Effects of Thermal Stimulation and Transcutaneous Electrical Nerve Stimulation on Sensory and Motor Function of Upper Extremity in Acute Stroke Survivors: A Randomized Controlled Pilot Study.

Objective Upper-limb coordination is crucial for daily activities, especially among stroke survivors who may encounter obstacles during upper-limb rehabilitation. This study aimed to investigate the effects of thermal stimulation (TS) and transcutaneous electrical nerve stimulation (TENS) on sensory and motor function during recovery in acute stroke patients. Design This is a parallel study with a randomized controlled design. The experiment was conducted in the E-Da Hospital Rehabilitation Department, Kaohsiung, Taiwan. Intervention Thirty participants were in-patients with acute stroke at the E-Da Hospital. Participants were randomly assigned to three groups for a one-week intervention: exercise combined with TS, exercise combined with TENS, or conventional physical therapy with exercise alone. The Fugl-Meyer upper extremity scale, Brunnstrom stage, minimal current perception (MCP), and modified Ashworth scale were collected for the assessment. Results The outcomes demonstrated considerable improvement in MCP in all the groups after treatment. Specifically, the groups receiving TS and TENS showed significant improvements in the Brunnstrom stage, suggesting that both treatments improved distal motor recovery. Conclusion The results, following a one-week intervention period, suggested that both TS and TENS contributed to the improvement of motor and sensory function, with a significant impact on the Brunnstrom stage in the upper extremity, particularly in the distal region. The inclusion of TS or TENS in rehabilitation protocols improved distal motor function compared to baseline measures, suggesting these treatments as effective components in acute stroke rehabilitation.

Compare the Quadriceps Activity between Mini-Midvastus and Mini-Medial Parapatellar Approach in Total Knee Arthroplasty with Electromyography.

Background: The comparison between the mini-midvastus (mini-MV) and mini-parapatellar (mini-MPP) approach in total knee arthroplasty (TKA) remains a subject of debate. The present study compared quadriceps activation, pain levels, and clinical outcomes between the two approaches; quadricep activation was assessed using surface electromyography (sEMG). Methods: This retrospective cross-sectional study comprised a total of 78 patients aged between 50 and 85 years with primary osteoarthritis. Patients were divided into a mini-MV (n = 38) group and a mini-MPP (n = 40) group according to the surgical approach. Results: The two groups exhibited no significant differences in sEMG for the vastus medialis (VM) or rectus femoris (RF) at the follow-up time points, with the exception that the mini-MV group exhibited superior strength of RF during extensions at the 2-week follow-up. However, the mini-MPP group had superior Western Ontario and McMaster Universities Index (WOMAC) total and function scores at the 2- and 6-week follow-ups. The mini-MPP group also had superior WOMAC stiffness scores at the 2-week follow-up. The two groups did not differ significantly in terms of pain levels or morphine consumption. Conclusions: The sEMG data of quadriceps muscle would not differ significantly between the mini-MV and mini-MPP approaches for TKA. Moreover, the mini-MPP approach may yield superior WOMAC scores when compared with the mini-MV approach.

Reliable Off-Resonance Correction in High-Field Cardiac MRI Using Autonomous Cardiac B0 Segmentation with Dual-Modality Deep Neural Networks.

B0 field inhomogeneity is a long-lasting issue for Cardiac MRI (CMR) in high-field (3T and above) scanners. The inhomogeneous B0 fields can lead to corrupted image quality, prolonged scan time, and false diagnosis. B0 shimming is the most straightforward way to improve the B0 homogeneity. However, today's standard cardiac shimming protocol requires manual selection of a shim volume, which often falsely includes regions with large B0 deviation (e.g., liver, fat, and chest wall). The flawed shim field compromises the reliability of high-field CMR protocols, which significantly reduces the scan efficiency and hinders its wider clinical adoption. This study aims to develop a dual-channel deep learning model that can reliably contour the cardiac region for B0 shim without human interaction and under variable imaging protocols. By utilizing both the magnitude and phase information, the model achieved a high segmentation accuracy in the B0 field maps compared to the conventional single-channel methods (Dice score: 2D-mag = 0.866, 3D-mag = 0.907, and 3D-mag-phase = 0.938, all p < 0.05). Furthermore, it shows better generalizability against the common variations in MRI imaging parameters and enables significantly improved B0 shim compared to the standard method (SD(B0Shim): Proposed = 15 ± 11% vs. Standard = 6 ± 12%, p < 0.05). The proposed autonomous model can boost the reliability of cardiac shimming at 3T and serve as the foundation for more reliable and efficient high-field CMR imaging in clinical routines.

Enhancing Whole-Brain Magnetic Field Homogeneity for 3D-Magnetic Resonance Spectroscopic Imaging with a Novel Unified Coil: A Preliminary Study.

The spectral quality of magnetic resonance spectroscopic imaging (MRSI) can be affected by strong magnetic field inhomogeneities, posing a challenge for 3D-MRSI's widespread clinical use with standard scanner-equipped 2nd-order shim coils. To overcome this, we designed an empirical unified shim-RF head coil (32-ch RF receive and 51-ch shim) for 3D-MRSI improvement. We compared its shimming performance and 3D-MRSI brain coverages against the standard scanner shim (2nd-order spherical harmonic (SH) shim coils) and integrated parallel reception, excitation, and shimming (iPRES) 32-ch AC/DC head coil. We also simulated a theoretical 3rd-, 4th-, and 5th-order SH shim as a benchmark to assess the UNIfied shim-RF coil (UNIC) improvements. In this preliminary study, the whole-brain coverage was simulated by using B0 field maps of twenty-four healthy human subjects (n = 24). Our results demonstrated that UNIC substantially improves brain field homogeneity, reducing whole-brain frequency standard deviations by 27% compared to the standard 2nd-order scanner shim and 17% compared to the iPRES shim. Moreover, UNIC enhances whole-brain coverage of 3D-MRSI by up to 34% compared to the standard 2nd-order scanner shim and up to 13% compared to the iPRES shim. UNIC markedly increases coverage in the prefrontal cortex by 147% and 47% and in the medial temporal lobe and temporal pole by 29% and 13%, respectively, at voxel resolutions of 1.4 cc and 0.09 cc for 3D-MRSI. Furthermore, UNIC effectively reduces variations in shim quality and brain coverage among different subjects compared to scanner shim and iPRES shim. Anticipated advancements in higher-order shimming (beyond 6th order) are expected via optimized designs using dimensionality reduction methods.

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital.

BACKGROUND: The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. METHODS: The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. RESULTS: Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. CONCLUSIONS: The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.

The Effect of Walking Backward on a Treadmill on Balance, Speed of Walking and Cardiopulmonary Fitness for Patients with Chronic Stroke: A Pilot Study.

This study determines the effect of walking backward on a treadmill on balance, speed of walking and cardiopulmonary fitness for patients with chronic stroke. Subjects with chronic stroke for more than six months, whose level of Brunnstrom stage is greater than IV and who are able to walk more than eleven meters with or without assistive devices were recruited. After grouping for a single-blind clinical randomized controlled trial, the subjects were divided into two groups: eight in the control group and eight in the experimental group. All subjects were subjected to 30 min traditional physical therapy, three times a week for four weeks. The experimental group was subjected to an additional 30 min of walking backward on a treadmill. The Berg Balance Scale (BBS) and the Timed Up and Go test (TUG) were used to determine the functional balance and walking ability. The walking speed was evaluated using a timed 10-Meter Walk Test (10MWT), and the cardiopulmonary fitness was determined using a 6-Minute Walk Test (6MWT) and a pulmonary function test (PFT). All assessments were made at baseline before training commenced (pre-training) and at the end of the four-week training period (post-training). A paired t-test and an independent t-test were used to determine the effect on balance, speed of walking and cardiopulmonary fitness before and after training. The level of significance α was 0.05. After four weeks of training, the experimental group showed significant differences (p < 0.05) on TUG, BBS, 10MWT, 6MWT, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). This pilot study shows that the 30 min of walking backward on a treadmill three times a week for four weeks increased balance, speed of walking and cardiopulmonary fitness. Trial registration: Current Controlled Trials NCT02619110.

Characteristics of the Electrophysiological Properties of Neuromuscular Motor Units and Its Adaptive Strategy Response in Lower Extremity Muscles for Seniors with Pre-Sarcopenia: A Preliminary Study.

Older adults with sarcopenia, which is an aging-related phenomenon of muscle mass loss, usually suffer from decreases in both strength and functional performance. However, the causality between function loss and physiological changes is unclear. This study aimed to explore the motor unit characteristics of the neurological factors between normal subjects and those with sarcopenia. Five risk-sarcopenia (age: 66.20 ± 4.44), five healthy (age: 69.00 ± 2.35), and twelve young (age: 21.33 ± 1.15) participants were selected. Each participant performed knee extension exercises at a 50% level of maximal voluntary isometric contraction. Next, electromyogram (EMG) signals were collected, and information on each parameter-e.g., motor unit number, recruitment threshold, the slope of the mean firing rate to recruitment threshold, y-intercept, firing rate per unit force, and mean motor unit firing rate (MFR)-was extracted to analyze muscle fiber discrimination (MFD). Meanwhile, force variance was used to observe the stability between two muscle groups. The results suggested that there was no difference between the three groups for motor unit number, recruitment threshold, y-intercept, mean firing rate, and motor unit discrimination (p > 0.05). However, the slope of MFR and firing rate per unit force in the risk-sarcopenia group were significantly higher than in the young group (p < 0.05). Regarding muscle performance, the force variance in the non-sarcopenia group was significantly higher than the young group (p < 0.05), while the risk-sarcopenia group showed a higher trend than the young group. This study demonstrated some neuromuscular characters between sarcopenia and healthy elderly and young people when performing the same level of leg exercise tasks. This difference may provide some hints for discovering aging-related strength and function loss. Future studies should consider combining the in vivo measurement of muscle fiber type to clarify whether this EMG difference is related to the loss of muscle strength or mass before recruiting symptomatic elderly participants for further investigation.

The Recovery Benefit on Skin Blood Flow Using Vibrating Foam Rollers for Postexercise Muscle Fatigue in Runners.

PURPOSE: To determine the effect of vibrating rollers on skin blood flow after running for recovery from muscle fatigue. METHOD: 23 healthy runners, aged between 20 to 45 years, participated in a crossover trial. Muscle fatigue was induced by running, and recovery using a vibrating roller was determined before and after the intervention. Each subject was measured at three time points (prerun, postrun, and postroller) to compare skin blood flow perfusion and blood flow oscillation at the midpoint of the dominant gastrocnemius muscle. The results show that blood perfusion is greater when a vibrating roller is used than a foam roller, but there is no statistical difference. The analysis of blood flow oscillation shows that vibrating rollers induce 30% greater endothelial activation than a foam roller. Vibrating rollers significantly stimulate the characteristic frequency for myogenic activation (p < 0.05); however, the effect size is conservative.

Near-Infrared Spectroscopy for Monitoring Sternocleidomastoid Muscular Oxygenation during Isometric Flexion for Patients with Mild Nonspecific Neck Pain: A Pilot Study.

Since there is merit in noninvasive monitoring of muscular oxidative metabolism for near-infrared spectroscopy in a wide range of clinical scenarios, the present study attempted to evaluate the clinical usability for featuring the modulatory strategies of sternocleidomastoid muscular oxygenation using near-infrared spectroscopy in mild nonspecific neck pain patients. The muscular oxygenation variables of the dominant or affected sternocleidomastoid muscles of interest were extracted at 25% of the maximum voluntary isometric contraction from ten patients (5 males and 5 females, 23.6 ± 4.2 years) and asymptomatic individuals (6 males and 4 females, 24.0 ± 5.1 years) using near-infrared spectroscopy. Only a shorter half-deoxygenation time of oxygen saturation during a sternocleidomastoid isometric contraction was noted in patients compared to asymptomatic individuals (10.43 ± 1.79 s vs. 13.82 ± 1.42 s, p < 0.001). Even though the lack of statically significant differences in most of the muscular oxygenation variables failed to refine the definite pathogenic mechanisms underlying nonspecific neck pain, the findings of modulatory strategies of faster deoxygenation implied that near-infrared spectroscopy appears to have practical potential to provide relevant physiological information regarding muscular oxidative metabolism and constituted convincing preliminary evidences of the adaptive manipulations rather than pathological responses of oxidative metabolism capacity of sternocleidomastoid muscles in nonspecific neck patients with mild disability.

Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial.

PURPOSE: To prospectively compare the efficacy of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) with a sham control group (normal saline solution [NS]) for knee osteoarthritis in a randomized, dose-controlled, placebo-controlled, double-blind, triple-parallel clinical trial. METHODS: A total of 87 osteoarthritic knees (53 patients) were randomly assigned to 1 of 3 groups receiving 3 weekly injections of either leukocyte-poor PRP (31 knees), HA (29 knees), or NS (27 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and International Knee Documentation Committee (IKDC) subjective score were collected at baseline and at 1, 2, 6, and 12 months after treatment. Data were analyzed using generalized estimating equations. RESULTS: All 3 groups showed statistically significant improvements in both outcome measures at 1 month; however, only the PRP group sustained the significant improvement in both the WOMAC score (63.71 ± 20.67, increased by 21%) and IKDC score (49.93 ± 17.74, increased by 40%) at 12 months. For the intergroup comparison, except for the first month, there was a statistically significant difference between the PRP and NS groups in both scores throughout the study duration (regression coefficients of 8.72 [P = .0015], 7.94 [P = .0155], and 11.92 [P = .0014] at 2, 6, and 12 months, respectively, for WOMAC score, and 9.1 [P = .0001], 10.28 [P = .0002], and 13.97 [P < .0001], respectively, for IKDC score). There was no significant difference in both functional outcomes between the HA and NS groups at any time point. Only the PRP group reached the minimal clinically important difference in the WOMAC score at every evaluation (15%, 21%, 18%, and 21% at 1, 2, 6, and 12 months, respectively) and the minimal clinically important difference in the IKDC score at 6 months (improvement of 11.6). CONCLUSIONS: Intra-articular injections of leukocyte-poor PRP can provide clinically significant functional improvement for at least 1 year in patients with mild to moderate osteoarthritis of the knee. LEVEL OF EVIDENCE: Level I, randomized controlled single-center trial.

Characteristics of the Motor Units during Sternocleidomastoid Isometric Flexion among Patients with Mechanical Neck Disorder and Asymptomatic Individuals.

Mechanical neck disorder is a widespread and non-neurological musculoskeletal condition resulting from modern lifestyles. Presently, the fundamental electrophysiological properties of the motor units of the sternocleidomastoid muscles and the characteristics of the short-term synchronization of the motor unit in patients with neck pain are ambiguous. This study therefore aims to clarify the fundamental electrophysiological properties of the motor units of the sternocleidomastoid muscles in patients with mechanical neck disorder and in asymptomatic individuals. We further investigated whether alterations in the degree of motor unit short-term synchronization occur. The surface electrophysiological signals of the bilateral sternal heads of the sternocleidomastoid muscles of twelve patients with mechanical neck disorder and asymptomatic individuals were detected at 25% of the maximum voluntary contraction during cervical isometric flexion and then decomposed into individual motor unit action potential trains. We found that the patients with mechanical neck disorder showed significantly higher initial and mean firing rates of the sternocleidomastoid muscles and displayed substantially lower motor unit short-term synchronization values compared with the asymptomatic subjects. Consequently, these convincing findings support the assertion that patients with mechanical neck disorder display altered neuromuscular control strategies, such as the reinforcement of motor unit recruitment firing rates in the sternocleidomastoid muscles. The motor units of these patients also revealed neural recruitment strategies with relatively poor efficiency when executing the required motor tasks.

Comparison of neck movement smoothness between patients with mechanical neck disorder and healthy volunteers using the spectral entropy method.

PURPOSE: Mechanical neck disorder is one of the most common health issues. No related observations have applied spectral entropy to explore the smoothness of cervical movement. Therefore, the objectives were to ascertain whether the spectral entropy of time-series linear acceleration could extend to estimate the smoothness of cervical movement and compare the characteristics of the smoothness of cervical movement in patients with mechanical neck pain (MND) with healthy volunteers. METHODS: The smoothness of cervical movement during cervical circumduction from 36 subjects (MND: n = 18, asymptomatic: n = 18) was quantified by the spectral entropy of time-series linear acceleration and other speed-dependent parameters, respectively. RESULTS: Patients with MND showed significantly longer movement time, higher value in the spectral entropy and wider band response in frequency spectrum than healthy volunteers (P = 0.01). CONCLUSIONS: The spectral entropy would be suitable to discriminate the smoothness of cervical movement between patients with MND with healthy volunteers and demonstrated patients with MND had significantly less smooth cervical movement.

A new concept for quantifying the complicated kinematics of the cervical spine and its application in evaluating the impairment of clients with mechanical neck disorders.

Mechanical neck disorder (MND) is one of the most common health issues and is characterized by restricted cervical mobility. However, traditional kinematic information often focuses on primary movement in the cardinal plane, which seems insufficient to fully determine the kinematics of the cervical spine because of the complexity of the anatomical structures involved. Therefore, the current investigation aimed to modify the concept of the three-dimensional workspace to propose an objective mathematical model to quantify the complicated kinematics of the cervical spine. In addition, the observation evaluated the characteristics of the cervical workspace in asymptomatic and MND groups. Seventeen healthy volunteers and twenty-five individuals with MND participated in the study and executed the motion of circumduction to establish the cervical workspace using an electromagnetic tracking system. The results produced a mathematical model to successfully quantify the cervical workspace. Moreover, MND groups demonstrated significant reduction in the normalization of the cervical workspace with respect to the length of the head-cervical complex. Accordingly, the current study provided a new concept for understanding the complicated kinematics of the cervical spine. The cervical workspace could be a useful index to evaluate the extent of impairment of the cervical spine and monitor the efficacy of rehabilitation programs for patients with MND.