The effect of electroacupuncture merged with rehabilitation for frozen shoulder syndrome: A single-blind randomized sham-acupuncture controlled study.

PURPOSE: Frozen shoulder syndrome (FSS) causes pain and reduces the range of motion in the shoulder joint. To investigate the short and medium-term effects of electroacupuncture in people with FSS, we evaluated the therapeutic effects of true and sham electroacupuncture on pain relief and improvement of shoulder function. METHODS: In this randomized, single-blind controlled clinical trial, 21 subjects with FSS were randomly assigned to two groups: a true electroacupuncture group (TEAG) and a sham electroacupuncture group (SEAG). The two groups underwent 18 sessions of treatment over approximately 6-9 weeks and were then followed up at 1, 3, and 6 months. Their effectiveness for alleviating the intensity of shoulder pain was evaluated with a visual analog scale (VAS), while improved shoulder mobility was evaluated by the active range of motion (AROM) and passive range of motion (PROM), and shoulder functional ability was evaluated using the Shoulder Pain and Disability Index (SPADI). RESULTS: It demonstrated that the TEAG or SEAG showed lasting effects at 1, 3, and 6 months, although with no significant difference between these two groups in the shoulder functional ability outcomes. However, the decline in the VAS occurred earlier in the TEAG than the SEAG. Also, there was much more improvement in AROM for flexion and abduction in the TEAG than the SEAG. An increase in the abduction angle after electroacupuncture and manual rehabilitation was also apparent. CONCLUSION: These results suggest that electroacupuncture plus rehabilitation may provide earlier pain relief for patients with FSS and could be applied clinically.

Bidirectional and multi-user telerehabilitation system: clinical effect on balance, functional activity, and satisfaction in patients with chronic stroke living in long-term care facilities.

BACKGROUND: The application of internet technology for telerehabilitation in patients with stroke has developed rapidly. OBJECTIVE: The current study aimed to evaluate the effect of a bidirectional and multi-user telerehabilitation system on balance and satisfaction in patients with chronic stroke living in long-term care facilities (LTCFs). METHOD: This pilot study used a multi-site, blocked randomization design. Twenty-four participants from three LTCFs were recruited, and the participants were randomly assigned into the telerehabilitation (Tele) and conventional therapy (Conv) groups within each LTCF. Tele group received telerehabilitation but the Conv group received conventional therapy with two persons in each group for three sessions per week and for four weeks. The outcome measures included Berg Balance Scale (BBS), Barthel Index (BI), and the telerehabilitation satisfaction of the participants. SETTING: A telerehabilitation system included "therapist end" in a laboratory, and the "client end" in LTCFs. The conventional therapy was conducted in LTCFs. RESULTS: Training programs conducted for both the Tele and Conv groups showed significant effects within groups on the participant BBS as well as the total and self-care scores of BI. No significant difference between groups could be demonstrated. The satisfaction of participants between the Tele and the Conv groups also did not show significant difference. CONCLUSIONS: This pilot study indicated that the multi-user telerehabilitation program is feasible for improving the balance and functional activity similar to conventional therapy in patients with chronic stroke living in LTCFs.

Low-cost tele-assessment system for home-based evaluation of reaching ability following stroke.

OBJECTIVE: Tele-assessment techniques can provide healthcare professionals with easily accessible information regarding patients' clinical progress. Recently, kinematic analysis systems have been used to assess rehabilitative outcomes in stroke patients. Kinematic systems, however, are not compatible with tele-assessment. The objective of our study was to develop a tele-assessment system for acquiring kinematic data of forward reaching movements in stroke patients, with an emphasis on cost-effectiveness, portability, and ease of use. MATERIALS AND METHODS: We selected four healthy control participants and eight hemiplegic stroke patients for our study. The stroke patients were classified as Brunnstrom stage III, stage IV, or stage V. Our tele-assessment system used two three-axes accelerometers, a potentiometer, a multifunctional data acquisition card, and two computers. A standardized kinematic system was applied simultaneously to validate the measurements recorded by our tele-assessment system during five repetitions of forward reaching movements. RESULTS: The correlation coefficients of the reaching displacement, velocity, and acceleration measurements obtained using our tele-assessment system and the standardized kinematic system were 0.956, 0.896, and 0.727, respectively. Differences in the maximum reaching distance and the maximum reaching velocity of forward reaching movements were observed among the study groups. There were no significant differences in the time required to complete the testing session among the study groups. CONCLUSIONS: Our tele-assessment system is valid for the evaluation of upper-extremity reaching ability in stroke patients. Further research is needed to investigate the feasibility of the use of the tele-assessment system in patients' homes.

The strategic use of standardized information exchange technology in a university health system.

This article illustrates a Web-based health information system that is comprised of specific information exchange standards related to health information for healthcare services in National Taiwan University Health System. Through multidisciplinary teamwork, medical and informatics experts collaborated and studied on system scope definition, standard selection challenges, system implementation barriers, system management outcomes, and further expandability of other systems. After user requirement analysis and prototyping, from 2005 to 2008, an online clinical decision support system with multiple functions of reminding and information push was implemented. It was to replace its original legacy systems and serve among the main hospital and three branches of 180-200 clinics and 7,500-8,000 patient visits per day. To evaluate the effectiveness of this system, user surveys were performed, which revealed that the average score of user satisfaction increased from 2.80 to 3.18 on a 4-point scale. Among the items, especially e-learning for training service, courtesy communications for system requests, and courtesy communications for system operations showed statistically significant improvement. From this study, the authors concluded that standardized information exchange technologies can be used to create a brand new enterprise value and steadily obtain more competitive advantages for a prestige healthcare system.

An agile enterprise regulation architecture for health information security management.

Information security management for healthcare enterprises is complex as well as mission critical. Information technology requests from clinical users are of such urgency that the information office should do its best to achieve as many user requests as possible at a high service level using swift security policies. This research proposes the Agile Enterprise Regulation Architecture (AERA) of information security management for healthcare enterprises to implement as part of the electronic health record process. Survey outcomes and evidential experiences from a sample of medical center users proved that AERA encourages the information officials and enterprise administrators to overcome the challenges faced within an electronically equipped hospital.

Efficacy of a home-based exercise program for orthotopic heart transplant recipients.

BACKGROUND: A hospital-based cardiac rehabilitation program can significantly improve the cardiopulmonary endurance and quality of life (QOL) in patients after orthotopic heart transplantation (OHT). Home-based programs for these patients have advantages of low cost and high accessibility, but little is known about their efficacy. This prospective study was designed to evaluate the effect of an 8-week home-based exercise program on muscular strength and endurance of lower limbs, aerobic capacity and QOL in OHT recipients. METHODS: Thirty-seven OHT recipients were randomized into exercise (n = 14) or control (n = 23) groups. Exercise group subjects were to exercise at least 3 times a week for 8 weeks. Each subject was evaluated by Cybex testing of right quadriceps strength and endurance, 1-min sit-to-stand test, a symptom-limited maximal exercise test and QOL assessment before and after 8 weeks. RESULTS: Subjects in the exercise group improved significantly in sit-to-stand test, fatigue index of the right quadriceps, maximal workload achieved and physical domain of QOL compared to controls after 8 weeks, regardless of older age and lower value for sit-to-stand test at baseline. CONCLUSIONS: OHT recipients can significantly improve their muscular endurance, sit-to-stand test scores and QOL after a medically directed home-based exercise program.

Patient-driven loop control for hand function restoration in a non-invasive functional electrical stimulation system.

PURPOSE: In this study, a patient-driven loop control in a non-invasive functional electrical stimulation (FES) system was designed to restore hand function of stroke patients with their residual capabilities. METHOD: With this patient-driven loop control, patients use the electromyographic (EMG) signals from their voluntary controlled muscles in affected limbs to adjust stimulus parameters of the system. A special designed FES system generated electrical stimuli to excite the paralyzed muscles through surface electrodes on the basis of the control command from the residual myoelectric signals. EMG signals were also served as the trigger and the adjustment of stimulus parameters and thereby adding versatility of the FES system. Four stroke patients were recruited in the experiment to validate our system. RESULTS: The experimental results showed that hemiplegics could successfully control the system to restore their lost hand functions with the strategy of patient-driven loop control (the average estimated success rate was 77.5% with the tasks of cylindrical grasp and lateral pinch); and further, they would benefit by using the residual capabilities to regain their hand functions from the viewpoints of rehabilitation and psychology. CONCLUSION: According to the experiment results, this patient-driven loop control can be beneficial for hemiplegics to restore their hand functions such as cylindrical grasp and lateral pinch. The control strategy of this study has the potential to be employed not only in the FES system but also in other assistive devices.

Changes of aerobic capacity, fat ratio and flexibility in older TCC practitioners: a five-year follow-up.

The objective of this study was to evaluate the 5-year changes of aerobic capacity, fat ratio and flexibility in older Tai Chi Chuan (TCC) practitioners and sedentary controls. Sixty-nine community-dwelling elderly individuals (mean age: 68.6 +/- 6.3 years) completed this study. The TCC group (18 M; 17 F) had been practicing TCC regularly for 6.3 +/- 3.7 years at baseline and continued training in the study interval. The control group (16 M; 18 F) did not participate in any regular exercise program. A graded bicycle exercise testing was conducted at the baseline and at 5-year to evaluate the age-related decline in aerobic capacity. Triceps and subscapular skinfolds, and thoracolumbar flexibility were also measured. At baseline, the TCC group displayed higher peak oxygen uptake $({\dot{\rm V}}{\rm O}_{2{\rm peak}})$ and thoraolumbar flexibility, and lower fat ratio than the control group. At the 5-year follow-up, the TCC group displayed a smaller decrease in $\dot{\rm V}{\rm O}_{2{\rm peak}}$ than the sedentary group. The annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ in TCC men and women was 0.32 and 0.22 ml . kg(-1) . min(-1), respectively. In the control group, the annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ was 0.50 and 0.36 ml . kg(-1) . min(-1) in men and women, respectively. The TCC group also showed a smaller increase of body fat ratio, and a less decrease of flexibility than the control group. In conclusion, long-term practice of TCC attenuates the age-related decline of aerobic capacity, and it also reduces the increase of body fat ratio in older individuals. TCC may be prescribed as a conditioning exercise for the elderly to maintain their health fitness.

Assistive Control System for Upper Limb Rehabilitation Robot.

This paper presents an assistive control system with a special kinematic structure of an upper limb rehabilitation robot embedded with force/torque sensors. A dynamic human model integrated with sensing torque is used to simulate human interaction under three rehabilitation modes: active mode, assistive mode, and passive mode. The hereby proposed rehabilitation robot, called NTUH-ARM, provides 7 degree-of- freedom (DOF) motion and runs subject to an inherent mapping between the 7 DOFs of the robot arm and the 4 DOFs of the human arm. The Lyapunov theory is used to analyze the stability of the proposed controller design. Clinical trials have been conducted with six patients, one of which acts as a control. The results of these experiments are positive and STREAM assessment by physical therapists also reveals promising results.

The M3S-based electric wheelchair for the people with disabilities in Taiwan.

PURPOSE: This study aims to establish an electronic wheelchair system in Taiwan that conforms to multiple master-multiple slave (M3S) standards. The proposed system could enhance the safety and convenience of people with disabilities. MATERIAL AND METHOD: The M3S-based head-controlled electric wheelchair consists of three parts: (A) the input device, (B) the output device, and (C) the safety device. Head movement can be used as the input control to cause the tilting device to produce a corresponding level of analog voltage (backward & forward/left & right) which is then transmitted to the analogy/digital conversion module to control the output device (wheelchair's motor). Ten subjects with C5 incompleted spinal cord injury were recruited in the clinical assessment. They were randomly assigned into groups A and B. In the group A, the subjects were assigned to operate the head-controlled wheelchair system with M3S standard before operating the head-controlled wheelchair system without M3S standard. In the group B, the subjects were assigned to operate the head-controlled wheelchair system without M3S standard before operating the head-controlled wheelchair system with M3S standard. Two subjects in the group B drop off due to their personal reasons. RESULTS: The time cost for group A in completing tasks 1, 2, and 3 with the M3S and without the M3S were insignificant (p>0.05). The time cost for completing in group B was insignificant (p>0.05). Thus, the wheelchair operating time is depended on the proficiency of the subjects, not the M3S standard added. DISCUSSIONS AND CONCLUSIONS: The time cost for subjects to operate the wheelchair was determined by their proficiency, not the M3S standard control added to the system. However, the M3S-based system did realize the safety mechanism and complex auxiliary tools with and without the plug-in and play function.

Tai Chi Chuan: an ancient wisdom on exercise and health promotion.

Tai Chi Chuan (TCC) is a Chinese conditioning exercise and is well known for its slow and graceful movements. Recent investigations have found that TCC is beneficial to cardiorespiratory function, strength, balance, flexibility, microcirculation and psychological profile. The long-term practice of TCC can attenuate the age decline in physical function, and consequently it is a suitable exercise for the middle-aged and elderly individuals. TCC can be prescribed as an alternative exercise programme for selected patients with cardiovascular, orthopaedic, or neurological diseases, and can reduce the risk of falls in elderly individuals. The exercise intensity of TCC depends on training style, posture and duration. Participants can choose to perform a complete set of TCC or selected movements according to their needs. In conclusion, TCC has potential benefits in health promotion, and is appropriate for implementation in the community.

Response of Taiwanese obese binge eaters to a hospital-based weight reduction program.

OBJECTIVE: To investigate the characteristics and prevalence of binge eating among overweight Taiwanese and to determine the effect of binge eating on outcome of weight loss treatment. METHODS: One hundred and eighty-nine participants in a 12-week traditional weight-reduction program were classified on the basis of the Bulimic Investigation Test, Edinburgh (BITE) scores into binge eaters (>/=20), subthreshold binge eaters (10-19), and nonbinge eaters (0-9). RESULTS: This study found a 15.9% prevalence of binge eating. The binge-eating groups (binge eaters and subthreshold binge eaters) were younger, had an earlier onset of obesity, and more psychological distress than nonbinge eaters. Differences in obesity treatment weight loss among binge eaters, subthreshold binge eaters, or nonbingers by last observation carried forward (LOCF) method were not significant. At the end of treatment, the subthreshold binge eaters had the greatest weight loss. Although their binge eating and mood significantly improved, binge eaters and subthreshold binge eaters still had significant pathology in eating behaviors at completion of the program. CONCLUSION: Alternative treatment strategies focusing on disordered eating behaviors are needed to supplement standard dietary management of overweight treatment-seeking binge eaters.

The comparison of electromyographic pattern classifications with active and passive electrodes.

Electromyographic (EMG) signals are usually acquired using surface electrodes, and they commonly serve as the control sources of myoelectric prosthetic limbs. The use of passive electrodes and amplifiers with adjustable gain is very popular in laboratories for the development of new control strategies. However, active electrodes without conductive jelly are used in most clinical applications of myoelectric hand control. There remains an important question: Are there any differences between using active and passive electrodes in EMG pattern classifications? Autoregressive and cepstral coefficients were used to evaluate recognition rates via both types of electrodes. The results showed that the estimated recognition rates in the passive electrodes were comparable to those in the active ones (averaged recognition rate, 88.5 vs. 85.84% in the autoregressive coefficients, and 84.84 vs. 83.5%, in the cepstral coefficients, respectively). Aside from the lack of significant statistical differences between them, the results imply that the differences between the recognition rates via these electrodes could be negligible. This would be helpful for the myoelectric control of assistive devices.

A head movement image (HMI)-controlled computer mouse for people with disabilities.

PURPOSE: This study proposes image processing and microprocessor technology for use in developing a head movement image (HMI)-controlled computer mouse system for the spinal cord injured (SCI). METHOD: The system controls the movement and direction of the mouse cursor by capturing head movement images using a marker installed on the user's headset. In the clinical trial, this new mouse system was compared with an infrared-controlled mouse system on various tasks with nine subjects with SCI. RESULTS: The results were favourable to the new mouse system. The differences between the new mouse system and the infrared-controlled mouse were reaching statistical significance in each of the test situations (p<0.05). CONCLUSIONS: The HMI-controlled computer mouse improves the input speed. People with disabilities need only wear the headset and move their heads to freely control the movement of the mouse cursor.

Infrared-based communication augmentation system for people with multiple disabilities.

PURPOSE: This study describes an eyeglass-type infrared-based communication board for the nonspeaking with quadriplegia. METHOD: This system is composed of four major components: a headset, an infrared transmitting module, an infrared receiving/signal-processing module, and a main controller, the Intel-8951 microprocessor. This design concept was based on the use of an infrared remote module fastened to the eyeglasses which could allow the convenient control of the input motion on the keys of a communication board, which are all modified with infrared receiving/signal-processing modules. For system evaluation, 12 subjects (all men, 21-45 years old, six normal subjects as the control group and six nonspeaking with quadriplegia as the experimental group) were recruited. RESULTS: The average accuracy of the control group and the experimental group were 93.1 +/- 4.3% and 89.7 +/- 5.5%, respectively. The average time cost of the control group and the experimental group were 78.3 +/- 8.7 s and 89.9 +/- 10.2 s, respectively. An independent t-test revealed that the differences in the average accuracy and the average time cost of the control group and the experimental group were not significant (p>0.05). CONCLUSIONS: The increase of opportunity to communicate using the infrared-based communication board would help people with multiple disabilities to socialize actively.

Distribution of plantar pressure on the second metatarsal head during walking.

BACKGROUND AND PURPOSE: Although high pressure occurs on the second metatarsal head during waking, the distribution of this plantar pressure has not been reported. The purpose of the study was to analyze the distribution of plantar pressure on the second to the fourth metatarsal heads during walking in healthy adults. METHODS: Plantar pressure was measured at the second and adjacent metatarsal heads by 2.54 mm x 2.54 mm transducers during walking in 72 healthy adults (32 women and 40 men). Data at the instant of peak pressure were analyzed using spatial statistics. The length and width of 90% predicted peak pressure (PPP), and anterior and posterior extents to 80, 70, 60, and 50% PPP were regressed by peak pressure, body height, body weight, gender, and foot length of the subjects. RESULTS: The distribution parameters of plantar pressure decreased proportionally from the second to the fourth metatarsal heads, and were different from the first metatarsal head. The distribution parameters were inversely correlated to peak pressure. Besides peak pressure, the length and width of 90% PPP, and anterior extent to 80% PPP could be predicted by body weight. The anterior extent to 70% PPP could be predicted by foot length. The posterior extent to 80, 70, 60, and 50% PPP could be predicted by body height of the subjects. CONCLUSIONS: Besides peak pressure, the distribution of plantar pressure was correlated with body weight, body height, and foot length at different areas on the second metatarsal head in normal adults.

Psychobehavioral response and weight loss prediction in a hospital-based weight reduction program.

BACKGROUND AND PURPOSE: Depression and binge eating are common adverse psychologic responses associated with weight loss in overweight and obese adults. This study aimed to assess the effects of different degrees of weight loss on psychologic functioning and the relationship between mood change and weight reduction, and to identify predictors of short-term weight loss among subjects in a hospital-based weight reduction program. METHODS: A total of 189 obese subjects who participated in a hospital-based weight-reduction program during a 12-week interval were enrolled in this study. They ranged in age from 18 to 67 years (mean, 40.5 +/- 12.3 yr) with female predominance (87.8%). Mean body weight was 79.3 +/- 13.9 kg and mean body mass index was 31.1 +/- 3.8 kg/m2 on entry into the program. Body weight was periodically measured and subjects were asked to complete two self-administered questionnaires including the Brief Symptom Rating Scale (BSRS) and the Bulimic Investigatory Test, Edinburgh (BITE), pre- and post-treatment. RESULTS: Using the last observation carried forward method of analysis, the average weight loss for all participants was 5.6 +/- 3.7 kg. For subjects who completed the 12-week program, weight loss was 6.6 +/- 3.6 kg. Subjects who completed the program (n = 115, 60.8%) had significantly reduced BITE as well as all BSRS subscale scores at the end of the program. There was no linear relationship between mood change and weight loss by correlation analysis, but subjects with higher degrees of weight loss had improvement in more dimensions of psychologic functioning. Initial mood and binge-eating status predicted neither compliance nor weight reduction. Two biologic factors (initial weight loss, initial body weight) and one behavioral factor (attendance rate) were identified as significant predictors of short-term weight loss for all subjects. CONCLUSIONS: There was no evidence that weight loss made mood or eating pathology worse among those who completed the weight loss program. Beneficial effects on general psychologic functioning and eating pathology were demonstrated for subjects with a minimal weight loss of 5% of initial weight and who completed the program. Psychologic assessments at the start of the program did not predict weight loss at the end of participation in this hospital-based weight loss program.

Relative exercise intensity of Tai Chi Chuan is similar in different ages and gender.

This study aims to determine the relative exercise intensity of classical Yang Tai Chi Chuan (TCC) in different ages and gender. One hundred TCC practitioners (54 men and 46 women) aged 25 to 80 years participated in this investigation. Men and women were separated into three groups: young (25-44 y/o), middle-aged (45-64 y/o) and elderly (65-80 y/o). Heart rate (HR) responses during TCC practice were measured by using electrocardiographic telemetry. An exercise test with breath-by-breath measurements of cardiorespiratory function was also performed for each subject during the incremental exercise of leg cycling. Measurements obtained during the TCC practice and exercise testing were compared to determine the exercise intensity of TCC. While performing TCC, the mean HR of men was 141 +/- 12 bpm, 132 +/- 9 bpm and 120 +/- 10 bpm in the young, middle-aged and elderly groups, respectively. Men practiced TCC with mean HR corresponding to 57.8 +/- 3.7%, 56.6 +/- 3.4% and 55.1 +/- 3.1% of heart rate reserve (HRR) in the three groups. Meanwhile, the mean HR of women was 136 +/- 10 bpm, 126 +/- 11 bpm and 115 +/- 12 bpm in the young, middle-aged and elderly groups, respectively. Women practiced TCC with mean HR corresponding to 52.7 +/- 2.8%, 51.5 +/- 2.6% and 50.3 +/- 2.9% of HRR in the three age groups. The results demonstrate that classical Yang TCC is an exercise with moderate intensity, and its exercise intensity is similar across different ages in each gender. In conclusion, TCC is an aerobic exercise and suitable for participants of different ages and gender to improve their functional capacity.

The cardiorespiratory response and energy expenditure of Tai-Chi-Qui-Gong.

The purpose of this study was to evaluate the cardiorespiratory response and energy expenditure during the practice of Tai-Chi-Qui-Gong (TCQG). Forty-seven TCQG practitioners with a mean age of 60.7 +/- 9.9 years participated in this study. The cardiorespiratory responses and energy expenditure were measured by a K4 telemetry system. TCQG has 54 motions and can be divided into 3 sets. The result indicated that the exercise intensity of each motion is about 3 metabolic equivalents (MET) and the energy expenditure of each set is about 60 Kcal. The estimated intensity of TCQG in elderly individuals approximated 50% of the maximum oxygen uptake (vO2max) for men, and 60% of the maximum oxygen uptake (vO2max) for women. The findings demonstrate that TCQG is a low intensity exercise and can be prescribed as an alternative exercise program for cardiopulmonary rehabilitation.

The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners.

The objective of this study was to compare cardiorespiratory responses to exercise among older Qigong participants, Tai Chi Chuan (TCC) practitioners and normal sedentary controls during cycle ergometry. Thirty-six community-dwelling men with a mean age of 59.1 +/- 6.6 years participated in this study. Each group (Qigong, TCC and control) included 12 subjects with matched age and body size. The Qigong group practiced Qigong regularly for 2.3 +/- 1.5 years; the TCC group practiced Yang TCC for 4.7 +/- 2.3 years. Heart rate (HR) responses were measured during the practice of Qigong and TCC. Additionally, breath-by-breath measurement of cardiorespiratory function was performed during the incremental exercise of leg cycling. The mean HR during Qigong and TCC practice was 91 +/- 5 bpm and 129 +/- 7 bpm, respectively. At the peak exercise and the ventilatory threshold (VeT), TCC group displayed highest oxygen uptake (VO2), O2 pulse and work rate among the three groups. The Qigong group also showed higher oxygen uptake and O2 pulse than the control group. At the same relative exercise intensity, the Qigong group had the highest tidal volume among the three groups. In conclusion, Qigong and TCC show a beneficial effect to aerobic capacity in older individuals, but TCC displays a better training effect than Qigong due to its higher exercise intensity. However, Qigong can enhance breathing efficiency during exercise due to the training effect of diaphragmatic breathing.