The comparative effectiveness of combined hydrodilatation/corticosteroid procedure with two different quantities for adhesive capsulitis.

OBJECTIVE: To assess the efficacy of injecting various amounts of fluid into the shoulder joints for capsule distension in patients with adhesive capsulitis. DESIGN: A randomized controlled trial. SETTING: Outpatient clinic of a tertiary care centre. PARTICIPANTS: Eighty-four patients with adhesive capsulitis underwent a baseline (time0), 6 weeks (time1), and 12 weeks (time2) follow-up after hydrodilitation. INTERVENTION: Group 1 (n = 42) received 20 ml of lidocaine, steroid, and saline hydrodilatation via posterior glenohumeral recess, while Group 2 (n = 42) received 10 ml of lidocaine, steroid, and saline hydrodilitation. MAIN MEASURES: The primary outcome was the visual analogue scale for pain. The secondary outcomes were shoulder pain and disability index (SPADI) and ROM of the shoulder. RESULTS: There was a significant reduce in VAS scores for pain, SPADI scores, and increased shoulder ROM in both groups over time; however, the group-by-time interactions for any of the outcomes between groups were not significant except VAS pain in motion. Post-hoc pairwise analysis of the marginal effect of time and group showed that the significant difference of VAS in motion is due to time effect: time1 vs time0 (95% CI -4.09 to -2.68), time2 vs time0 (-4.21 to -2.77), and time2 vs time1 (-0.83 to 0.63), without between-group difference: group 1 vs group 2 (-0.38 to 0.59). CONCLUSION: Our study suggests hydrodilatation achieved an optimal effect at time1 for patients with adhesive capsulitis in both groups, and adding more saline offers additional benefits in flexion and external roatation until time2.

Effects of individualized Tai-Chi on balance and lower-limb strength in older adults.

BACKGROUND: To investigate whether a simplified and personalized Tai-Chi program could be beneficial for practitioners. A prospective quasi-experimental observer-blinded controlled trial was done in Beitou District of Taipei City. METHODS: Community-dwelling adults aged 65 and older without debilitating disease (N = 50) participated the study. Those who were willing to participate in exercise program were assigned to individualized Tai-Chi (iTC) group (n = 20), receiving iTC training for 8 weeks, and traditional Tai-Chi (tTC) group (n = 15), receiving tTC training for 8 weeks. Those who were not willing to participate in exercise training were included in the control group (n = 15). Functional balance tests, the Berg Balance Scale (BBS), timed up-and-go (TUG) test, functional-reach test, and measurement of lower-extremity muscle strength were conducted before and 8 weeks after the intervention. RESULTS: Significant improvements were noted in all functional balance tests and strength assessments of 16 major lower-limb muscle groups in participants of the iTC group compared to the control group, whereas only BBS and muscle strength of hips and ankles were improved in the tTC group. Practitioners of iTC outperformed tTC in BBS and strength of two major muscles. CONCLUSIONS: Personalized Tai-Chi training designed based on an objective measurement and conducted according to graded intensity and complexity benefitted practitioners after a short period. TRIAL REGISTRATION: Trial registration number: ClinicalTrials.gov ID: NCT03659396 , Unique Protocol ID: 1000087 Date of registration: 03/28/2017 The trial was registered retrospectively.

Bidirectional association between migraine and fibromyalgia: retrospective cohort analyses of two populations.

OBJECTIVE: Fibromyalgia (FM) and migraine are common pain disorders that tend to coexist. This study determined whether these two conditions exhibited any mutual influences. SETTING: Cohort study. PARTICIPANTS: A retrospective, longitudinal cohort study was conducted using data obtained from a nationwide healthcare database. This study had two arms. Arm 1 comprised 33 216 patients with FM and arm 2 consisted of 7420 patients with migraine; all of these patients were diagnosed between 2000 and 2010. Using the aforementioned database, control subjects who had neither FM nor migraine and were matched with the FM and migraine patients by sex, age and index date of diagnosis were recruited. Each control cohort was four times the size of the corresponding study cohort. Follow-up for the control and study cohorts was conducted until the end of 2011. RESULTS: The incidence rates of FM and migraine were calculated in arms 1 and 2, respectively. The overall incidence of migraine was greater in the FM cohort than in the corresponding control cohort (4.39 vs 2.07 per 1000 person-years (PY)); crude HR=2.12, 95% CI=1.96 to 2.30; adjusted HR (aHR)=1.89, 95% CI=1.75 to 2.05). After adjustment for sex, age and comorbidities, the overall incidence of FM in the migraine cohort was 1.57 times greater than that in the corresponding control cohort (7.01 vs 4.49 per 1000 PY; aHR=1.52, 95% CI=1.39 to 1.65). CONCLUSIONS: The present study revealed a bidirectional link between FM and migraine.

Risk factors and prediction model for persistent breast-cancer-related lymphedema: a 5-year cohort study.

PURPOSE: Breast-cancer-related lymphedema (BCRL) can be a transient or persistent condition. The aims of this study were to (1) identify and weigh the risk factors for persistent lymphedema (PLE) among all patients with BCRL and (2) establish a prediction model for the occurrence of PLE. METHODS: A cohort of 342 patients with BCRL with a median follow-up of 5 years after the onset of swelling was analyzed. PLE was defined as a hardening of the subcutaneous tissue, the persistence of the circumferential difference (CD) between arms, or a flare-up of swelling during follow-up. Multiple logistic regression was used to identify risk factors for PLE, including tumors, treatments, and patient-related factors. The prediction accuracy of the model was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Of the 342 patients with BCRL, 229 (67%) had PLE. Multiple logistic regression analysis revealed that the number of lymph node metastases (p = 0.012), the maximal CD between arms at the first occurrence of swelling (p < 0.001), and the largest difference during follow-up (p < 0.001) were significant predictors for PLE. The corresponding AUC was 0.908. Although inclusion of body weight gains (p = 0.008) and maximal CD at the latest follow-up (p = 0.002) increased the analytical accuracy (AUC = 0.920), the resulting AUC values (p = 0.113) were not significantly different. CONCLUSIONS: BCRL is persistent in two thirds of patients. Patients with more lymph node metastases, weight gain, and larger CD since the onset of swelling and during follow-up have an increased likelihood of developing PLE.

Speed and temporal adaptations during nonmotorized treadmill walking in Parkinson disease and nondisabled individuals.

Few studies have explored the potential of gait analysis and training in nonmotorized treadmill (NMT) in Parkinson's disease (PD) patients. We investigated (a) the walking strategy adopted by patients with PD on NMT and (b) how balance may influence spatiotemporal gait parameters. We enrolled 12 patients with PD of modified Hoehn and Yahr stage 2-3 and 13 nondisabled individuals as controls. All participants were evaluated using Tinetti's performance oriented mobility assessment scale, freezing of gait questionnaire, modified falls efficacy scale, and the timed up and go test. They were asked to ambulate with comfortable and maximal speeds on the NMT. The gait parameters acquired on the NMT included walking speed, cadence (CAD), step length, and vertical ground reaction force, which were calculated for intragroup and intergroup comparisons. The PD group took on with higher contribution of CAD and less contribution of step length to increase walking speed as compared with control group. The postural stability is correlated significantly positively to the CAD at the setting of maximal speed in the PD group. Moreover, a significantly lower ratio of vertical ground reaction force/body weight was noted in the PD group during both comfortable and maximal walking speeds compared with the nondisabled controls. Our study outcomes clearly support the perceived benefits of NMT to differentiate spatiotemporal gait parameters between PD and controls. NMT may potentially be useful to evaluate the recovery of physical activities in PD receiving medications and/or rehabilitation.

Association between Cervical Spondylosis and Migraine: A Nationwide Retrospective Cohort Study.

Background: Few studies have investigated the longitudinal association between cervical spondylosis (CS) and migraine by using a nationwide population-based database. Methods: We conducted a retrospective cohort study from 2000 to 2011 identifying 27,930 cases of cervical spondylosis and 111,720 control subjects (those without cervical spondylosis) from a single database. The subjects were frequency-matched on the basis of sex, age, and diagnosis date. The non- cervical spondylosis cohort was four times the size of the cervical spondylosis cohort. To quantify the effects of cervical spondylosis on the risk of migraine, univariate and multivariate Cox proportional hazard regression analyses were used to calculate the hazard ratio (HR), and 95% confidence interval (CI). Results: After a 10-year follow-up controlling for potential confounding factors, overall migraine incidence was higher in the cervical spondylosis cohort than in the non-cervical spondylosis cohort (5.16 and 2.09 per 1000 people per year, respectively; crude hazard ratio = 2.48, 95% confidence interval = 2.28-2.69), with an adjusted hazard ratio of 2.03 (95% confidence interval = 1.86-2.22) after accounting for sex, age, comorbidities, and medication. Individuals with myelopathy in the cervical spondylosis cohort had a 2.19 times (95% confidence interval = 1.80-2.66) higher incidence of migraine when compared than did those in the non- cervical spondylosis cohort. Conclusions: Individuals with cervical spondylosis exhibited a higher risk of migraine than those without cervical spondylosis. The migraine incidence rate was even higher among individuals with cervical spondylotic myelopathy.

Speed and temporal-distance adaptations during non-motorized treadmill walking in stroke and non-disabled individuals.

BACKGROUND: Treadmill training has received widespread attention to facilitate gait retraining and allow gait analysis in the stroke population in recent decades. While previous studies have used motorized treadmills for gait analysis or training, no study has investigated the use of non-motorized treadmill (NMT) in a rehabilitation setting. AIM: The aim of this study was to compare the speed between overground (OG) and NMT walking and measure the adaptation of the gait pattern from comfortable to maximal walking speeds during NMT walking in participants with stroke and non-disabled individuals. DESIGN: Cross-sectional study. SETTING: Tertiary care center. POPULATION: Twenty chronic hemiplegic stroke patients and 20 non-disabled controls. METHODS: The speeds attained OG and on a NMT were compared within each group. Cadence and stride length were measured while walking on the NMT. Adaptations of the gait pattern from comfortable to maximal walking speeds during NMT walking were measured in both groups. RESULTS: In both groups, when walking on the NMT, participants walked with significantly lower speed than on the ground. While on the NMT, the non-disabled individuals significantly increased the cadence and stride length simultaneously as the speed increased. The participants with stroke significantly increased the cadence but showed little increase in stride length with increased speed. CONCLUSIONS: Participants ambulated with significantly lower speeds on the NMT than during OG. Participants with stroke use a different strategy to increase walking velocity during NMT walking, relying mostly on increasing the cadence. CLINICAL REHABILITATION IMPACT: Lower speed during NMT walking indicated that lesser total distance covered with NMT training when compared to OG gait training, which may inadvertently impact training amount. This is an important obstacle to overcome in order for NMT to be used effectively in the retraining of gait in patients with stroke.

First-ever stroke following hip replacement surgeries: a large population-based survey.

OBJECTIVE: This study was designed to determine the prevalence, subtypes and risk factors of first-ever stroke following hip replacement (HR) in a large population of Taiwan. METHODS: Using the National Health Insurance system of Taiwan, we identified patients undergoing HR from 2000 to 2011 and randomly selected 4 : 1 age- and sex-matched controls for each HR patients. The index date for HR patients was defined the date for HR. All study subjects were followed from the index date until stroke occurred at admission. T-test and chi-square test were used for continuous and categorical variables, respectively. The hazard ratios of risk factors were determined with Cox proportional hazard regression model. RESULTS: A total of 3604 HR patients and 14 394 controls were enrolled. In comparison with controls, patients undergoing HR had a significantly higher incidence of comorbidities (i.e. atrial fibrillation, hypertension, diabetes) and consumed more medications (i.e. antihypertension, antidiabetes, nonsteroid anti-inflammatory drugs and anticoagulants) before surgery. The HR patients had a significant higher incidence of first-ever stroke, especially for those aged over 65. (Hazard ratio: 1·33, 95% confidence interval: 1·12-1·58) The significantly higher risk for first-ever stroke occurred within 3 months and ≥ 1 year after HR. The incidence rate of ischaemic stroke is about five times than that of haemorrhagic stroke. CONCLUSION: Our study identifies multiple risk factors that cause cerebrovascular complications after HR, which is vital in creating treatment plans to prevent for said problems.

A Nationwide Population-Based Cohort Study of Migraine and Organic-Psychogenic Erectile Dysfunction.

As chronic illnesses and chronic pain are related to erectile dysfunction (ED), migraine as a prevalent chronic disorder affecting lots of people all over the world may negatively affect quality of life as well as sexual function. However, a large-scale population-based study of erectile dysfunction and other different comorbidities in patients with migraine is quite limited. This cohort longitudinal study aimed to estimate the association between migraine and ED using a nationwide population-based database in Taiwan.The data used for this cohort study were retrieved from the Longitudinal Health Insurance Database 2000 in Taiwan. We identified 5015 patients with migraine and frequency matched 20,060 controls without migraine from 2000 to 2011. The occurrence of ED was followed up until the end of 2011. We used Cox proportional hazard regression models to analyze the risks of ED.The overall incidence of ED was 1.78-fold greater in the migraine cohort than in the comparison cohort (23.3 vs 10.5 per 10,000 person-years; 95% confidence interval [CI] = 1.31-2.41). Furthermore, patients with migraine were 1.75-fold more likely to develop organic ED (95% CI = 1.27-2.41) than were the comparison cohort. The migraine patients with anxiety had a 3.6-fold higher HR of having been diagnosed with ED than the comparison cohort without anxiety (95% CI, 2.10-6.18).The results support that patients with migraine have a higher incidence of being diagnosed with ED, particularly in the patient with the comorbidity of anxiety.

Long-term sacral magnetic stimulation for refractory stress urinary incontinence.

OBJECTIVE: To evaluate the effects of sacral magnetic stimulation (SMS) on functional and urodynamic improvement in patients with refractory stress urinary incontinence (SUI). DESIGN: A sham-controlled, double-blind, parallel study design with a 4.5-month follow-up. SETTING: A tertiary hospital. PARTICIPANTS: Women (age, 45-75y) with SUI refractory to first-line management (N=34) were allocated to either an experimental (n=20) group or a sham (n=14) group. INTERVENTIONS: The SMS protocol consisted of 5-Hz, 20-minute treatments administered over the bilateral third sacral roots, with the intensity set at approximately 70% of the maximal output, for 12 consecutive weekdays. MAIN OUTCOME MEASURES: Urodynamic assessments and 2 life stress questionnaires, namely, the Urge-Urinary Distress Inventory (U-UDI) and the Overactive Bladder Questionnaire (OAB-q), were administered pre- and post-SMS intervention. We administered the U-UDI (primary outcome measure) and the OAB-q at 3-week intervals during the follow-up period until 18 weeks after the final intervention. RESULTS: The experimental group exhibited significant improvements in both U-UDI and OAB-q scores postintervention (P=.011-.014) and at follow-up visits (P<.001-.007) compared with the sham group. In addition, significant increases in bladder capacity, urethral functional length, and the pressure transmission ratio (P=.009-.033) were noted postintervention. Multivariate regression analysis revealed that patients with more severe symptoms benefited more from SMS. A poorer baseline U-UDI score and a shorter urethral functional length were associated with a greater response to SMS. CONCLUSIONS: Our observations of a greater response to SMS in patients with more severe SUI than in those with mild symptoms, as well as the long-term benefits of the treatment, confirm the efficacy of SMS in treating SUI.

Effects of intravascular laser irradiation of blood in mitochondria dysfunction and oxidative stress in adults with chronic spinal cord injury.

OBJECTIVE: This study investigated the clinical effects of intravascular laser irradiation of blood (ILIB) therapy on oxidative stress and mitochondrial dysfunction in subjects with chronic spinal cord injury (SCI) resulting from trauma. BACKGROUND DATA: Little is known about how ILIB may generate antioxidant defenses in humans, and there is still a lack of randomized, sham-control studies to indicate its influence on different metabolic pathways. METHODS: Twenty-four chronic SCI subjects (assigned to a sham and a study group), and 12 normal subjects were recruited. The study group underwent 1 h daily of ILIB for 15 days over 3 weeks. The sham group underwent ILIB with no laser power. RESULTS: Baseline measurements established higher oxidative stress and mitochondrial dysfunction in the SCI subjects than in the normal subjects. At day 15 of therapy, the study group revealed a significantly higher mitochondrial DNA (mtDNA) copy number, white blood cell adenosine triphosphate (WBC ATP) synthesis, and total antioxidant capacity (TAC) with significantly reduced malondialdehyde (MDA), than did the sham group. The study group intragroup comparison revealed significantly increased mtDNA copy numbers, WBC ATP synthesis, and TAC, with significantly reduced MDA, compared with its baseline measurements. The sham group intragroup comparisons demonstrated no statistical differences. Low-density lipoprotein (LDL) in the study group was significantly reduced at days 10 and 15, with significantly higher high-density lipoprotein (HDL) at day 45. CONCLUSIONS: Our study results contribute to the knowledge about the effectiveness of ILIB in alleviating oxidative stress and mitochondrial dysfunction in chronic SCI patients.

The impact of exsanguination by Esmarch bandage on venous hemodynamic changes in total knee arthroplasty - A prospective randomized study of 38 knees.

Elastic (Esmarch) bandage exsanguination is widely used in lower limb surgery to provide a bloodless operating field. Nevertheless, it is still not known exactly how exsanguination through Esmarch bandage usage contributes to venous pressure physiology following TKA. We wished to determine whether exsanguination with Esmarch bandage affects the venous hemodynamics of the lower limb in the first few weeks following TKA, so a prospectively randomized study was set. We prospectively collected consecutive 38 male patients with unilateral advanced osteoarthritis of the knee. All of the subjects were randomly assigned to one of two TKA procedures: TKA with (Group A) or without (Group B) Esmarch bandage exsanguination. No pharmacologic thromboembolic prophylaxis was used in this study. The venous hemodynamics of each operated leg was assessed by strain-gage plethysmography, firstly before the operation, then postoperatively on days 2, 6, 14 and 28. The postoperative results revealed significant falls in venous outflow 2, 6 and 14 days following TKA in Group A; and 2 and 6 days following TKA in Group B. Twenty-eight days after TKA, venous outflow in both groups had returned to baseline level. Over the 28 days following the operation, Group A venous outflow tended to fall more significantly than in Group B. As with venous outflow, venous capacitance in both groups showed significant falls 2 and 6 days following TKA, with recovery to baseline levels 28 days postoperation. More significant falls in arterial filling index were recorded in Group A 6 days following TKA, returning to their baseline level 14 days postoperation. It appears that better leg venous hemodynamic changes are attained during the first month after TKA in Group B. We therefore question the need for exsanguination with Esmarch bandage before knee arthroplasty.

Computer-aided vestibular autorotational testing of the vestibulo-ocular reflex in senile vestibular dysfunction.

BACKGROUND AND OBJECTIVE: Studies have already investigated vestibulo-ocular reflex (VOR) responses in elderly subjects, mostly at low frequencies (<1 Hz) during passive head turns, or continuous active head turns in a rotational chair. However, natural head movements usually occur at frequencies above 1 Hz and at varying rates, rather than at continuously increasing rates as tested in most studies to date. The aim of this study was to compare VOR responses within or between normal and bilateral peripheral vestibular hypofunction (BPVH) elderly subjects with a computer base program incorporating random active high-frequency head movements. SUBJECTS: Seventeen senior patients with bilateral peripheral vestibular hypofunction and 13 age-matched paid healthy subjects participated in this study. DESIGN: All the subjects performed 8s of active, side-to-side head motions at 1 Hz, 2 Hz and 3 Hz in response to four experimental conditions: (A) a stationary visual target; (B) a stationary visual target and a moving target with a horizontal trajectory; (C) a stationary visual target and a moving target with a spiral trajectory; and (D) a stationary visual target with combined horizontal- and vertical-spiral moving targets. RESULTS: Repeated-measures ANOVA showed that across the different frequencies of headshaking, a significant increase took place in the phase lag of the BPVH subjects (p<0.001) compared with the normal controls. Post hoc analysis showed significant within-group differences in BPVH subjects (1 Hz vs 2 Hz, 2 Hz vs 3 Hz) and normal controls (1 Hz vs 2 Hz, 1 Hz vs 3 Hz). A significant VOR gain took place among the BPVH subjects at 3 Hz VAT (p<0.001) as compared with 1 Hz VAT and no significant differences in VOR gain could be detected among the controls at either of these frequencies. Repeated-measures ANOVA revealed that under our test conditions, significant main effect was noted for VOR asymmetry (F=4.45, p<0.05). Post hoc analysis showed significant within-group differences in the BPVH subjects (test A vs test B, test A vs test C, and test A vs test D). CONCLUSIONS: Our results showed that the VAT paradigm can be improved by using concurrent horizontal and vertical moving targets. The VOR phase may be useful for differentiating VAT responses between BPVH and healthy elderly subjects. Moreover, the results of this study demonstrate that gains in VOR at different frequencies of headshaking and asymmetry during different test conditions can be useful parameters for within-group assessment.

Psychological benefits of virtual reality for patients in rehabilitation therapy.

CONTEXT: Whether virtual rehabilitation is beneficial has not been determined. OBJECTIVE: To investigate the psychological benefits of virtual reality in rehabilitation. DESIGN: An experimental group underwent therapy with a virtual-reality-based exercise bike, and a control group underwent the therapy without virtual-reality equipment. SETTING: Hospital laboratory. PATIENTS: 30 patients suffering from spinal-cord injury. INTERVENTION: A designed rehabilitation therapy. MAIN OUTCOME MEASURES: Endurance, Borg's rating-of-perceived-exertion scale, the Activation-Deactivation Adjective Check List (AD-ACL), and the Simulator Sickness Questionnaire. RESULTS: The differences between the experimental and control groups were significant for AD-ACL calmness and tension. CONCLUSION: A virtual-reality-based rehabilitation program can ease patients' tension and induce calm.

Outcomes of common peroneal nerve lesions after surgical repair with acidic fibroblast growth factor.

BACKGROUND: There have been no clinical trials concerning the effect of acidic fibroblast growth factor (aFGF) on human peripheral nerve lesions. Our interest was focused on the question of whether a repair strategy incorporating growth factors could be applied to repair of common peroneal nerve lesions. METHODS: This study involved three groups of patients with common peroneal nerve lesions: group 1 (n = 21) received surgical repair with fibrin glue added with aFGF; group 2 (n = 8) received surgical repair only; group 3 (n = 16) did not receive any surgical intervention. All patients received electrophysiologic examinations and physical examination at baseline, 6 months, and 12 months postsurgically. RESULTS: Group 1 demonstrated significantly increased average muscle strength score by 0.4299 and 0.5045 at 6 and 12 months after the operation (p = 0.0197 and 0.0297, respectively). In groups 2 and 3 patients, however, significant increase of average muscle strength scores was not achieved either at 6 or 12 months postoperatively. During the first follow-up evaluation the average muscle strength score in group 1 (3.06 +/- 1.60) was significantly higher than those in group 2 (1.04 +/- 0.86) and group 3 (1.65 +/- 1.43) (p = 0.005). However, significant difference was not achieved during the second follow-up evaluation. CONCLUSION: This study demonstrated the potential of this innovative repair strategy with aFGF treatment to facilitate nerve regeneration and motor function recovery following peripheral nerve lesions.

Efficacy of functional magnetic stimulation in neurogenic bowel dysfunction after spinal cord injury.

OBJECTIVE: The aims of this study were to assess the usefulness of functional magnetic stimulation in controlling neurogenic bowel dysfunction in spinal cord injured patients with supraconal and conal/caudal lesions, and to investigate the efficacy of this regimen with a 3-month follow-up. DESIGN: A longitudinal, prospective before-after trial. SUBJECTS: A total of 22 patients with chronic spinal cord injured and intractable neurogenic bowel dysfunction. They were divided into group 1 (supraconal lesion) and group 2 (conal/caudal lesion). METHODS: The colonic transit time assessment and Knowles-Eccersley-Scott Symptom Questionnaire were carried out for each patient before they received a 3-week functional magnetic stimulation protocol and on the day following the treatment. RESULTS AND CONCLUSION: Following functional magnetic stimulation, the mean colonic transit time for all patients decreased from 62.6 to 50.4 h (p<0.001). The patients' Knowles-Eccersley-Scott Symptom scores decreased from 24.5 to 19.2 points (p<0.001). The colonic transit time decrement in both group 1 (p=0.003) and group 2 (p=0.043) showed significant differences, as did the Knowles-Eccersley-Scott Symptom score in both groups following stimulation and in the 3-month follow-up results (p<0.01). The improvements in bowel function indicate that functional magnetic stimulation,featuring broad-spectrum application, can be incorporated successfully into other therapies as an optimal adjuvant treatment for neurogenic bowel dysfunction resulting from spinal cord injury.

Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial.

This is a single blind randomized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke. Twenty subjects with stroke were assigned randomly to either the control group (n=9) or the experimental group (n=11). Subjects in the control group received the treadmill training. Subjects in the experimental group underwent the virtual reality-based treadmill training. Walking speed, community walking time, walking ability questionnaire (WAQ), and activities-specific balance confidence (ABC) scale were evaluated. Subjects in the experimental group improved significantly in walking speed, community walking time, and WAQ score at posttraining and 1-month follow-up periods. Their ABC score also significantly increased at posttraining but did not maintain at follow-up period. Regarding the between-group comparisons, the experimental group improved significantly more than control group in walking speed (P=0.03) and community walking time (P=0.04) at posttraining period and in WAQ score (P=0.03) at follow-up period. Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke.

Use of virtual reality to improve upper-extremity control in children with cerebral palsy: a single-subject design.

BACKGROUND AND PURPOSE: Virtual reality (VR) creates an exercise environment in which the intensity of practice and positive feedback can be systematically manipulated in various contexts. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy (CP). PARTICIPANTS: Four children with spastic CP were recruited. METHOD: A single-subject design (A-B with follow-up) was used. All children were evaluated with 3 baseline, 4 intervention, and 2 follow-up measures. A 4-week individualized VR training program (2 hours per week) with 2 VR systems was applied to all children. The outcome measures included 4 kinematic parameters (movement time, path length, peak velocity, and number of movement units) for mail-delivery activities in 3 directions (neutral, outward, and inward) and the Fine Motor Domain of the Peabody Developmental Motor Scales-Second Edition (PDMS-2). Visual inspection and the 2-standard-deviation-band method were used to compare the outcome measures. RESULTS: Three children who had normal cognition showed improvements in some aspects of reaching kinematics, and 2 children's change scores on the PDMS-2 reached the minimal detectable change during the intervention. The improvements in kinematics were partially maintained during follow-up. DISCUSSION AND CONCLUSION: A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP, especially in children with normal cognition and good cooperation. The training effects were retained in some children after the intervention.

Effect of a virtual reality-enhanced exercise protocol after coronary artery bypass grafting.

BACKGROUND AND PURPOSE: Virtual reality (VR) technology has gained importance in many areas of medicine. Knowledge concerning the application and the influence of VR-enhanced exercise programs is limited for patients receiving coronary artery bypass grafting. The purpose of this study was to evaluate the effect of a virtual "country walk" on the number of sessions necessary to reach cardiac rehabilitation goals in patients undergoing coronary artery bypass grafting. SUBJECTS: Twenty subjects who were seen for cardiac rehabilitation between January and June 2004 comprised the study sample. METHODS: The protocol for this study included an initial maximum graded exercise tolerance test, given to determine the subsequent training goals for the subject, followed by biweekly submaximal endurance training sessions. All subjects were assigned by lot to 1 of 2 submaximal endurance training programs, one (group 2) with and the other (group 1) without the added VR environment. In all other respects, the 2 programs were identical. Each training session lasted for 30 minutes and was carried out twice per week for about 3 months. The primary outcome measures were maximum load during the work sessions, target oxygen consumption, target heart rate (beats per minute), and number of training sessions required to reach rehabilitation goals. RESULTS: By the end of 20 training sessions, only 4 of the 10 control subjects had reached the heart rate target goal of 85% their maximum heart rate. In contrast, 9 of the 10 subjects in the VR program had attained this goal by 9 or fewer training sessions. When target metabolic cost (75% peak oxygen consumption) was used as the training goal, all 10 subjects in the VR program had reached this target after 2 training sessions (or, in some cases, 1 training session), but not until training session 15 did a cumulative number of 9 control subjects reach this goal. DISCUSSION AND CONCLUSION: These study outcomes clearly support the notion that incorporating a VR environment into cardiac rehabilitation programs will accelerate maximum recovery of patients' cardiovascular function.

Concordance and discrepancy between electrodiagnosis and magnetic resonance imaging in cervical root avulsion injuries.

To clarify the relationships between electromyography (EMG) and magnetic resonance imaging (MRI), we compared findings in 37 selected patients who presented with cervical root avulsion injuries. Nerve root repair with C4-T1 hemilaminectomy was subsequently performed on 19 patients. The agreement between the two evaluative modalities with complete or incomplete lesions of ventral root and pre- or postganglionic lesions of dorsal root was measured for each root level. Both with ventral and dorsal root evaluation, C6, C7, and C8 yielded high agreement values, ranging from 86% to 94%. C5 manifested the lowest agreement values: 54% on ventral root assessment. Additionally, EMG, in comparison with MRI, revealed a higher quantity of implicated injured components. MRI, in turn, detected more lesion components than surgical exploration alone achieved. The capability of EMG to recognize axonotmesis leads to the discrepant findings between the two modalities. The visualization of mild neurotmesis by MRI, which cannot be achieved by surgical inspection, results in divergent findings between the two modalities. Both EMG and the MRI play crucial roles in preoperative assessment, and they may complement each other.