Effects of combining two techniques of non-invasive brain stimulation in subacute stroke patients: a pilot study.

BACKGROUND: Strokes have recently become a leading cause of disability among Thai people. Non-invasive brain stimulation (NIBS) seems to give promising results in stroke recovery when combined with standard rehabilitation programs. OBJECTIVE: To evaluate the combined effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and cathodal transcranial direct current stimulation (tDCS) over the non-lesional primary motor cortex on upper limb motor recovery in patients with subacute stroke. No reports of a combination of these two techniques of NIBS were found in the relevant literature. METHODS: This pilot study was a double-blinded, randomized controlled trial of ten patients with subacute stroke admitted to the Rehabilitation Medicine Inpatient Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. They were randomized into two groups: five in an active and five in a sham intervention group. Fugl-Meyer's upper extremity motor score (FMA-UE) and Wolf Motor Function Test (WMFT) were used to assess motor recovery at baseline, immediately, and 1 week after stimulation. RESULTS: A two-way repeated ANOVA (mixed design) showed a significant improvement in FMA-UE scores in the active intervention group both immediately and 1 week after stimulation in comparison to the baseline, [time, F (2, 16) = 27.44, p < 0.001, time x group interaction, F (2, 16) = 13.29, p < 0.001]. Despite no statistical significance, a trend toward higher WMFT scores was shown in the active intervention group. CONCLUSIONS: A single session of low-frequency rTMS and cathodal tDCS over the non-lesional primary motor cortex may enhance upper limb motor recovery in patients with subacute stroke.

Effectiveness of Receptive Music Therapy with Imbedded 10 Hz Binaural Beats Compared with Standard Care for Patients with Major Depressive Disorder: A Randomized Controlled Trial.

OBJECTIVES: The purpose of this study was to determine the effectiveness of music therapy (MT) with imbedded 10 Hz binaural beats in combination with standard treatment in comparison to standard treatment alone in patients diagnosed with major depressive disorder (MDD). METHODS: This study was a randomized controlled trial enrolling 18 MDD adult patients aged ≥20 years old with mild to moderate levels of acute phase depression. The intervention group received MT along with standard treatment, while the control group received only standard treatment. 10-Hz binaural beats were embedded into soothing music. The participants listened to the MT via stereo headphones for 20 min at the clinic and were instructed to continue listening to the track at home at least 3 times/week. The primary outcome was depression score using patient health questionnaire depression screening (PHQ-9). The secondary outcomes were quality of life, measured by the Euro Quality of Life Five-Dimension (EQ-5D) rating, and medications adherence, measured by the medication adherence rating scale (MARS). The outcomes were measured at week 0, week 4, and week 8. RESULTS: At baseline, the primary outcome of PHQ-9 did not differ between the MT group and the control group (13.3 ± 4.4; 13.9 ± 3.37; p-value = 0.77). After a follow-up of 4 and 8 weeks, the PHQ-9 in the MT group was lower than the control group by 1.50 (95 % confidence interval: -4.46 to 1.46). However, this difference was not significant, with p-value = 0.32. As for the secondary outcome, there were no significant differences in terms of EQ-5D and MARS. CONCLUSIONS: This study concluded that MDD patients who received 10-Hz binaural beat imbedded MT combined with standard treatment had experienced no significant differences compared with control group in terms of depression score, quality of life, and medication adherence. Further studies are suggested to investigate the long-term effect of MT with binaural beats.

Prognostic Factors of Functional Outcome Assessed by Using the Modified Rankin Scale in Subacute Ischemic Stroke.

BACKGROUND: Most stroke survivors spent their lifetime with disability which not only affects the clients themselves and the family but also brings economic cost to the country. Therefore, this retrospective cohort study aimed to identify independent prognostic determinants associated with functional recovery in ischemic stroke within 6 months after onset. METHODS: Data from all first-onset ischemic stroke patients admitted to the acute stroke unit of the tertiary, university hospital were reviewed for 5 years consecutively. The functional outcome of the patients was recorded during 6-month follow-up by using the modified Rankin Scale (mRS). Baseline characteristics, motor assessment and all stroke-related variables were assessed during first week after stroke and 6-month follow-up. In order to derive clinical predictors, the backward stepwise multivariable risk regression analyses were used with the generalized linear model. RESULTS: The result revealed that in the 358 patients recruited into this study, 255 (71.2%) were in the functional recovery group (mRS score of 1 - 3) within 6 months after onset. The final model of multivariable risk regression analysis, with generalized linear model, demonstrated that the independent variables of functional recovery were leg score with a risk ratio (RR = 1.92, 95% confidence interval (CI): 1.14 - 3.21, P = 0.013), arm score (RR = 1.75, 95% CI: 1.02 - 3.01, P = 0.042) and age older than 75 years (RR = 1.36, 95% CI: 1.04 - 1.77, P = 0.025). CONCLUSIONS: Achieving functional recovery during 6 months post stroke was related to age and motor improvement. With limited resources, continuity of rehabilitation training in the community system or allocation of caregiver training should be a part of discharge planning to promote recovery.

Preliminary study: comparative effects of lung volume therapy between slow and fast deep-breathing techniques on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, 6-minute walking distance, and quality of life in persons with COPD.

BACKGROUND: Lung volume therapy with the Voldyne® device can improve lung volume and has a nonsignificant benefit on respiratory muscle strength via the slow deep-breathing technique (SDBT); whereas respiratory muscle training with a respiratory muscle trainer via the fast deep-breathing technique (FDBT) has produced a significant improvement in people with COPD. Thus, the aim of this study was to compare the efficiency of lung volume therapy with the Voldyne® device with the SDBT and FDBT on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, walking capacity, and quality of life (QoL) in people with COPD. METHODS: A total of 30 COPD patient volunteers with mild (stage I) to moderate (stage II) severity were randomized into two groups: SDBT (n=15) and FDBT (n=15). Pulmonary function (FVC, FEV1, and FEV1/FVC), maximal inspiratory mouth pressure (PImax), oxidative stress status (total antioxidant capacity [TAC], glutathione [GSH], malondialdehyde [MDA], and nitric oxide [NO]), inflammatory cytokines (tumor necrosis factor-alpha [TNF-α] and IL-6), 6-minute walking distance (6MWD), and total clinical COPD questionnaire (CCQ) score were evaluated before and after 4 weeks of training. RESULTS: All the parameters had no statistical difference between the groups before training. The PImax, TAC, IL-6, total QoL score, and 6MWD changed significantly in the SDBT group after the 4-week experiment as compared to those in the pre-experimental period, whereas FVC, FEV1, FEV1%, FEV1/FVC%, PImax, TAC, MDA, NO, TNF-α, IL-6, 6MWD, and total CCQ score changed significantly in the FDBT group as compared to those in the pre-experimental period. The FEV1%, PImax, TNF-α, IL-6, and total CCQ score differed significantly in the FDBT group in the post-experimental period as compared to those in the SDBT group. CONCLUSION: This preliminary study concluded that the application of incentive spirometry with the Voldyne® device via fast deep breathing possibly improved respiratory muscle strength and QoL and reduced inflammatory cytokines, MDA, and NO better than that via slow deep breathing among people with COPD.

Prognostic Factors of Functional Recovery from Left Hemispheric Stroke.

Although lateralization of the brain affects some specialized cortical functions, there are still limited data to address its influence on clinically important outcomes. This study aimed to reveal the prognostic variables that relate to functional recovery in stroke patients with a left-sided hemispheric lesion during 6 months of follow-up. Data from 167 left-sided and 183 right-sided hemispheric strokes were reviewed retrospectively. Outcomes in this study included walking capacity and functional recovery, assessed by the modified Rankin Scale (mRS). In order to obtain independent predictive variables, this study used the step-backward method of multivariable regression analysis of parameters. The final model demonstrated that motor function of the hemiparetic leg was the strongest independent predictor for both walking ability and functional recovery (risk ratio (RR) of 2.41, 95% CI: 1.61-3.60, and p < 0.001 and RR of 1.83, 95% CI: 1.03-3.26, and p = 0.04, resp.). Therefore, lateralization did not seem to be involved. Understanding predictable variables that are associated with recovery can guide the rehabilitation team in setting priority and appropriate treatment for stroke patients.

Effects of a simple prototype respiratory muscle trainer on respiratory muscle strength, quality of life and dyspnea, and oxidative stress in COPD patients: a preliminary study.

BACKGROUND: The aim of this study was to evaluate the efficiency of a simple prototype device for training respiratory muscles in lung function, respiratory muscle strength, walking capacity, quality of life (QOL), dyspnea, and oxidative stress in patients with COPD. METHODS: Thirty COPD patients with moderate severity of the disease were randomized into three groups: control (n=10, 6 males and 4 females), standard training (n=10, 4 males and 6 females), and prototype device (n=10, 5 males and 5 females). Respiratory muscle strength (maximal inspiratory pressure [PImax] and maximal expiratory pressure [PEmax]), lung function (forced vital capacity [FVC], percentage of FVC, forced expiratory volume in 1 second [FEV1], percentage of FEV1 [FEV1%], and FEV1/FVC), 6-minute walking distance (6MWD), QOL, and oxidative stress markers (total antioxidant capacity [TAC]), glutathione (GSH), malondialdehyde (MDA), and nitric oxide (NO) were evaluated before and after 6 weeks of training. Moreover, dyspnea scores were assessed before; during week 2, 4, and 6 of training; and at rest after training. RESULTS: All parameters between the groups had no statistical difference before training, and no statistical change in the control group after week 6. FVC, FEV1/FVC, PImax, PEmax, QOL, MDA, and NO showed significant changes after 6 weeks of training with either the standard or prototype device, compared to pre-training. FEV1, FEV1%, 6MWD, TAC, and GSH data did not change statistically. Furthermore, the results of significant changes in all parameters were not statistically different between training groups using the standard and prototype device. The peak dyspnea scores increased significantly in week 4 and 6 when applying the standard or prototype device, and then lowered significantly at rest after 6 weeks of training, compared to pre-training. CONCLUSION: This study proposes that a simple prototype device can be used clinically in COPD patients as a standard device to train respiratory muscles, improving lung function and QOL, as well as involving MDA and NO levels.

Short-Term Pulmonary Rehabilitation for a Female Patient with Chronic Scleroderma under a Single-Case Research Design.

Although previously proposed that chronic scleroderma should be cared for clinically and early rehabilitation should be performed in hospital by a chest physical therapist, little evidence is currently available on its benefits. Therefore, this study demonstrated the benefits of short-term pulmonary rehabilitation during hospitalization in a female patient with chronic scleroderma. The aim of rehabilitation was to improve ventilation and gas exchange by using airway clearance, chest mobilization, and breathing-relearning techniques, including strengthening the respiratory system and the muscles of the limbs by using the BreathMax® device and elastic bands. Gross motor function and activities of daily life were regained by balancing, sitting, and standing practices. Data on minimal chest expansion, high dyspnea, high respiratory rate, and low maximal inspiratory mouth pressure were recorded seven days before rehabilitation or at the baseline period. But there was a clinically significant improvement in dyspnea, chest expansion, maximal inspiratory mouth pressure, and respiratory rate, when compared to baseline data, which were recorded by a chest physical therapist during seven days of rehabilitation. Furthermore, physicians decided to stop using a mechanical ventilator, and improvement in functional capacity was noted. Therefore, in the case of chronic and stable scleroderma, short-term rehabilitation during hospitalization for chest physical therapy possibly shows clinical benefits by improving both pulmonary function and physical performance.

Effects of manual percussion during postural drainage on lung volumes and metabolic status in healthy subjects.

OBJECTIVE: The aim of this study was to evaluate the influence of manual percussion during three different positions of postural drainage (PD) on lung volumes and metabolic status. METHODS: Twenty six healthy volunteers (13 women and 13 men), with a mean age of 20.15 ± 1.17 years, participated. They were randomized into three standard positions of PD (upper, middle, or lower lobes) and given manual percussion at a frequency of 240 times per minute for 5 min. Lung volumes, including tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and vital capacity (VC); and metabolic status, such as oxygen consumption (VO2), carbon dioxide (VCO2), respiratory rate (RR), and minute ventilation (VE) were evaluated. RESULTS: The lung volumes showed no statistical difference in VC or IRV from percussion during PD in all positions, except for the lower lobe, where increased TV and decreased ERV were found when compared to PD alone. Furthermore, percussion during PD of the upper and middle lobes did not affect RR or VE, when compared to PD alone. In addition, percussion during PD of the middle and lower lobes increased VO2 and VCO2 significantly, when compared to PD alone, but it did not influence PD of the upper lobe. CONCLUSION: This study indicated that up to 5 min of manual percussion on PD of the upper and middle lobes is safe mostly for lung volumes, RR, and VE, but it should be given with care in PD conditions of the lower lobe.

N-acetylcysteine supplementation controls total antioxidant capacity, creatine kinase, lactate, and tumor necrotic factor-alpha against oxidative stress induced by graded exercise in sedentary men.

Aim of this study was to evaluate the effects of short-term (7 days) N-acetylcysteine (NAC) at 1,200 mg daily supplementation on muscle fatigue, maximal oxygen uptake (VO(2max)), total antioxidant capacity (TAC), lactate, creatine kinase (CK), and tumor necrotic factor-alpha (TNF-α). Twenty-nine sedentary men (13 controls; 16 in the supplement group) from a randomized control were included. At before and after supplementation, fatigue index (FI) was evaluated in the quadriceps muscle, and performed a graded exercise treadmill test to induce oxidative stress, and as a measure of VO(2max). Blood samples were taken before exercise and 20 minutes after it at before and after supplementation, to determine TAC, CK, lactate, and TNF-α levels. Results showed that FI and VO(2max) increased significantly in the supplement group. After exercise decreased the levels of TAC and increased lactate, CK, and TNF-α of both groups at before supplementation. After supplementation, lactate, CK, and TNF-α levels significantly increased and TAC decreased after exercise in the control group. Whereas the TAC and lactate levels did not change significantly, but CK and TNF-α increased significantly in the supplement group. Therefore, this results showed that NAC improved the muscle fatigue, VO(2max), maintained TAC, controlled lactate production, but had no influence on CK and TNF-α.

Thai Short-form McGill Pain Questionnaire.

OBJECTIVE: To validate the Thai Short-Form McGill Pain Questionnaire (Th-SFMPQ). MATERIAL AND METHOD: A postal survey to find the most corresponding terms to those used in the original English short-form McGill Pain Questionnaire had been performed The Thai version was created and validated. Sixty patients who had either musculoskeletal or neuropathic pain were assessed by two interviewers with this Th-SFMPQ. RESULTS: Forty four women and sixteen men participated in this study. Average age was 44.3 +/- 12.8 years and 80% of them had musculoskeletal pain. Means of sensory score was 8.98, affective score was 5.73, total score was 14.71, total count was 7.33, Present Pain Intensity (PPI) was 3.21 and Visual Analog Scale (VAS) was 53.61. Cronbach's a value was 0.7881 and inter-rater validity value of PPI was more than 0.7. The correlation coefficient was quite high (r > 0.8) for all scales. Regarding content validity, three pain descriptors (ie. stabbing, gnawing, and splitting) did not meet 33% in Melzack's criteria. CONCLUSION: The Th-SFMPQ has good internal consistency and inter-rater validity. Three uncommon descriptors should be substituted by other words or discarded in later version.

Botulinum toxin type A injections for treating neurogenic detrusor overactivity combined with low-compliance bladder in patients with spinal cord lesions.

OBJECTIVE: To evaluate botulinum toxin type A (BTX-A) for treating neurogenic detrusor overactivity in patients with spinal cord lesions, including those with abnormally low bladder compliance. DESIGN: Nonrandomized, before-after trial (9-mo follow-up). SETTING: Hospitalized care. PARTICIPANTS: Ten patients with high detrusor contraction pressure and/or poor response to oxyphencyclimine with incontinence selected as a consecutive sample. INTERVENTION: BTX-A (Botox; 300U) was injected into the detrusor muscle. MAIN OUTCOME MEASURES: Urinary continence, functional bladder capacity, bladder compliance, detrusor contraction pressure, and volume at first reflex voiding. Measurements were taken before and 6, 16, and 36 weeks posttreatment. RESULTS: Six weeks after treatment, complete continence was restored in 7 patients without oxyphencyclimine. Mean functional bladder capacity (P=.008), compliance (P=.012), and reflex volume (P=.045) significantly increased, whereas maximal detrusor contraction pressure significantly decreased (P<.001). Urodynamic variables remained significantly improved at 16 weeks, but values were returning toward baseline levels by 36 weeks. The procedure was generally uneventful, without any serious side effects. CONCLUSIONS: BTX-A injections are an effective, well-tolerated treatment for neurogenic detrusor overactivity in patients with spinal cord lesions, even in patients with abnormally low bladder compliance. Patients may require repeat injections after 16 weeks to remain continent.