inpatient rehabilitation, and complications that required transfer off the rehabilitation ward were recorded for each patient. Univariate and stepwise multiple logistic regression analyses were performed to determine the factors that were significantly associated with the occurrence of any medical complication.Forty-four percent of patients experienced 1 or more complications. The most common complications were musculoskeletal pain (15.0%), urinary tract infection (13.6%), depression (9.3%), upper gastrointestinal tract bleeding (4.9%), and pneumonia (4.9%). Ten patients were transferred to the acute care ward during admission because of severe medical complications. Among them, 5 had a recurrent stroke, 3 had pneumonia, 1 had ventriculoperitoneal shunt obstruction, and 1 had organic psychosis. The occurrence of any of the medical complications was significantly associated with the following factors which were presented at admission or transfer to the rehabilitation ward: being female, having no voluntary movement of the affected hand, being more functionally dependent, and having to undergo Foley catheter insertion.Medical complications were common among stroke patients undergoing inpatient rehabilitation. Prevention and proper management are also very important in the rehabilitation ward.

The purpose of this study was to investigate the relationship between flexible flatfoot and plantar fasciitis.Twenty-three subjects with flexible flatfoot and 23 subjects with normal arched feet were enrolled. Footprint analysis was used to evaluate the foot conditions in both groups to calculate the individual arch index. We compared the sonographic images of plantar fascia in the flexible flatfoot group with the normal arch group using high-frequency ultrasound.The analysis results indicated that the thickening of the plantar fascia in the flexible flatfoot group was significantly different from the normal arch group. In the flexible flatfoot group, 10 of 23 patients (43.4%) had plantar fasciitis, but only two subjects (8.7%) in the normal arch group had plantar fasciitis.There was a higher incidence of plantar fasciitis in the flexible flatfoot group than the normal arch control group in this study.

To examine the gait patterns and the sagittal ground reaction forces (GRFs) in persons with knee osteoarthritis (OA) after intra-articular injection of hyaluronate and to investigate the duration of its treatment effectiveness.Case-comparison study.Gait laboratory in a tertiary care center.Fifteen subjects (30 knees) with symptomatic knee OA (stage I or II, according to the Ahlbäck grading system), and 15 age-, mass-, and gender-matched non-OA control subjects (30 knees).After initial gait analysis, the group with knee OA received 5 weekly intra-articular injections of hyaluronate to bilateral knees. Gait analysis was performed again for the group with knee OA after the completion of hyaluronate injections.Forceplate sagittal GRFs and gait parameters of velocity, cadence, step length, and stride time.The distinctive 2-peak force vector GRF was lost in persons with knee OA. The first peak rise time was significantly delayed (P.05). The group with knee OA also revealed slower walking velocity and cadence, as well as longer stride time, than the control group (P.05). The distinctive 2-peak force vector GRF diagram could be recovered in patients with knee OA after the completion of hyaluronate injections.Gait patterns and GRFs improved significantly after intra-articular knee injection of hyaluronate in persons with Ahlbäck stages I and II knee OA. The clinical treatment effect was immediate and may last for 6 months or more.

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using the middle third of the patellar tendon is an effective method for treating ACL insufficiency. Donor site morbidities are usually mild. This article presents a case of simultaneous patellar fracture and patellar tendon avulsion that occurred 8 weeks after this operation. Such a case has rarely been reported. Theoretically, an accelerated rehabilitation protocol after ACL reconstruction may increase patellar stress and the potential for patellar fracture. However, it is still very important because complications such as arthrofibrosis, muscle atrophy, and patellofemoral pain may outweigh the chance of patellar fracture if adequate rehabilitation is not performed.

This study was undertaken to investigate the nutritional status of children with spastic cerebral palsy (CP) and to identify the risk factors of undernutrition.Seventy-five spastic CP children, 47 boys and 28 girls, (ages, 5 months to 10 years) underwent anthropometric assessment, including body weight, recumbent length, and knee height. Their functional status, medical condition, and feeding status were also recorded. The data were analyzed to estimate the influences of various factors on the nutritional status of the spastic CP children.The nutritional status of 31 of the 75 children (41.3%) were below the 10th percentile (undernutrition) and three (4%) were above 90th percentile (overnutrition) of healthy children. In the multivariate analysis, we found that undernutrition was significantly associated with: (1) girls (p = 0.006), (2) more feeding problems (p = 0.018), (3) shorter duration per meal (p = 0.022), and (4) poor communication ability (p = 0.001).It appears that periodic anthropometric assessments of CP children are indicated for the early identification of nutritional risk. Further nutritional management should be arranged for undernourished children to promote their nutritional status and improve growth and functional capacity.

To examine whether electrical acupuncture therapy through adhesive surface electrodes and concomitant auricular acupuncture therapy could improve the neurologic or functional recovery in acute traumatic spinal cord injury patients.A total of 100 acute traumatic spinal cord injury patients with American Spinal Injury Association (ASIA) impairment grading of A and B were recruited into this study. They were randomly divided into the acupuncture and control groups. In the acupuncture group, electrical acupuncture therapy via the adhesive surface electrodes were applied to the bilateral Hou Hsi (SI3) and Shen Mo (B62) acupoints. In auricular acupuncture, four acupoints related to the spinal cord were selected for stimulation at the antihelix, helix, and lower portion of the ear-back areas. Acupuncture therapy was initiated early in the emergency room setting or soon after spinal surgical intervention. Rehabilitation therapy was also provided to the patients during acupuncture therapy. In the control group, only rehabilitation therapy was provided to the patients. Neurologic and functional scores were assessed during the time of admission, hospital discharge, and 1-yr postinjury follow-up.There were significant improvements in neurologic (sensory and motor), functional, and FIM scores in the acupuncture group compared with the initial admission period when assessed during the time of hospital discharge and the 1-yr postinjury follow-up. A greater percentage of patients in the acupuncture group recovered to a higher ASIA impairment grading.The use of concomitant auricular and electrical acupuncture therapies, when implemented early in acute spinal cord injury, can contribute to significant neurologic and functional recoveries.

Primary hyperparathyroidism today is diagnosed in the asymptomatic phase because of the inclusion of serum calcium in sequential multichannel analysis. The purpose of present study was to test for neuromuscular abnormalities in asymptomatic patients and to test the improvement of neuromuscular performance after parathyroidectomy.Nine patients with primary hyperparathyroidism and nine patients with nodular goiter were enrolled in this study. Neuromuscular recovery including muscle power, sensation, and fine motor movement was studied before operation and 1 week and 4 weeks after operation. The muscle power was measured as grip power, palm pinch, lateral pinch, and three-chuck pinch. The sensation was measured as touch sensation and two-point discrimination. The fine motor movement was measured with the Purdue Pegboard Test and the Minnesota Manual Dexterity Test.Four weeks after the operation the patients with hyperparathyroidism had increased their muscle strength and had improved fine motor movement but no change was noted in two-point and touch sensation. When the postoperative muscle recovery was compared, there was a reversible correlation (r = -0.62; p0.05) with the preoperative muscle strength and no correlation with the preoperative serum calcium, phosphate, alkaline phosphatase, and intact parathyroid hormone levels. No such improvement was detectable among the control subjects.Surgery can improve muscle strength and fine motor movement but does not affect sensation in asymptomatic patients.