Chein-Wei Chang

Mobilization Techniques in Subjects With Frozen Shoulder Syndrome: Randomized Multiple-Treatment Trial

Background and Purpose: The purpose of this study was to compare the use of 3 mobilization techniques—end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM)—in the management of subjects with frozen shoulder syndrome (FSS). Subjects: Twenty-eight subjects with FSS were recruited. Methods: A multiple-treatment trial on 2 groups (A-B-A-C and A-C-A-B, where A=MRM, B=ERM, and C=MWM) was carried out. The duration of each treatment was 3 weeks, for a total of 12 weeks. Outcome measures included the functional score and shoulder kinematics. Results: Overall, subjects in both groups improved over the 12 weeks. Statistically significant improvements were found in ERM and MWM. Additionally, MWM corrected scapulohumeral rhythm significantly better than ERM did. Discussion and Conclusion: In subjects with FSS, ERM and MWM were more effective than MRM in increasing mobility and functional ability. Movement strategies in terms of scapulohumeral rhythm improved after 3 weeks of MWM.

Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: A randomized control trial

Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops, shorten its duration. We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach (EMSMTA) in a subgroup of subjects with frozen shoulder syndrome (FSS). Based on the kinematics criteria from a prediction method, 34 subjects with FSS were recruited. Eleven subjects were assigned to the control group, and 23 subjects who met the criteria were randomly assigned to the criteria-control group with a standardized physical therapy program or to the EMSMTA group. Subjects attended treatment sessions twice a week for 8 weeks. Range of motion (ROM), disability score, and shoulder complex kinematics were obtained at the beginning, 4 weeks, and 8 weeks. Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria-control group at 4 weeks (mean difference=0.2 of normalized hand-behind-back reach) and 8 weeks (mean difference=22.4 degrees humeral external rotation, 0.31 of normalized hand-behind-back reach, 7.5 disability, 5 degrees tipping and 0.32 rhythm ratio). Similar improvements were found between the EMSMTA group and control group. The EMSMTA was more effective than a standardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method.

Evident trans-synaptic degeneration of motor neurons after stroke: a study of neuromuscular jitter by axonal microstimulation

Neuronal degradation accompanied by axonal degeneration has been known to occur in lower motor neurons following a stroke. In the present study, the functional integrity of neuromuscular transmission was assessed, utilizing a sensitive electrodiagnostic method consisting of stimulated single-fiber electromyography (SFEMG), along with axonal microstimulation, in paralytic muscles of stroke patients. Neuromuscular jitter was measured in the hemiplegic side extensor digitorum communis (EDC) as well as in anterior tibial (AT) muscles for 28 stroke patients and also for 13 age-matched controls. The disease duration, i.e. from the onset of stroke until the stimulated SFEMG examination, extended from 2 months to 8 years. Mean jitters obtained in EDC and AT muscles of stroke patients were found to be significantly greater than those in normal controls. Mean jitters obtained in severely weak muscles of stroke patients were greater than those in moderately weak muscles. Positive correlations were noted between the increased jitter and the disease duration from the onset of stroke until the time of the stimulated SFEMG test. These findings demonstrate a dysfunction of neuromuscular transmission in the paralytic muscles of stroke patients and suggests that trans-synaptic degeneration of motor neurons may occur in stroke. Furthermore, the neuronal degradation in stroke was positively correlated with the course duration of the disease.

Spinal Nerve Stimulation in the Diagnosis of Lumbosacral Radiculopathy

Direct spinal nerve stimulation was compared with needle electromyography (EMG) in 40 patients who were suspected of having an L5 or SI radiculopathy. For spinal nerve stimulation, we adapted a monopolar needle electrode inserted deep into the paraspinal muscle. The minimal latency, amplitude, and negative phase area of compound muscle action potential from myotomal muscles were recorded with computer assistance. Abnormality was considered to be significant when the value fell outside of 2 SD of control mean values. Among 17 patients with clinical evidence of radiculopathy, needle EMG was abnormal in 10 patients (58.8%), whereas in the nerve stimulation test the abnormalities were shown in 16 patients (94.1%); in amplitude difference and the abnormal area, differences were shown in 12 patients (70.6%). Among 23 patients with only subjective symptoms of radiculopathy, needle EMG was abnormal in nine patients (39.1%), whereas the abnormal amplitude differences were shown in 18 patients (78.3%) and 15 patients (65.2%) with abnormal area difference by spinal nerve stimulation, respectively. Direct spinal nerve stimulation is recognized as an objective and sensitive test in the diagnosis of lumbosacral radiculopathy.

Evidence of Neuroaxonal Degeneration in Myofascial Pain Syndrome: A Study of Neuromuscular Jitter by Axonal Microstimulation

The mechanism of myofascial pain syndrome (MPS) is unclear. Previous reports pointed out that pathogenesis of either referred pain or local twitch response in trigger point of MPS is related to the nerve degeneration and disintegration of motor and sensory nerves in spinal cord.

Ventilatory and mouth occlusion pressure responses to hypercapnia in chronic tetraplegia.

OBJECTIVE To compare the ventilatory response to hypercapnia and the mouth occlusion pressure measured at 0.1 second following inspiration (P0.1) in hypercapnia between chronic tetraplegic and normal subjects. DESIGN A case-control study with an uneven sample size for the study of clinical disorders. SETTING Patients were recruited from the outpatient clinic of a rehabilitation department. PARTICIPANTS Seven normal men and 9 men with tetraplegia who had cervical cord injuries (C5-C8), with a mean injury duration of 9.7 yrs. INTERVENTIONS Pulmonary function tests were performed during resting, whereas minute ventilation (VE) and P0.1 were measured during CO2 rebreathing. RESULTS The maximal voluntary ventilation (MVV), vital capacity (VC), and maximal respiratory muscle strength in the tetraplegic subjects were significantly less than in the normal subjects. Both the ventilatory and P0.1 responses to hypercapnia were significantly reduced in tetraplegic as compared with normal subjects, but the reductions were eliminated by normalizing with maximal ventilatory performance (MVV or VC) and maximal inspiratory muscle strength (PImax), respectively. CONCLUSIONS Chronic tetraplegic persons have diminished ventilatory and P0.1 responses to hypercapnia. Respiratory muscle weakness may be a primary factor contributing to the diminished ventilatory response observed in these patients.

Varied clinical patterns, physical activities, muscle enzymes, electromyographic and histologic findings in patients with post-polio syndrome in Taiwan

Study design: A study of the clinical features, physical activity, muscle enzyme, electromyography and histopathological alternations of muscles in patients with post-polio syndrome (PPS).Objective: To assess the varied patterns of PPS in Taiwan.Setting: Taiwan.Methods: Thirty-one patients who fulfill the inclusion criteria of PPS were selected for study. Clinical features, physical activity scale, serum concentrations of creatine kinase, electromyography and histopathological alterations of muscles were assessed and correlated to the causes of PPS patients.Results: Patients with PPS in Taiwan are relatively young, with a mean age of 39.3 years. Elevated concentration of creatine kinase was found predominantly in male patients with higher physical activities. Electromyographic examinations as well as histological tests of affected muscles revealed prominent evidence of chronic and active denervation with reinnervation in PPS patients.Conclusion: Patients with PPS in Taiwan are young. Thus, PPS should not be attributed to aging. Physical attrition with degradation of nerve terminals is considered the main cause of this disease.Sponsorship: This study was supported by the National Science Council, Republic of China under grant no. NSC-83-0412-B002-302.Spinal Cord (2001) 39, 526–531.

Evident transsynaptic degeneration of motor neurons after spinal cord injury: a study of neuromuscular jitter by axonal microstimulation.

Chang C-W: Evident transsynaptic degeneration of motor neurons after spinal cord injury: a study of neuromuscular jitter by axonal microstimulation. Am J Phys Med Rehabil 1998;77:118–121 Neuronal degradation accompanied with axonal degeneration has been known to occur in spinal motor neurons after an upper level of spinal cord lesion. In the present study, the functional integrity of neuromuscular transmission was assessed by utilizing a sensitive electrodiagnostic method comprising of stimulated single-fiber electromyography (SFEMG), along with axonal microstimulation, in paralytic muscles of patients with spinal cord injury (SCI). Neuromuscular jitter was measured in anterior tibial muscles for 30 patients with SCI and also for 12 normal controls. Mean jitter of 37.4 \pm 14.7 (mean \pm SD) μs, as obtained in SCI patients, was found to be significantly greater than the results of 20.1 \pm 8.4 μs in normal controls (P < 0.01). Jitter measurement was not significantly different in varied functional scales of SCI. A positive correlation was noted between the increased jitter and the disease duration from the onset of cord lesion till the time of stimulated SFEMG test (r = 0.68; P < 0.01). The present abnormal finding of neuromuscular jitter provides an electrophysiologic evidence for axonal degeneration and suggests that transsynaptic degeneration of motor neuron may occur below the level of cord lesion in SCI patients. Furthermore, the neuronal degradation in SCI was positively correlated with the course duration of the disease.

Relative and Absolute Reliabilities of the Myotonometric Measurements of Hemiparetic Arms in Patients With Stroke

OBJECTIVE To investigate the relative and absolute reliabilities of the myotonometer. DESIGN Psychometric study. SETTING Three medical centers. PARTICIPANTS Patients with stroke (N=61). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Muscle tone, elasticity, and stiffness of relaxed affected deltoid, triceps brachii, biceps brachii, extensor digitorum, flexor carpi radialis, and flexor carpi ulnaris were measured twice, 30 minutes apart, using the myotonometer. Intraclass correlation coefficient, a relative reliability index, was calculated for 3 muscular properties and for each muscle to examine the degree of consistency and agreement between the 2 test sessions. Absolute reliability indices, including the SEM, smallest real difference, and Bland-Altman limits of agreement, were used to quantify measurement errors and check systematic biases of the 2 test sessions. RESULTS The intraclass correlation coefficients were .83 to .95 for muscle tone, elasticity, and stiffness of all muscle groups. The SEM and the smallest real difference of muscle tone, elasticity, and stiffness of the biceps were the smallest among the 6 muscles tested. The Bland-Altman analyses showed no systematic bias between most of the repeated measurements. Compared with other muscles, biceps had narrower limits-of-agreement ranges, indicating that the myotonometric measurements of the biceps had higher stability and less variation over time. CONCLUSIONS The myotonometer reliably measures muscular properties, with good relative and absolute reliabilities. These findings are useful for clinicians and researchers to assess muscle properties reliably and determine whether a real change has occurred in groups and on individual levels of patients with stroke.

Quantification of shoulder tightness and associated shoulder kinematics and functional deficits in patients with stiff shoulders.

Measurement of anterior/posterior shoulder tightness, humeral external/internal rotation range of motion (ROM), scapular upward rotation/tipping ROM, and functional limitations were made in 46 patients with unilateral stiff shoulders (SSs) using a clinical measurement (shoulder tightness), a three-dimensional electromagnetic tracking device (shoulder ROM), and self-reports of function. Patients with SSs in their dominant shoulder demonstrated statistically greater posterior shoulder tightness compared to nondominant shoulder. Control dominant shoulders demonstrated decreased internal ROM as compared with control nondominant shoulders (p=0.021). In SSs, significant relationships were found between humeral internal rotation ROM and posterior shoulder tightness (R=0.49, p<0.0005), humeral external rotation ROM and anterior shoulder tightness (R=0.59, p=0.0002), scapular tipping and anterior shoulder tightness (R=0.57, p=0.004). Specifically, in patients with dominant SSs, posterior shoulder tightness and functional limitation were related (R=0.56, p=0.002). In patients with dominant involved shoulders, emphasise on posterior tightness stretch may improve functional ability directly. In addition to stretching program in patients with SSs, internal rotation ROM of control dominant shoulder is also important to consider in the rehabilitation of patients with SSs.