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.

Standard early rehabilitation and lower limb transcutaneous nerve or neuromuscular electrical stimulation in acute stroke patients: a randomized controlled pilot study.

OBJECTIVE: We investigated adding lower limb transcutaneous nerve stimulation or neuromuscular electrical stimulation to standard early rehabilitation in acute stroke patients. DESIGN: An assessor-blinded, randomized controlled pilot study. SETTING: A medical stroke center. SUBJECTS: First-stroke patients aged 20-80 years admitted to the stroke center within 24 hours post stroke. INTERVENTIONS: A total of 42 participants were randomly assigned to groups: transcutaneous nerve stimulation + standard early rehabilitation, neuromuscular electrical stimulation + standard early rehabilitation, or standard early rehabilitation-only. Transcutaneous nerve or neuromuscular electrical stimulation was delivered to the affected tibialis anterior and quadriceps muscles for 30 minutes a day, five days per week for two weeks. MAIN MEASURES: The Postural Assessment Scale for Stroke Patients, the Functional Independence Measure, and three mobility milestones, namely, sitting for >five minutes, standing for >one minute, and walking ⩾50 m, were evaluated, respectively, at baseline, at the two-week post-intervention, and at two-week follow-up. RESULTS: Significant differences existed in the Postural Assessment Scale for Stroke Patients scores between the transcutaneous nerve stimulation and standard early rehabilitation-only groups measured at two-weeks post-intervention (mean (SD) = 31.38 (5.39) and 18.00 (8.65), respectively) and at the two-week follow-up (34.08 (2.69) and 26.14 (7.77), respectively). A higher proportion of participants could walk ⩾50 m independently in the transcutaneous nerve stimulation group than in the standard early rehabilitation-only group at the two-week post-intervention (P = 0.013) and two-week follow-up (P = 0.01) marks. CONCLUSION: Two weeks of transcutaneous nerve stimulation added to standard early rehabilitation improved postural stability and walking in acute stroke patients.

Reliability of lower extremity muscle strength measurements with handheld dynamometry in stroke patients during the acute phase: a pilot reliability study.

[Purpose] No literature has described a suitable method for measuring muscle strength in a supine position during acute phase after stroke. This study investigated the feasibility and reliability of using a commercial handheld dynamometer to measure the muscle strengths of the hip flexor, knee extensor, and dorsiflexor in the supine position with a modified method for patients at a stroke intensive care center within 7 days of stroke onset. [Subjects and Methods] Fifteen persons with acute stroke participated in this cross-sectional study. For each patient, the muscle strengths of the hip flexors, knee extensors, and dorsiflexors were measured twice by two testers on the same day. Each patient was re-tested at the same time of day one day later. Inter-rater and test-retest reliability were then determined by the intraclass correlation coefficients (ICCs). [Results] For the three muscle groups, the inter-rater reliability ICCs were all 0.99 and the test-retest reliability ICCs were greater than 0.85. The investigated method thus has good inter-rater reliability and high agreement between the test-retest measurements, with acceptable measurement errors. [Conclusion] The modified method using a handheld dynamometer to test the muscle strength of acute stroke patients is a feasible and reliable method for clinical use.

Influence of Verbal Instruction on Gait Training in Parkinson Disease: A Randomized Controlled Trial.

OBJECTIVE: Verbal instruction is one of the most commonly used methods that therapists use to correct walking pattern for people with Parkinson disease. This study aimed to compare the long-term training effects of two different verbal instructions that either asked the participants to "take big steps" or "strike the ground with the heel" on walking ability in individuals with Parkinson disease. DESIGN: Forty-five participants with Parkinson disease were randomized into the big-step or heel strike group. The participants underwent 12 sessions of treadmill and overground gait training. Throughout the interventions, the big-step group received an instruction to "take big steps," while the heel strike group received an instruction to "strike the ground with your heel." The primary outcome was gait performance, including velocity, stride length, cadence, and heel strike angle. The participants were assessed before, immediately after, and 1 mo after training. RESULTS: Both groups showed significant improvements in gait performance after training. The heel strike group showed continuous improvements in velocity and stride length during the follow-up period; however, the big-step group showed slightly decreased performance. CONCLUSIONS: A verbal instruction emphasizing heel strike can facilitate long-term retention of walking performance in people with Parkinson disease.

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.

Influences of Aerobic Exercise on Motor Sequence Learning and Corticomotor Excitability in People With Parkinson's Disease.

BACKGROUND: People with Parkinson's disease (PD) are known to have motor learning difficulties. Although numerous studies have demonstrated that a single bout of aerobic exercise (AEX) can facilitate motor learning in non-disabled adults, the same beneficial effect in PD is unknown. Furthermore, associated neuroplastic changes have not been investigated. OBJECTIVES: This study aimed to determine whether a single bout of aerobic exercise (AEX) can facilitate motor sequence learning in people with PD and to investigate the associated neurophysiological changes. METHODS: Thirty individuals with PD were recruited and randomized into the exercise group (PD + AEX) and non-exercise group (PD - AEX). At the first visit, corticomotor excitability was assessed using transcranial magnetic stimulation (TMS). All participants then performed a serial reaction time task (SRTT) followed by 20 minutes of moderately-high intensity aerobic exercise (AEX) for the PD + AEX group or rest for the PD - AEX group. The SRTT and TMS were reevaluated at 3 time points: immediately after aerobic exercise (AEX) or rest, on the second day after practice (D2), and a week after practice (D7). RESULTS: Both groups showed improvement throughout practice. At retention, the PD + AEX group showed improved SRTT performance on D7 compared to D2 (P = .001), while the PD - AEX group showed no change in performance. TMS results showed that the PD + AEX group had significantly higher corticomotor excitability than the PD - AEX group on D7. CONCLUSION: A single session of aerobic exercise (AEX) could enhance motor sequence learning and induce neuroplastic changes. Clinicians can consider providing aerobic exercise (AEX) after motor task training for people with PD. CLINICAL REGISTRATION: NCT04189887 (ClinicalTrials.gov).

Reliability of using foot-worn devices to measure gait parameters in people with Parkinson's disease.

BACKGROUND: Recent advances in technology have warranted the use of wearable sensors to monitor gait and posture. However, the psychometric properties of using wearable devices to measure gait-related outcomes have not been fully established in patients with Parkinson's disease (PD). OBJECTIVE: This study aimed to investigate the test-retest reliability of body-worn sensors for gait evaluation in people with PD. Additionally, the influence of disease severity on the reliability was determined. METHODS: Twenty individuals with PD were recruited. During the first evaluation, the participants wore inertial sensors on their shoes and walked along a walkway thrice at their comfortable walking speed. The participants were then required to return to the lab after 3-5 days to complete the second evaluation with the same study procedure. Test-retest reliability of gait-related outcomes were calculated. To determine whether the results would be affected by disease severity, reliability was re-calculated by subdividing the participants into early and mid-advanced stages of the disease. RESULTS: The results showed moderate to good reliability (ICC = 0.64-0.87) of the wearable sensors for gait assessment in the general population with PD. Subgroup analysis showed that the reliability was higher among patients at early stages (ICC = 0.71-0.97) compared to those at mid-advanced stages (ICC = 0.65-0.81) of PD. CONCLUSIONS: Wearable sensors could reliably measure gait parameters in people with PD, and the reliability was higher among individuals at early stages of the disease compared to those at mid-advanced stages. Absolute reliability values were calculated to act as references for future studies.

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.

Effects of using relaxation breathing training to reduce music performance anxiety in 3rd to 6th graders.

The current study examined the effects of applying relaxation breathing training (RBT) as a means to reduce music performance anxiety (MPA) in young, talented musicians. A group of 59 young musicians from 3rd to 6th grade participated in this study, and all of them started RBT twice a week for 2 months prior to the examination. Four tests--2 mos, 1 mos, half an hour and 5 min before the examination--were conducted to examine the level of MPA after the application of RBT. Results show that the degree of MPA 5 min before the trial was lower than the degree of performance anxiety half an hour before the jury (t = -3.683, p < 0.01), which indicated that the RBT was associated with a decrease in MPA. Although a series of RBT exercises was applied, results indicated that when approaching the date of examination, the degree of performance anxiety still increased and reached its maximum half an hour before the jury. The recommendation for future studies is to combine the application of RBT with other methods to expand its effect in reducing MPA.

Corticomotor Excitability Changes Associated With Freezing of Gait in People With Parkinson Disease.

BACKGROUND AND PURPOSE: Freezing of gait (FOG) is a debilitating gait disorder in people with Parkinson's disease (PD). While various neuroimaging techniques have been used to investigate the pathophysiology of FOG, changes in corticomotor excitability associated with FOG have yet to be determined. Research to date has not concluded if changes in corticomotor excitability are associated with gait disturbances in this patient population. This study aimed to use transcranial magnetic stimulation (TMS) to investigate corticomotor excitability changes associated with FOG. Furthermore, the relationship between corticomotor excitability and gait performances would be determined. METHODS: Eighteen participants with PD and FOG (PD + FOG), 15 without FOG (PD - FOG), and 15 non-disabled adults (Control) were recruited for this study. Single and paired-pulse TMS paradigms were used to assess corticospinal and intracortical excitability, respectively. Gait performance was measured by the 10-Meter-Walk test. Correlation analysis was performed to evaluate relationships between TMS outcomes and gait parameters. RESULTS: Compared with the Control group, the PD + FOG group showed a significantly lower resting motor threshold and reduced short intracortical inhibition (SICI). Correlation analysis revealed a relationship between resting motor evoked potential and step length, and between SICI and walking velocity in the Control group. While the silent period correlated with step length in the PD - FOG group, no significant relationship was observed in the PD + FOG group. DISCUSSION AND CONCLUSION: Compared to the Control group, the PD + FOG group exhibited reduced corticomotor inhibition. Distinct correlations observed among the three groups suggest that the function of the corticomotor system plays an important role in mediating walking ability in non-disabled adults and people with PD - FOG, while people with PD + FOG may rely on neural networks other than the corticomotor system to control gait.

Effects of rhythmic auditory cueing on stepping in place in patients with Parkinson's disease.

BACKGROUND: Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease(PD). METHODS: Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition). RESULTS: In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023). CONCLUSIONS: Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.

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.

Practice Variability Combined with Task-Oriented Electromyographic Biofeedback Enhances Strength and Balance in People with Chronic Stroke.

OBJECTIVES: To investigate the effects of practice variability combined with task-oriented electromyographic biofeedback (EMGBFB) on strength and balance in people with chronic stroke. METHODS: Thirty-three participants were randomly assigned into the constant force EMGBFB tibialis anterior (TA) exercise (constant) group, the variable force EMGBFB tibialis anterior exercise (variable) group, or the upper extremity exercise without EMGBFB (control) group. Subjects in each group received 6 weekly sessions of exercise training (18 sessions, 40 minutes each). Motor outcomes were TA strength, balance (anteroposterior sway amplitude defined by limits of stability test in dynamic posturography), walking speed, Timed Up and Go test (TUGT), and six-minute walk test (6MWT). Data were measured at baseline, 1 day, 2 weeks, and 6 weeks posttraining. RESULTS: TA strength increased significantly in both the constant and variable groups after training. Balance significantly improved only in the variable group. All participants showed improvements in walking speed, TUGT, and 6MWT. CONCLUSIONS: Task-oriented EMGBFB-assisted TA exercise training improved muscle strength in people with chronic stroke. Practicing to reach varying force levels during EMGBFB-assisted tibialis anterior exercises facilitated improvements in the ability to sway in the anteroposterior direction while standing. Our findings highlight the importance of task-oriented and motor learning principles while using the EMGBFB as an adjunct therapy in stroke rehabilitation. This trial was registered with trial registration number NCT01962662.

Effects of Extracorporeal Shock Wave-Mediated Transdermal Local Anesthetic Drug Delivery on Rat Caudal Nerves.

Cavitation plays a substantial role in the clinical effects of extracorporeal shock wave therapy (ESWT). It is also generally accepted as a major mechanism in sonophoresis. To identify the enhancing effect of extracorporeal shock wave-mediated transdermal drug delivery, 24 Wistar rats were randomly assigned to four groups: (i) topical application of a eutectic mixture of local anesthetics (EMLA); (ii) 1-MHz ultrasound; (iii) ESWT pre-treatment combined with EMLA application; (iv) ESWT concurrent with EMLA application on rat tails. The degree of anesthesia was assessed using the amplitude and latency of sensory nerve action potentials within 5 min after a 60-min EMLA application. The results indicated that ESWT pre-treatment and concurrent ESWT accelerated the anesthetic effects of the EMLA cream on the tail nerve (p < 0.05). This finding might indicate that shock wave-mediated transdermal drug delivery is possible during the ESWT period.

Football APP based on smart phone with FES in drop foot rehabilitation.

BACKGROUND: Long-term, sustained progress is necessary in drop foot rehabilitation. The necessary inconvenient body training movements, the return trips to the hospital and repetitive boring training using functional electrical stimulation (FES) often results in the patient suspending their training. The patient's drop foot rehabilitation will not progress if training is suspended. OBJECTIVE: A fast spread, highly portable drop foot rehabilitation training device based on the smart phone is presented. This device is combined with a self-made football APP and feedback controlled FES. The drop foot patient can easily engage in long term rehabilitation training that is more convenient and interesting. METHODS: An interactive game is established on the smart phone with the Android system using the originally built-in wireless communications. The ankle angle information is detected by an external portable device as the game input signal. The electrical stimulation command to the external device is supplemented with FES stimulation for inadequate ankle efforts. RESULTS: After six-weeks training using six cases, the results indicated that this training device showed significant performance improvement (p< 0.05) in the patient's ankle dorsiflexion strength, ankle dorsiflexion angle, control timing and Timed Up and Go. CONCLUSIONS: Preliminary results show that this training device provides significant positive help to drop foot patients. Moreover, this device is based on existing and universally popular mobile processing, which can be rapidly promoted. The responses of clinical cases also show this system is easy to operate, convenient and entertaining. All of these features can improve the patient's willingness to engage in long term rehabilitation.

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 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.

SEMG-controlled telephone interface for people with disabilities.

This paper proposes the development of a surface electromyographic (SEMG)-controlled telephone interface for the disabled. The system is composed of three major components: (1) a SEMG receiving/signal-processing module; (2) a row-column scanning interface for the telephone dialling pad; and (3) a main controller, the Intel-8951 microprocessor. The design concept was based on the idea of using a SEMG generated by the disabled and converting it into a trigger pulse. This could allow convenient control of the dialing motion in the row-column scanning keys of a telephone dialling pad. People with disabilities are competent for certain kinds of work such as being a telephone operator. The increase of opportunities to perform a job for the disabled would help them live independently.

A problem-based e-Learning prototype system for clinical medical education.

The purpose of this system is to establish virtual medical school (VMS) as the platform of e-learning center, which integrates collaborative and self-directed learning environment by virtual group, classroom and library, and automatically converts valuable clinical case from Hospital Information System (HIS) database into virtual patient by online authoring tools for problem-based e-learning. In this system, the VMS provides a problem-based e-learning environment, and utilizes HIS to capture and store valuable clinical cases. All medical students and residents now have the opportunity to learn from these typical cases online. The VMS at National Taiwan University has the potential to develop into a national medical education network for the meditation and provision of comprehensive medical resources. The system will use the international standard SCORM 1.2 to develop teaching material and assist with the HL7 v2.4, CDA v1.0 standards to connect Electronic Medical Record (EMR) systems in the hospital. It can provide resources sharing among medical centers by using high transportation ability of Grid Computing integrated with the broadband video platform, Access Grid, and personal multiple point videoconference platform, Multi-video, to popularize the application of e-learning in clinical medical education.

Reducing anterior tibial translation by applying functional electrical stimulation in dynamic knee extension exercises: quantitative results acquired via marker tracking.

BACKGROUND: Pain that accompanies anterior cruciate ligament deficiency during dynamic knee extension exercises is usually caused by excessive anterior tibial translation, which can be restricted if the anterior cruciate ligament was intact. METHODS: A functional electrical stimulator is incorporated with a training device to induce hamstring contractions during certain degrees of knee extension to replicate effects similar to those generated by an intact anterior cruciate ligament and to reduce anterior tibial translation. By using a camera that tracks markers placed on bony prominences of the femur and tibia, the anterior tibial translations corresponding to various settings were determined by customized image processing procedures. FINDINGS: In the electrical stimulation sessions, the knee extensions with electrical stimulation feedback induced significantly (n=6, P<.05) less anterior tibial translation over the range of 20 to 50° when compared to those using the standard isokinetic shank restraint. Likewise, the knee extensions with an anti-shear device that blocks tibia displacement mechanically also induced significantly (n=6, P<.05) less anterior tibial translation, but over a different range of knee extension (30 to 70°). INTERPRETATION: Despite the fact that both the electrical stimulator and the anti-shear device assisted in reducing anterior tibial translation, the tendency of the curves generated with the functional electrical stimulation was generally more similar to those generated when using the standard isokinetic shank restraint.