Using near-infrared spectroscopy to investigate the effects of pressures and durations of cupping therapy on muscle blood volume and oxygenation.

Cupping therapy has been widely used to manage musculoskeletal impairment. However, the effects of pressure and duration of cupping therapy on the hemodynamic activity of the muscle have not been investigated. A 2 × 2 repeated measures factorial design was used to examine the main effect and interaction of pressure (-225 and -300 mmHg) and duration (5 and 10 min) on biceps muscle blood flow using near-infrared spectroscopy in 18 participants. The results showed that a significant interaction is between pressure and duration on deoxy-hemoglobin (p = 0.045). A significant main effect of pressure is on oxyhemoglobin (p = 0.005) and a significant main effect of duration is on oxyhemoglobin (p = 0.005). Cupping therapy at -300 mmHg for 10 min results in a higher oxyhemoglobin (6.75 ± 2.08 µM) and deoxy-hemoglobin (1.71 ± 0.78 µM) compared to other three combinations. Our study provides first evidence that the pressure and duration factors of cupping therapy can significantly affect muscle blood volume and oxygenation.

The effects of low-level laser therapy on muscle strength and functional outcomes in individuals with knee osteoarthritis: a double-blinded randomized controlled trial.

The purpose of this study was to compare the therapeutic effects of low-level laser therapy (LLLT) with 808 and 660 nm wavelength on muscle strength and functional outcomes in individuals with knee osteoarthritis (OA). A total of 47 participants were randomly assigned to the 808 nm, 660 nm, and sham control groups. Two LLLT groups received continuous LLLT with a mean power of 300 mW in different wavelengths at the knee joint 15 min a session three days per week for eight weeks, while the control group received the sham LED treatment. The knee strength and functional performance involving 30-s sit-to-stand, 40 m fast-paced walk, stair climbing, and the TUG test were measured at the baseline and one week after the interventions were completed. The results showed that knee extensor strength was more improved in the 808 nm group as compared to the 660 nm group (p < 0.001, d = 0.57) and the sham control (p < 0.001, d = 0.40), while increased flexor strength was demonstrated in the 808 nm (p = 0.009, d = 0.67) and sham control groups (p < 0.001, d = 0.97). The number of 30-s sit-to-stand was increased only in the 660 nm group (p = 0.006, d = 0.49). All three groups exhibited improvements in the other three functional performance-based tests after the interventions with no statistically significant differences among the groups. In conclusion, both intervention groups improved muscle strength and functional performance as compared to the control group. The 808 nm wavelength group showed better results in knee extensor strength. Therefore, laser therapy is suggested to be integrated into rehabilitation programs to improve muscle strength and functional performance in the population with knee OA.

Effects of a task-based biofeedback training program on improving sensorimotor function in neuropathic hands in diabetic patients: a randomized controlled trial.

BACKGROUND: Symptoms of diabetic hands have been gradually elucidated, however the interventions for these hand problems are typically underemphasized. Few studies have discussed intervention effects on sensorimotor problems in hands, which prevent diabetic patients from executing their daily routines and lower their quality of life (QoL). AIM: This study has investigated the effects of task-based biofeedback training compared with home-based programs on sensorimotor function and QoL in diabetic patients with neuropathic hands. DESIGN: A single blind randomized controlled trial. SETTING: Outpatient clinic at a university hospital. POPULATION: Thirty-eight patients with diabetic hand neuropathy whose sensorimotor functions were impaired based on screening with a pinch-holding-up activity (PHUA) test. METHODS: Participants were randomly assigned to either a computerized evaluation and re-education biofeedback (CERB) (N.=20) or a home-based (tendon gliding exercise in conjunction with resistive exercise) (N.=18) group. The primary outcome was sensorimotor control of a hand using the PHUA test. Secondary outcomes included changes in Semmes-Weinstein monofilament, two-point discrimination, the Purdue Pegboard test and a self-reported QoL questionnaire. The measurements were conducted before and after a 6-week treatment program. RESULTS: The CERB group significantly improved efficiency in pinch force output during the PHUA test by reducing the percentage of maximum pinch strength (change from 34.5±11.66 to 30.7±10.16%, P=0.001), and there was a statistically significant between-group difference (P=0.00, 95% CI: -12.59 to -3.34, F=9.42). The CERB group showed superior treatment effects as compared to the control group on the two-point discrimination results (P=0.01) as well as the pin insertion subtests in the Purdue pegboard test (P=0.01). The QoL results also revealed significant between-group differences in several items of the Diabetes-39 (P<0.05). CONCLUSIONS: This study showed that a task-based biofeedback training program provides superior benefits for restoration of hand sensorimotor functioning in diabetic patients as compared to a home-based program combining tendon gliding exercise and resistive exercise. CLINICAL REHABILITATION IMPACT: Using task-based biofeedback training as one of the rehabilitation strategies may be an effective approach for restoration of sensory function, precision pinch performance, hand dexterity, and QoL for patients with diabetes-related neuropathy.

Setup of a novel biofeedback prototype for sensorimotor control of the hand and preliminary application in patients with peripheral nerve injuries.

BACKGROUND: Biofeedback training is widely used for rehabilitative intervention in patients with central or peripheral nervous impairment to train correct movement patterns; however, no biofeedback apparatus is currently available to correct pinch force ratios for patients with sensory deficiencies. DESIGN: A cross-sectional and longitudinal design was used in an observational measurement study for establishing a prototype and to determine the effects of biofeedback intervention, respectively. OBJECTIVE: This study aimed to develop a computerized evaluation and re-education biofeedback (CERB) prototype for application in clinical settings. METHODS: A CERB prototype was developed integrating pinch apparatus hardware, a biofeedback user-controlled interface, and a data processing/analysis interface to detect momentary pinch performances in 79 people with normal hand sensation. Nine patients with hand sensory impairments were recruited to investigate the effects of training hand function with the CERB prototype. RESULTS: Hand dominance, pinch pattern, and age significantly affected the peak pinch force and force ratio for lifting a 480-g object with a steel surface. In the case of the 79 volunteers with normal hand sensation, hand dominance affected the time lag between peak pinch force and maximum load; however, it was unaffected by pinch pattern or age. Training with the CERB prototype produced significant improvements in force ratio and better performance in the pin insertion subtests, although the results for both 2-point discriminative and Semmes-Weinstein monofilament tests did not change significantly. LIMITATIONS: The intervention findings are preliminary. CONCLUSIONS: This study developed a conjunct system suited for evaluating and restoring sensorimotor function for patients with impaired hand sensibility. The results from the participants with normal hand sensation could serve as a reference database for comparison with patients with nerve injuries.

Clinical application of computerized evaluation and re-education biofeedback prototype for sensorimotor control of the hand in stroke patients.

BACKGROUND: Hemianaesthesia patients usually exhibit awkward and inefficient finger movements of the affected hands. Conventionally, most interventions emphasize the improvement of motor deficits, but rarely address sensory capability and sensorimotor control following stroke. Thus it is critical for stroke patients with sensory problems to incorporate appropriate strategies for dealing with sensory impairment, into traditional hand function rehabilitation programs. In this study, we used a custom-designed computerized evaluation and re-education biofeedback (CERB) prototype to analyze hand grasp performances, and monitor the training effects on hand coordination for stroke patients with sensory disturbance and without motor deficiency. METHODS: The CERB prototype was constructed to detect momentary pinch force modulation for 14 sub-acute and chronic stroke patients with sensory deficiency and 14 healthy controls. The other ten chronic stroke patients (ranges of stroke period: 6-60 months) were recruited to investigate the effects of 4-weeks computerized biofeedback treatments on the hand control ability. The biofeedback procedures provide visual and auditory cues to the participants when the interactive force of hand-to-object exceeded the target latitude in a pinch-up-holding task to trigger optimal motor strategy. Follow-up measurements were conducted one month after training. The hand sensibility, grip forces and results of hand functional tests were recorded and analyzed. RESULTS: The affected hands of the 14 predominant sensory stroke patients exhibited statistically significant elevation in the magnitude of peak pinch force (p = 0.033) in pinching and lifting-up tasks, and poor results for hand function tests (p = 0.005) than sound hands did. In addition, the sound hands of patients were less efficient in force modulation (p = 0.009) than the hands of healthy subjects were. Training with the biofeedback system produced significant improvements in grip force modulation (p = 0.020) and better performances in the subtests of pin insertion (p = 0.019), and lifting of lightweight objects (p = 0.005). CONCLUSIONS: The CERB prototype can provide momentary and interactive information for quantitative assessing and re-educating force modulation appropriately for stroke patients with sensory deficits. Furthermore, the patients could transfer the learned strategy to improve hand function.

Adjuvant hyperbaric oxygen therapy in the treatment of hemodialysis patients with chronic osteomyelitis.

BACKGROUND: Hemodialysis dependence is an independent risk factor for hematogenous complication, including distant metastatic infection and osteomyelitis. Chronic osteomyelitis is a serious disease that fails to respond to aggressive medical and surgical treatment. Hyperbaric oxygen therapy has been proved to enhance bone and soft tissue healing in many studies. This article presents the preliminary result of hyperbaric oxygen therapy in hemodialysis-dependent patients with chronic osteomyelitis. MATERIALS AND METHODS: Ten hemodialysis dependent patients who were diagnosed with chronic diffuse osteomyelitis were treated prospectively with adjunctive hyperbaric oxygen therapy, in addition to aggressive surgical debridement and antibiotic treatment. RESULTS: The hyperbaric oxygen therapy averaged 20 daily sessions. Successful treatment was achieved in eight patients (80%). The mean length of treatment was 21 days. The preliminary results are comparable with other series. CONCLUSION: Hyperbaric oxygen is effective as an adjunct to aggressive medical and surgical treatment in chronic refractory osteomyelitis among hemodialysis-dependent patients.