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Study design Case report. Objective To discuss a case of atlantoaxial rotatory fixation (AARF) successfully treated with manual therapy. Summary of background data A 9-year-old girl experienced acute torticollis and neck stiffness after a traffic accident. Image studies revealed AARF, a cause of pediatric torticollis. She received closed reduction with the aid of C-arm fluoroscopy under general anesthesia. She was referred to the researchers' rehabilitation clinic because of unsolved torticollis and limited head rotation. At her initial visit, we found that her head tilted to the right and rotated to the left. Tenderness and muscle guarding over the right suboccipital region were also apparent. The first manual therapy significantly improved neck motion after soft tissue release applying to the suboccipital muscle group. Methods We arranged for her to enter a rehabilitation program including (1) soft tissue release technique to the suboccipital muscle group for 10 minutes and (2) muscle energy technique for neck flexion, extension, lateral bending, and rotation for 10 to 15 minutes. Results After 3 months' rehabilitation, her symptoms of torticollis, neck pain, and limited range of motion achieved near-total recovery. Conclusion This case report presents the association between suboccipital muscles and AARF, suggesting that the soft tissue release of suboccipital muscle group may facilitate recovery from AARF. More studies are needed to verify the inferences of this case report.

Background: Ischemic stroke (IS) is a prevalent disease causing a body disability, the third leading cause of death in Taiwan. It shows that the level of intercellular adhesion molecular-1 (ICAM-1) in IS patients is higher than control subjects. Objective: This study is to investigate the possible association of ICAM-1 (G1548A) polymorphism in IS patients. Materials and Methods: A total of 646 subjects were enrolled in this study, including 312 IS patients, and 334 controls without a history of symptomatic IS. The ICAM-1 (G1548A) polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. Clinical factors were also determined. Results: The frequencies of the ICAM-1 (G1548A) polymorphism for G/G, G/A, and A/A were 74.8%, 23.9%, and 0.3%, respectively, in healthy controls, and 62.8%, 32.1%, and 5.1%, respectively, in patients. The frequency of the ICAM-1 (G1548A) A allele (21.2% versus 13.2%, respectively; P = 0.007) and the carriers of the ICAM-1 (G1548A) A allele (37.2% versus 25.2%; P = 0.019, OR 1.76, 95% CI 1.1-2.83) are great in IS patients compared with healthy controls. There is a higher risk of IS associated with homozygosity for the ICAM-1 (G1548A) A allele (AA genotype) compared with the control population (5.1% vs. 0.3%, respectively, P = 0.04; OR 5.1, 95% CI 1.19-21.66). We also observed both hypertension and diabetes has shown a positive association with IS. Conclusions: The ICAM-1 (G1548A) polymorphism was associated with independent risk factor for the development of IS.

Background and objective . Botulinum toxin type A (BtxA) injection and modified constraint-induced movement therapy (mCIMT) are both promising approaches to enhance recovery after stroke. The combined application of these 2 promising modalities has rarely been studied. The aim was to investigate whether combined BtxA and mCIMT would improve spasticity and upper extremity motor function more than BtxA plus conventional rehabilitation in chronic stroke patients with upper extremity spasticity. Methods. In a prospective, randomized controlled, observer-blinded trial with 6-month follow-up, 32 patients (≥1 year after stroke) with ability to actively extend >10° at metacarpophalangeal and interphalangeal joints and 20° at wrist of the affected upper limb were randomized to receive BtxA + mCIMT (combination group) or BtxA + conventional rehabilitation (control group) for 2 hours/day, 3 days/week for 3 months.The primary outcome assessed spasticity on the Modified Ashworth Scale. Secondary outcomes assessed real-world arm function (Motor Activity Log), laboratory motor activity (Action Research Arm Test), and patients’ global satisfaction. Results. A total of 32 stroke patients were recruited, and 29 completed the study. Spasticity significantly improved in all subjects at 4 weeks and 3 months postinjection without between-group differences.The combination group showed significantly greater improvements in elbow, wrist, and finger spasticity ( P = .019, P = .019, and P < .001, respectively), affected upper extremity real-world arm function ( P < .001) and laboratory motor activity ( P < .001) than the control group at 6-month postinjection. Patients reported considerable satisfaction and no serious adverse events occurred. Conclusions. Combining BtxA and mCIMT is an effective and safe intervention for improving spasticity and motor function in chronic stroke patients. The results are promising enough to justify further studies. We recommend future research to address the likely need for including rehabilitation with BtxA to improve function in patients with poststroke spasticity.

SummaryObjectiveTo investigate the effects of intraarticular hyaluronic acid (HA) (Artzal, Seikagaku Corp., Japan) in geriatric participants with unilateral knee osteoarthritis (OA).MethodThis was a prospective, observer-blind study with 6 months follow-up done in the setting of an outpatient rehabilitation department in a university-affiliated tertiary care medical center. Sixty-eight patients, aged 65 years or above, with symptoms and radiographic evidence of unilateral knee OA for at least 6 months were recruited. Patients received five weekly intraarticular injections of Artzal into symptomatic knees. Fifty-six participants completed the study. Fifty age-, body mass- and gender-matched healthy individuals were selected as control. Visual analog scale (VAS), Lequesne index and four balance tests including single-leg stance test (SLS), function reach test (FRT), timed “Up-and-Go” test (TUG) and Berg balance scale (BBS) were assessed before injection and at each follow-up visit in the OA group. Four balance tests were obtained on healthy participants for data comparison.ResultsBefore Artzal injections, the OA group showed significantly worse VAS, Lequesne index and four balance tests scores than did the control group (P

We present a case involving a 24-year-old woman who developed anterior spinal cord infarction with paraplegia but preserved posterior column sensation shortly after her first surfing lesson. The clinical presentation and magnetic resonance imaging findings were compatible with anterior cord infarction from T11 to conus medullaris. However, a thorough diagnostic workup revealed no predisposing factors of ischemia. Like previously reported cases of surfer's myelopathy, our patient was inexperienced and lacked trained back muscles, though none of the previously related cases were reported to have anterior cord infarction. In this case report, we discuss the probable relationship between surfing and ischemic myelopathy. Non-traumatic myelopathy in surfing is a relatively new entity thought to occur in surfers while paddling their boards in a hyperextended position and perform the Valsalva maneuver while attempting to stand up on the boards, which may increase intra-spinal pressure. Increased awareness of this injury may make it possible to recognize its early symptoms and prevent further injury.

SummaryObjectiveTo investigate the efficacy, safety and the duration of treatment effectiveness of intra-articular hyaluronic acid (Artz, Japan) in patients with ankle osteoarthritis (OA).MethodAs a prospective clinical trial, 93 patients with unilateral ankle pain for at least 6 months and radiographically classified as Kellgren–Lawrence grade I or II ankle OA were included. After five weekly intra-articular Artz injections, the Ankle Osteoarthritis Scale (AOS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, ankle sagittal range of motion (ROM), patients' global satisfaction, local adverse events and consumption of rescue analgesics were analyzed.ResultsSeventy-five patients completed the study. Significant improvement in AOS and AOFAS ankle/hindfoot scores was noted at 1 week, 1 month, 3 months and 6 months post the fifth injection (P0.05). The majority of patients reported satisfaction at 1 week (100%), 1 month (100%), 3 months (90.7%) and 6 months (86.7%) follow-up. Local adverse events occurred in 6.7% of patients. Acetaminophen consumption dropped significantly following treatment (P