[Application of "eliminating stagnation and bloodletting/fire needling" in treatment of jingjin diseases].

Based on the development of conditions, the etiology and pathogenesis of jingjin (muscle region of meridian) diseases are summarized as 3 stages, i.e. stagnation due to over-exertion at early stage, manifested by tendon-muscle contracture and tenderness; cold condition due to stagnation, interaction of stasis and cold, resulting in clustered nodules at the middle stage; prolonged illness and missed/delayed treatment, leading to tendon-muscle contracture and impairment of joint function at the late stage. It is proposed that the treatment of jingjin diseases should be combined with the characteristic advantages of fire needling and bloodletting technique, on the base of "eliminating stagnation and bloodletting/fire needling". This combined therapy warming yang to resolve stasis and dispels cold to remove nodules, in which, eliminating the stagnation is conductive to the tissue regeneration, and the staging treatment is delivered in terms of the condition development at different phases.

Yoga and Cutaneous Functional Unit Recruitment for a Patient with Cervical and Upper Extremity Burn Scar Contracture: Case Report.

Burn scar contracture greatly limits function for burn survivors, particularly when the scarring crosses multiple joints. Previous research has identified fields of skin recruited during single joint motion, called cutaneous functional units (CFU), indicating that impairments may be seen distal to the injured tissue. This case report connects the principles of CFU and yoga-inspired therapy modalities in improving clinical outcomes for a burn survivor. The patient is a 38-year-old male who sustained deep partial-thickness electrical burns to his neck, chest, and bilateral upper extremities, presenting with significantly decreased range of motion. The patient attended physical therapy 4 days a week, where he performed a specific yoga asana program during each session. Outcomes including standard range of motion measures, the Vancouver Scar Scale (VSS), and the Neck Disability Index (NDI), which were recorded every 10 sessions. CFUs of cervical extension and shoulder flexion were analyzed via photographs comparing cutaneous position during specified yoga poses and resting anatomical position in standing. Over 30 visits, cervical and shoulder range of motion increased, although the VSS and NDI did not show significant improvement. Yoga poses showed overall cutaneous recruitment distal to the targeted joints, and burned skin was recruited similarly to nonburned skin in positions of stretch. Incorporating multijoint approaches for stretching, like yoga, appears to contribute to improved clinical range-of-motion outcomes when paired with traditional burn-rehabilitation interventions. Yoga poses involving multiple joints align with the principle of CFUs, warranting continued investigation.

Acupotomy treatment for finger joint contracture after immobilization: Case report.

INTRODUCTION: Contractures frequently occur in the finger joints after immobilization. This report describes the effect of acupotomy treatment in patients with joint contracture due to immobilization of the finger joints. PATIENT CONCERNS AND CLINICAL FINDINGS: Case 1 was of a 39-year-old male patient who had flexion limitation of the left thumb and difficulty in grasping. Case 2 was of a 41-year-old female patient who had flexion limitation of the right index finger and difficulty in typing. Stiffness occurred after tendon repair surgery and cast immobilization in both cases. In Case 1, the patient had limited flexion movement of the first metacarpophalangeal and interphalangeal joints after 5 weeks of immobilization of the left thumb in a cast. In Case 2, the patient had limited flexion movement after 3 weeks of immobilization of the second proximal interphalangeal joint of the left hand in a cast. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: We diagnosed both patients with finger joint contracture due to immobilization. Conservative treatment for approximately 4 weeks did not lead to improvement in either patient. Acupotomy is the key treatment for improving movement in Korean Medicine. Therefore, acupotomy was performed, and joint stiffness markedly improved without adverse events. Both patients reported that the daily use of the damaged fingers became comfortable. CONCLUSION: We found that acupotomy may be effective for finger joint contracture due to improper immobilization. We suggest it as a simple and safe treatment for joint contracture.

[Clinical effect of plum-blossom needle tapping at three yin meridians of wrist on wrist joint contracture after stroke].

OBJECTIVE: To compare the therapeutic effect of plum-blossom needle tapping at three yin meridians of wrist combined with rehabilitation training and simple rehabilitation training on wrist joint contracture after stroke. METHODS: A total of 72 patients with wrist joint contracture after stroke were randomized into an observation group and a control group, 36 cases in each one. In the control group, simple rehabilitation training was applied, 5 times a week, 3 weeks as one course and totally 3 courses were required. On the basis of the treatment in the control group, plum-blossom needle tapping at three yin meridians of wrist was adopted in the observation group. The tapping regions were wrist traveling parts of three yin meridians of hand, ranging from up 3 cun to below 1 cun of wrist crease, 3 times a week, 3 weeks as one course and totally 3 courses were required. The active range of motion (AROM) of active wrist extension, Fugl-Meyer score (FMA) and Barthel index (BI) score were observed before and after treatment in the two groups. RESULTS: The AROM, FMA scores and BI scores after treatment in the two groups were superior to before treatment (P<0.05), and the improvements of 3 indexes in the observation group were superior to the control group (P<0.05). CONCLUSION: The therapeutic effect of plum-blossom needle tapping at three yin meridians of wrist combined with rehabilitation training is superior to simple rehabilitation training on wrist joint contracture after stroke.

Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review.

Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors' aim was to improve patient care through clarifying the definition of camptodactyly and indications for surgical and/or conservative management, summarizing outcomes, and defining risks. A systematic review was conducted of articles in all languages on outcomes following surgical and/or conservative management of idiopathic camptodactyly in children using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, EMBASE (Excerpta Medica database), AMED (Allied and Complementary Medicine), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) (until January 2017). The primary outcome was posttreatment flexion contracture, and the secondary outcomes were indications for surgery, complications, and patient satisfaction. Database searching generated 16 final articles, with 7 case series and 9 retrospective cohort studies. There was a lack of consistency on the definition of camptodactyly and in outcome reporting. All 16 studies received a "Weak" global rating and demonstrated low-quality evidence, suggesting that treatment of camptodactyly with operative or nonoperative measures reduces the degree of flexion contracture in most patients (from pretreatment averages of 20°-85° to posttreatment averages of 5°-37°). There was general agreement that surgery should be reserved for contracture >30° or failure to respond to conservative management. Surgery generally led to more complications compared with conservative management. Only one study reported on functional limitations, and another reported on patient-reported outcomes. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. Future research may consider the development of decision aids to guide patients and families through selecting management strategies and to promote shared decision making.

Low-Level Laser Therapy Prevents Treadmill Exercise-Induced Progression of Arthrogenic Joint Contracture Via Attenuation of Inflammation and Fibrosis in Remobilized Rat Knees.

We investigated whether the combination of exercise and anti-inflammatory/anti-fibrotic treatment using low-level laser therapy (LLLT) promotes recovery from joint contracture without arthrogenic contracture progression. Rat knees were immobilized for 3 weeks in a flexed position. After fixator removal, rats were divided into no intervention (RM), daily treadmill walking (WALK), and daily treadmill walking and LLLT (W + L) groups. Total and arthrogenic contractures were assessed by restrictions of passive range of motion (ROM) before (m-ROM) and after myotomy (a-ROM), respectively. After 7 days of remobilization, m-ROM restriction decreased equally in all groups. Conversely, a-ROM restriction further increased after remobilization in the RM and WALK groups. Furthermore, this restriction was significantly larger in the WALK group compared with the RM group. In the W + L group, however, progression of a-ROM restriction during remobilization was prevented. After 1 or 7 days of remobilization, inflammatory and fibrotic reactions in the joint capsule were induced in the RM group and were more pronounced in the WALK group, but these reactions were milder in the W + L group than in the WALK group. m-ROM restriction representing total contracture initially established by immobilization was partially improved by remobilization. Additional LLLT and exercise intervention did not further reduce total contracture, but LLLT suppressed the progression of arthrogenic contracture caused by ambulation and treadmill exercise. Therefore, exercise with LLLT in the early phase of remobilization would be one possible adjunct therapy to prevent further progression of arthrogenic contracture.

Manipulation Under Anesthesia as a Treatment of Posttraumatic Elbow Stiffness.

OBJECTIVES: Evaluate the safety and efficacy of manipulation under anesthesia (MUA) for posttraumatic elbow stiffness. DESIGN: Retrospective, case series. SETTING: Single institution; level 1 trauma center. PATIENTS/PARTICIPANTS: Chart review of 45 patients over a 10-year period treated with MUA for posttraumatic elbow stiffness after elbow injuries treated both operatively and nonoperatively. INTERVENTION: None. MAIN OUTCOME MEASURES: Change in total flexion arc pre- to postmanipulation; time to manipulation; complications. RESULTS: Average time from most recent surgical procedure or date of injury to MUA was 115 days. Average premanipulation flexion arc was 57.9 degrees; average flexion arc at the final follow-up was 83.7 degrees. The improvement in elbow flexion arc of motion was statistically significant (P < 0.001). Post hoc analysis of the data revealed 2 distinct groups: 28 patients who underwent MUA within 3 months of their most recent surgical procedure (early manipulation), and 17 patients who underwent MUA after 3 months (late manipulation). Average improvement in elbow flexion arc in the early MUA group was 38.3 degrees (P < 0.001); improvement in the late MUA group was 3.1 degree. Comparison of improvement between the early and late MUA groups found a significant difference (P < 0.001) in mean flexion arc improvement from premanipulation to postmanipulation, favoring the early group. One patient had a complication directly attributable to MUA. Nineteen patients required additional procedures on the injured extremity after MUA. CONCLUSIONS: MUA is a safe and effective adjunct to improving motion in posttraumatic elbow stiffness when used within 3 months from the original injury or time of surgical fixation. After 3 months, MUA does not reliably increase elbow motion. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats.

BACKGROUND: Contractures are a prevalent and potentially severe complication in patients with neurologic disorders. Although heat, cold, and stretching are commonly used for treatment of contractures and/or spasticity (the cause of many contractures), the sequential effects of these modalities remain unclear. QUESTIONS/PURPOSES: Using an established rat model with spinal cord injury with knee flexion contracture, we sought to determine what combination of heat or cold before stretching is the most effective for treatment of contractures derived from spastic paralyses and investigated which treatment leads to the best (1) improvement in the loss of ROM; (2) restoration of deterioration in the muscular and articular factors responsible for contractures; and (3) amelioration of histopathologic features such as muscular fibrosis in biceps femoris and shortening of the joint capsule. METHODS: Forty-two adolescent male Wistar rats were used. After spasticity developed at 2 weeks postinjury, each animal with spinal cord injury underwent the treatment protocol daily for 1 week. Knee extension ROM was measured with a goniometer by two examiners blinded to each other's scores. The muscular and articular factors contributing to contractures were calculated by measuring ROM before and after the myotomies. We quantitatively measured the muscular fibrosis and the synovial intima length, and observed the distribution of collagen of skeletal muscle. The results were confirmed by a blinded observer. RESULTS: The ROM of heat alone (34° ± 1°) and cold alone (34° ± 2°) rats were not different with the numbers available from that of rats with spinal cord injury (35° ± 2°) (p = 0.92 and 0.89, respectively). Stretching after heat (24° ± 1°) was more effective than stretching alone (27° ± 3°) at increasing ROM (p < 0.001). Contrastingly, there was no difference between stretching after cold (25° ± 1°) and stretching alone (p = 0.352). Stretching after heat was the most effective for percentage improvement of muscular (29%) and articular (50%) factors of contractures. Although quantification of muscular fibrosis in the rats with spinal cord injury (11% ± 1%) was higher than that of controls (9% ± 0.4%) (p = 0.01), no difference was found between spinal cord injury and each treatment protocol. The total synovial intima length of rats with spinal cord injury (5.9 ± 0.2 mm) became shorter than those of the controls (7.6 ± 0.2 mm) (p < 0.001), and those of stretching alone (6.9 ± 0.4 mm), stretching after heat (7.1 ± 0.3 mm), and stretching after cold (6.7 ± 0.4 mm) increased compared with rats with spinal cord injury (p = 0.01, p = 0.001, and p = 0.04, respectively). The staining intensity and pattern of collagen showed no difference among the treatment protocols. CONCLUSIONS: This animal study implies that heat or cold alone is ineffective, and that stretching is helpful for the correction of contractures after spinal cord injury. In addition, we provide evidence that heat is more beneficial than cold to increase the effectiveness of stretching. CLINICAL RELEVANCE: Our findings tend to support the idea that stretching after heat can improve the loss of ROM and histopathologic features of joint tissues. However, further studies are warranted to determine if our findings are clinically applicable.

Preliminary experience with delayed non-operative therapy of multiple hand and wrist contractures in a woman with Freeman-Sheldon syndrome, at ages 24 and 28 years.

We describe two proof-of-concept trials of delayed non-operative therapy of multiple hand and wrist contractures in a woman with a severe expression of Freeman-Sheldon syndrome (FSS), at ages 24 and 28 years. Having presented as an infant to a university referral centre, passive correction was not accompanied by strengthening exercises, and correction was lost. FSS is described as a myopathic distal arthrogryposis; diagnosis requires the following: microstomia, whistling face appearance, H-shaped chin dimpling, nasolabial folds, and multiple hand and foot contractures. Spinal deformities, metabolic and gastroenterological problems, other craniofacial characteristics, and visual and auditory impairments, are frequent findings. To avoid possible FSS-associated complications of malignant hyperthermia and difficult intubation, and to reduce or eliminate need for surgery, we proceeded with passive manipulation without anaesthesia or sedation. We believe this is the first report of attempted non-operative correction of multiple hand and wrist contractures in an adult with FSS.

Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.

QUESTION: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? DESIGN: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. INTERVENTION: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. OUTCOME MEASURES: The primary outcome was passive ankle dorsiflexion with a 12Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. OUTCOME MEASURES were taken at baseline (Week 0), end of intervention (Week 6), and follow-up (Week 10). RESULTS: The mean between-group differences (95% CI) for passive ankle dorsiflexion at Week 6 and Week 10 were -3 degrees (-8 to 2) and -1 degrees (-6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists' perceived treatment credibility. CONCLUSION: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. TRIAL REGISTRATION: ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014) Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.Journal of Physiotherapy60: 201-208].

Prevalence and effect of oxytetracycline on congenital fetlock knuckling in neonatal dairy calves.

Musculoskeletal system deformities were observed in 24 (34.3%) of 70 neonatal dairy calves that presented with different congenital abnormalities. Among them, 19 calves (27.1%), the majority of which were crossbred Jersey calves of either gender with mean (± s.e.) body weight 22.00 kg ± 1.17 kg and aged 7.11 ± 1.16 days, were presented for treatment of congenital knuckling. Five of the knuckling calves had additional concurrent congenital conditions and were excluded from the present study. All of the remaining 14 calves showing moderate, bilateral fetlock knuckling had a wooden or polyvinyl chloride (PVC) splint applied to the palmar or plantar aspect of the affected limbs. All of the animals received a dose of the analgesic tolfenamic acid intramuscularly, and were randomly allocated to two equal groups. Calves of Group I additionally received oxytetracycline (20 mg/kg intravenous daily for 3 days). The condition resolved satisfactorily in 83.3% and 80.0% calves from the two groups, respectively. The left and right fetlock angle (mean ± SE) reduced significantly (p ≤ 0.01) from 50.57° ± 4.20° to 4.00° ± 2.27° and 48.71° ± 2.37° to 5.33° ± 3.03°, respectively in animals of Group I. In Group II calves, the angles showed reduction from 50.86° ± 2.94° to 4.20° ± 2.75° and from 48.71° ± 3.14° to 6.80° ± 3.34°, respectively. From the present study, it was concluded that bilateral moderate fetlock knuckling in the neonatal dairy calves can be managed satisfactorily with early application of splints. Supplementary use of oxytetracycline at repeated doses of low toxicity had only a marginally beneficial effect.

A randomized controlled trial of surface neuromuscular electrical stimulation applied early after acute stroke: effects on wrist pain, spasticity and contractures.

OBJECTIVES: To investigate effects of surface neuromuscular electrical stimulation applied early after stroke to the wrist and finger extensor muscles on upper limb pain, spasticity and contractures in patients with no functional arm movement. DESIGN: Secondary analysis from a Phase II, randomized, controlled, single-blind study. SETTING: An acute hospital stroke unit. SUBJECTS: Patients with no useful arm function within six weeks of a first stroke. INTERVENTION: Patients were randomized to treatment (30-minute sessions of surface neuromuscular stimulation to wrist and finger extensors and 45 minutes of physiotherapy) or control (45 minutes of physiotherapy) groups. All patients had access to routine care. Treatment was given for six weeks from recruitment. RESULTS: Ninety patients (49% male, median age 74 years (range 32-98), median time since stroke onset three weeks (range one to six weeks)) were included. Treatment compliance was variable (mean 28%). The treatment prevented the development of pain (mean difference in rate of change 0.4 units/week, 95% confidence interval (CI) 0.09 to 0.6). Treatment may have prevented a deterioration in contractures (quantified by measuring passive range of movement) in severely disabled patients (mean rate of deterioration -0.5 deg/week; 95% CI -0.9 to -0.06). There were no significant changes in stiffness and spasticity. CONCLUSION: Surface neuromuscular electrical stimulation reduces pain in stroke patients with a non-functional arm. There was some evidence that treatment with electrical stimulation was beneficial in reducing contractures. Treatment had no effect on spasticity.

[Efficacy of a manual treatment method according to the fascial distortion model in the management of contracted ("frozen") shoulder]. / Wirksamkeit einer manuellen Behandlungstechnik nach dem Fasziendistorsionsmodell bei schmerzhaft eingeschränkter Schulterbeweglichkeit (Frozen Shoulder).

BACKGROUND: Frozen shoulder is a common problem and difficult to treat. The present prospective randomised single-blind controlled trial evaluates the efficacy of the 'fascial distortion model' according to Typaldos as a remedy for the 'frozen shoulder'. MATERIALS AND METHODS: A total of 60 patients were randomised to receive either the FDM-guided treatment (FDM, n = 30) or a 'conventional' manual therapy (MT, n = 30). The primary endpoint for the treatment effect was the shoulder mobility, and secondary endpoints were pain (measured on a VAS), raw force and function as expressed by the Constant-Murley and DASH scores. RESULTS: Before therapy, groups were well comparable in terms of all outcome parameters. All endpoints showed a substantial and significant improvement in both treatment groups. Improvement was significantly more marked in the FDM group as compared to the MT group, and the effect occurred significantly faster. During post-treatment observation, there was no further improvement and the achieved benefit in mobility in the FDM group decreased. However, the abduction ability of 150.2 ± 37.2° continued to be substantially better than in control patients (124.1 ± 38.6°, p < 0.01), and the ultimate improvement in abduction was 59.4° (64 % more than baseline) as opposed to 25.9° (27 %) in controls. Secondary outcome parameters (raw force, functional handicap, and pain) showed a significant improvement in both groups but a significantly better result in patients treated according to FDM guidelines. However, patients in this group experienced pain during the treatment more frequently (21/27 vs. 10/27, p < 0.01). CONCLUSION: Frozen shoulder treatment according to the FDM is an effective modality with swift onset of action and acceptable side effects that is superior to conventional manual therapy. Long-term effects and modes of action need to be investigated.

Efectos de la manipulación dorsal en síndromes cervicales agudos / Effects of dorsal joint manipulation on cervical accute syndromes

Objetivo: Revisar la eficacia de la manipulación dorsal en pacientes con patología cervical aguda. Metodología: Se realizó una comparación de las asistencias realizadas a trabajadores del área de Fisioterapia del Servicio de Prevención de General Motors España, en Figueruelas, Zaragoza, en los períodos 2004-2006 (311 casos) y 2007-2009 (265 casos), el primero sin técnicas de manipulación dorsal y el segundo con estas técnicas. Los problemas del cuello representaron el 19,73% de los casos atendidos en estos 6 años y para su análisis se agruparon en 4 grandes grupos en función del síntoma dominante: síndromes de inestabilidad, síndromes musculares, síndromes neurológicos y síndromes dolorosos. Resultados: La media de sesiones requeridas en los síndromes musculares tuvo una disminución estadísticamente significativa (p=0,02) en el período 2007-2009 frente al 2004-2006. Conclusiones: Las terapias basadas en técnicas de manipulación osteopática constituyen una de los tratamientos fisioterápicos más eficaces en los síndromes musculares agudos de cuello (AU)

Objective: To review the efficacy of dorsal manipulation in patients with acute cervical disease. Methods: A comparison was made of the interventions performed on employees from the physiotherapy area of the Prevention Department of General Motors Spain, in Figueruelas, Zaragoza, in the periods 2004-2006 (311 patients) and 2007-2009 (265 patients), the first without dorsal manipulation techniques and second with these techniques. Neck problems accounted for 19.73% of the cases attended over these 6 years. For analysis, patients were grouped in 4 large groups based on the dominant symptom: instability syndromes, muscular syndromes, neurological syndromes and pain syndromes. Results: Mean sessions required in muscle syndromes showed a statistically significant decrease (p=0.02) in the period 2007-2009 versus 2004-2006. Conclusions: Therapies based on osteopathic manipulation techniques are one of most effective physiotherapeutic treatments for acute neck muscle syndromes (AU)

Hinged cast brace for persistent flexion contracture following total knee replacement.

The reported incidence of persistent knee flexion contracture following total knee arthroplasty (TKA) has varied from 1-15 percent Various treatment modalities have been described in attempts to manage this often difficult problem. This paper describes a novel method of treatment by using a hinged cast brace (previously reported for treatment of femur fractures and knee contractures secondary to hemophilia and cerebral palsy) for use in patients with symptomatic knee flexion contractures. Application of this cast brace with frequent adjustment (every three to four days, initially) toward full extension can often improve knee extension, after physical therapy and other modalities such as extension-assist braces have failed. Care must be taken in the application and use of this device which utilizes frequent manipulations to reduce and maintain the knee flexion angle. We report two clinical cases in which this protocol was effectively used in decreasing symptomatic knee flexion contractures.

Treatment of scars with flexion contracture using carbon dioxide laser and fractional photothermolysis.

Scars with flexion contracture of various origins are challenging problems which may cause not only cosmetic concerns, but also severe functional restriction. In this report, we describe a case presenting scars with flexion contracture: a 23-year-old Korean female with surgical scars on both axillae, which were treated by laser-cision (incision using carbon dioxide laser) with second intention wound healing followed by a non-ablative fractional photothermolysis system.

Management of quadriceps contracture in a dog using a static flexion apparatus and physiotherapy.

A four-month-old golden retriever developed quadriceps contracture following management of a comminuted femoral fracture with an intramedullary pin and cerclage wire. Management involved surgical release of the quadriceps, rigid stabilisation of the fracture, use of a static stifle flexion apparatus and postoperative physiotherapy. The dog returned to full activity with normal stifle function.

[Acupuncture treatment for a patient with prolonged consciousness disturbance after a brain tumor surgery].

Acupuncture has long been applied as a therapeutic technique in China, Japan, Korea and other countries. Recently, its application began to be extended to the treatment of neural disorders. We experienced a 13-year-old boy with prolonged consciousness disturbance after a pineal tumor surgery and muscle contracture of lower extremity by long-term recumbency. We applied him acupuncture treatment for 4 months which was effective to alleviate these symptoms. Repeated IMP SPECT showed improvement of the cerebral blood flow (CBF) during the course of acupuncture therapy. Acupuncture was effective to improve prolonged coma after a brain surgery and also muscle contracture by long-lasting recumbency. CBF showed a slight increase along with the recovery of consciousness suggesting a strong relevance between CBF and improvement of these symptoms.

Prevention and management of hypertrophic scars and keloids after burns in children.

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.