Alice May-Kuen Wong

Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial.

Abstract Transcutaneous electrical nerve stimulation (TENS) is one of the non‐pharmacological means of pain relief for labor and delivery. We aimed to investigate the efficacy and safety of TENS on specific acupuncture points for reducing pain in the first stage of labor. In this double‐blind, placebo‐controlled trial, we randomly assigned healthy full‐term parturients in active phase of first‐stage labor to either TENS on four acupuncture points (Hegu [Li 4] and Sanyinjiao [Sp 6]) (n = 52) or the TENS placebo (n = 53). Visual analogue scale (VAS) was used to assess pain before and 30 and 60 min after treatment. The primary outcome was the rate of VAS score decrease ⩾3 in each group. A questionnaire was given at 24 h post‐partum to evaluate the satisfaction of pain relieving method and the willingness to have the same treatment again. Mode of delivery and neonatal effect were measured as secondary outcome. One hundred women were eligible for analysis. TENS group experienced VAS score reduction ⩾3 significantly more common than the TENS placebo group (31/50 [62%] vs 7/50 [14%], P < 0.001). Willingness of using the same analgesic method for a future childbirth was also significantly different (TENS: 48/50 [96%] vs TENS placebo: 33/50 [66%], P < 0.001). Operative delivery was increased in the TENS group (12/50 [24%] vs 4/50 [8%], P = 0.05), but the neonatal outcomes were not different. The application of TENS on specific acupuncture points could be a non‐invasive adjunct for pain relief in the first stage of labor.

Tai Chi Chuan in Medicine and Health Promotion

Tai Chi Chuan (Tai Chi) is a Chinese traditional mind-body exercise and recently, it becomes popular worldwide. During the practice of Tai Chi, deep diaphragmatic breathing is integrated into body motions to achieve a harmonious balance between body and mind and to facilitate the flow of internal energy (Qi). Participants can choose to perform a complete set of Tai Chi or selected movements according to their needs. Previous research substantiates that Tai Chi has significant benefits to health promotion, and regularly practicing Tai Chi improves aerobic capacity, muscular strength, balance, health-related quality of life, and psychological well-being. Recent studies also prove that Tai Chi is safe and effective for patients with neurological diseases (e.g., stroke, Parkinsons disease, traumatic brain injury, multiple sclerosis, cognitive dysfunction), rheumatological disease (e.g., rheumatoid arthritis, ankylosing spondylitis, and fibromyalgia), orthopedic diseases (e.g., osteoarthritis, osteoporosis, low-back pain, and musculoskeletal disorder), cardiovascular diseases (e.g., acute myocardial infarction, coronary artery bypass grafting surgery, and heart failure), chronic obstructive pulmonary diseases, and breast cancers. Tai Chi is an aerobic exercise with mild-to-moderate intensity and is appropriate for implementation in the community. This paper reviews the existing literature on Tai Chi and introduces its health-promotion effect and the potential clinical applications.

Pharmacotherapy of Spasticity in Children With Cerebral Palsy

Spasticity is a common disability in children with cerebral palsy. Pharmacological and non-pharmacological treatments, including physical therapy, occupational therapy, orthotics, rhizotomy, and orthopedic surgery, all play important roles in the management of spasticity. The purpose of this article is to provide an overview of available medications for treatment of spasticity in children with cerebral palsy. Common medications include benzodiazepines, dantrolene sodium, baclofen, tizanidine, botulinum toxins, phenol, alcohol and intrathecal baclofen. In general, oral medications and intrathecal baclofen are used for treating generalized spasticity, whilst chemodenervation agents (botulinum toxins, phenol, and alcohol) are used to treat localized spasticity. There is more sufficient evidence for the recommendation of botulinum toxin A as an effective anti-spasticity treatment in children with cerebral palsy. However, more data concerning safety and long-term effects of botulinum toxin A is needed. Further study is needed to determine which kinds of medications can cause substantial improvement in daily activity, participation level, self-competence, or quality of life in children with cerebral palsy.

Longitudinal followup study of ultrasonography in congenital muscular torticollis.

High-resolution ultrasonography was used to examine affected sternocleidomastoid muscles in patients with congenital muscular torticollis at different times. Thirty-one female and 42 male patients were recruited and classified as having one of four types of fibrosis based on the sonograms. Compared with initial assessment, 22 (95.6%) patients with Type I fibrosis and 22 (57.9%) patients with Type II fibrosis had a change in classification at the end of the study. Among the patients with Type I fibrosis, the classification of one patient was changed to Type III fibrosis, the classifications of two patients were changed to normal muscle, and the classifications of the other patients were changed to Type II fibrosis. For patients with Type II fibrosis, the classifications of two patients were changed to Type III fibrosis, the classifications of three patients were changed to Type IV fibrosis, and the classifications of the other patients were changed to normal muscle. No changes in classification of patients with Types III and IV fibrosis occurred during followup. Patients with Type IV fibrosis had a significantly high incidence of surgical intervention. Congenital muscular torticollis is a dynamic disease. Ultrasonography can be valuable in observing the alteration. Aggressive management may be necessary for patients with Type IV fibrosis.

The traction angle and cervical intervertebral separation

Seventeen normal young adults were evaluated for cervical intervertebral separation under different traction angles through motorized intermittent traction in the supine position. In all cases, the anterior and posterior intervertebral spaces were increased by traction at neutral position and in 30°flexion, but not in 15° extension. The effects of separation were 1) neutral position: anterior intervertebral separation C4–5 (12%) > C3–4 (8%), posterior intervertebral separation C6–7 (37%) > C3–4 (22%) > C4–5 (19%); and 2) 30° flexion: anterior intervertebral separation C2–3 (21 %) > C4–5 (16%) > C5–6 (15%) > C3–4 (10%), posterior intervertebral separation C6–7 (20%) > C5–6 (19%) > C4–5 (17%). There was a significant decrease in intervertebral separation posteriorly in extension traction, especially at C6–7 (−50%), C5–6 (−37%), C4–5 (−26%), and C3–4 (−14%). The separation of facet joint surfaces was found after traction at 15° extension, but not in the neutral or flexion positions.

Decreased central fatigue in multiple sclerosis patients after 8 weeks of surface functional electrical stimulation.

Effective treatments for multiple sclerosis (MS)-associated central fatigue have not been established. Surface functional electrical stimulation (FES), which can challenge the peripheral neuromuscular system without overloading the central nervous system, is a relatively safe therapeutic strategy. We investigated the effect of 8 weeks of surface FES training on the levels of general, central, and peripheral fatigue in MS patients. Seven of nine individuals with MS (average age: 42.86 +/- 13.47 years) completed 8 weeks of quadriceps muscle surface FES training. Maximal voluntary contraction, voluntary activation level, twitch force, General Fatigue Index (FI), Central Fatigue Index (CFI), Peripheral Fatigue Index, and Modified Fatigue Impact Scale (MFIS) scores were determined before and after training. The results showed that FI (p = 0.01), CFI (p = 0.02), and MFIS (p = 0.02) scores improved significantly after training. Improvements in central fatigue contributed significantly to improvements in general fatigue (p < 0.01). The results of the current study showed that central fatigue was a primary limitation in patients with MS during voluntary exercise and that 8 weeks of surface FES training for individuals with MS led to significantly reduced fatigue, particularly central fatigue.

Ciprofloxacin up-regulates tendon cells to express matrix metalloproteinase-2 with degradation of type I collagen

Ciprofloxacin‐induced tendinopathy and tendon rupture have been previously described, principally affecting the Achilles tendon. This study was designed to investigate the effect of ciprofloxacin on expressions of matrix metalloproteinases (MMP)‐2 and ‐9, tissue inhibitors of metalloproteinase (TIMP)‐1 and ‐2 as well as type I collagen in tendon cells. Tendon cells intrinsic to rat Achilles tendon were treated with ciprofloxacin and then underwent MTT (tetrazolium) assay. Real‐time reverse‐transcription polymerase chain reaction (RT‐PCR) and Western blot analysis were used, respectively, to evaluate the gene and protein expressions of type I collagen, and MMP‐2. Gelatin zymography was used to evaluate the enzymatic activities of MMP‐2 and ‐9. Reverse zymography was used to evaluate TIMP‐1 and ‐2. Immunohistochemical staining for MMP‐2 in ciprofloxacin‐treated tendon explants was performed. Collagen degradation was evaluated by incubation of conditioned medium with collagen. The results revealed that ciprofloxacin up‐regulated the expression of MMP‐2 in tendon cells at the mRNA and protein levels. Immunohistochemistry also confirmed the increased expressions of MMP‐2 in ciprofloxacin‐treated tendon explants. The enzymatic activity of MMP‐2 was up‐regulated whereas that of MMP‐9, TIMP‐1 or TIMP‐2 was unchanged. The amount of secreted type I collagen in the conditioned medium decreased and type I collagen was degraded after ciprofloxacin treatment. In conclusion, ciprofloxacin up‐regulates the expressions of MMP‐2 in tendon cells and thus degraded type I collagen. These findings suggest a possible mechanism of ciprofloxacin‐associated tendinopathy.

The Relationship Between Parental Concerns and Final Diagnosis in Children With Developmental Delay

Parental concern is a useful screening approach for early detection of children with developmental delay. We investigated the relationships among parental concerns, functional impairment, and final diagnosis of children (n = 273) with developmental delays. Of these, motor, language, and global delay were most common. Parental concerns, especially in language and motor development, were good predictors of children with language or motor delay, and provided reliable information for detection of children with delays in these domains. Parents were less likely to identify children with cognitive problems, global delay, or associated behavioral problems. Co-occurrence of developmental disorders was also recognized, especially in children with global delay. We conclude that parental concerns are useful information for detection of specific developmental problems in children. Because co-occurrence of developmental disorders is common, their early recognition would be helpful for better care of these children.

Eye-hand Coordination of Elderly People Who Practice Tai Chi Chuan

BACKGROUND/PURPOSE The objective of this study was to evaluate the effect of motor control from Tai Chi Chuan (TCC) on eye-hand coordination in the elderly. METHODS Forty-two elderly people were recruited into this study. People in the TCC group (n = 22) had been practicing TCC regularly for more than 3 years. The control group (n = 20) comprised healthy and active elderly people. Subjects were asked to stroke target sensors in a test device with computer recording. There were three different target sensor sizes (1 cm, 1.5 cm and 2 cm in diameter) for different tests. For each target stroking, the following were recorded and calculated: start and end positions, duration of movement, pause time, peak velocity, and the time to reach peak velocity. RESULTS The TCC group showed significantly better results in decrease of displacement (p = 0.003), movement time (p = 0.002), pause time (p < 0.001), number of submovements (p = 0.001), and better skewness coefficients (p < 0.001) than the control group. However, the difference in the peak velocity of the TCC and control groups did not reach statistical significance (p = 0.026). CONCLUSION The elderly TCC group had better results on the eye-hand coordination test than the control elderly group.

Clinical trial of a cervical traction modality with electromyographic biofeedback.

A new design of cervical traction modality with closed loop traction weight control based on electromyographic (EMG) biofeedback was developed. It consists of the development of a high signal-to-noise ratio EMG scanner, on-line self-adjusted traction weight controller, computer interface hardware, and closed loop biofeedback control software. Six healthy, young adults received conventional cervical traction to establish basic information of cervical EMG activities. Twenty-four patients with cervical radiculopathy were randomly divided into two groups for clinical assessment by conventional and new EMG biofeedback traction modality. The average electromyographic activity in healthy subjects ranged from 2.41 to 3.49 microV, whereas EMG activity in patients with neck pain ranged from 4.75 to 6.97 microV. There was a significant decrease of EMG activity during the whole traction phase, especially at pull phase in healthy subjects, but it was not as significant in patients with cervical radiculopathy. There was no significant change of myoelectric activity in the paraspinal muscles at vertebral levels C1-2, C3-4, and C5-6. Comparison of the average EMG activity of the paraspinal C-5 muscle in different phases of cervical traction showed a more significant decrease of EMG activity during the pull phase of traction as well as after traction in the high muscle tension group (with EMG activity above 5 microV), especially with the biofeedback traction modality. The raised traction force from start to optimum was shortened from 4 to 2 wk to achieve the same effective outcome by biofeedback as conventional traction modality.