Chia-Hsin Chen

The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity

OBJECTIVE To evaluate the effect of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. METHODS A total of 126 patients with bilateral knee osteoarthritis and obesity were classified into 3 groups by their stages of osteoarthritis. Each group was divided into subgroups a, b, and c. The subjects in subgroup a received weight reduction treatment, those in subgroup b received weight reduction and electrotherapy modalities, and those in subgroup c received electrotherapy modalities to relieve pain. RESULTS Pain reduction, weight reduction, ambulation speed, and changes of Lequesnes index were greater in patients in subgroups a and b than in subgroup c after treatment. Although the last pain scores in subgroup b were less than those in subgroup a, as measured by a visual analog scale (VAS), there was no significant difference between their functional status. Significant pain relief (VAS < 2) and an acceptable functional status (Lequesnes index < 7) were indicated when weight reduction was more than 15% and 12%, respectively, of the initial body weight of the individual. CONCLUSION Weight reduction was found to be a practical adjuvant treatment in the rehabilitation of patients with knee osteoarthritis.

Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis.

We recruited 132 subjects with bilateral knee osteoarthritis (Altman Grade II) to compare the effects of different stretching techniques on the outcomes of isokinetic muscle strengthening exercises. Patients were randomly divided into four groups (I–IV). The patients in Group I received isokinetic muscular strengthening exercises, Group II received bilateral knee static stretching and isokinetic exercises, Group III received proprioceptive neuromuscular facilitation (PNF) stretching and isokinetic exercises, and Group IV acted as controls. Outcomes were measured by changes in Lequesnes index, range of knee motion, visual analog pain scale, and peak muscle torques during knee flexion and extension. Patients in all the treated groups experienced significant reductions in knee pain and disability, and increased peak muscle torques after treatment and at follow‐up. However, only patients in Groups II and III had significant improvements in range of motion and muscle strength gain during 60°/second angular velocity peak torques. Group III demonstrated the greatest increase in muscle strength gain during 180°/second angular velocity peak torques. In conclusion, stretching therapy could increase the effectiveness of isokinetic exercise in terms of functional improvement in patients with knee osteoarthritis. PNF techniques were more effective than static stretching.

Low-level laser irradiation promotes cell proliferation and mRNA expression of type I collagen and decorin in porcine achilles tendon fibroblasts In Vitro

Achilles tendon problems are commonly encountered in sports medicine and low‐level laser therapy (LLLT) is widely used in rehabilitative applications to decrease pain, reduce inflammatory processes, and promote tissue healing. This study examined the effects on the proliferation of porcine Achilles tendon fibroblasts and gene expression, using different doses of low‐level laser irradiation (LLLI). Four groups of identically cultured fibroblasts were exposed to LLLI and harvested after 24 h. The control group (Group 1) was subjected to no LLLI. Other groups received 1 J/cm2 (Group 2), 2 J/cm2 (Group 3), and 3 J/cm2 (Group 4), respectively. Cell proliferation and mRNA expressions of type I collagen and decorin were then measured. When compared to the control group, the cell proliferation of irradiated Achilles tendon fibroblasts in the other three groups increased significantly by 13% ± 0.8% (Group 2), 30% ± 0.4% (Group 3), and 12% ± 0.6% (Group 4) respectively. But progressively higher laser intensity did not achieve a correspondingly higher cell proliferation effect in Achilles tendon fibroblasts. The mRNA expressions of decorin and type I collagen in fibroblasts with LLLI were significantly higher (p < 0.05). Therefore, suitable dosages of LLLI may result in more effective tissue healing by promoting type I collagen and decorin synthesis. However, these positive effects of LLLI on the repair of the Achilles tendon in humans should be further investigated in clinic. Published by Wiley Periodicals, Inc. J Orthop Res 27: 646–650, 2009

EFFECT OF KNEE SLEEVE ON STATIC AND DYNAMIC BALANCE IN PATIENTS WITH KNEE OSTEOARTHRITIS

Patients with knee osteoarthritis (OA) find that use of elastic knee sleeves gives them partial pain relief and a greater sense of joint stability. However, the scientific effects of knee OA patients wearing braces are unclear. The purpose of this study was to investigate the effects of knee sleeves on static and dynamic balance in knee OA patients. Fifty patients with knee OA were enrolled in the study and all subjects were randomly divided into two groups. Initially, subjects in group A did not wear a neoprene sleeve while receiving balance tests but then wore them to be re‐tested. Subjects in group B did just the reverse procedure. In this investigation, an instrument (KAT 2000; Breg Inc., Vista, CA, USA), which quantified motor control performance of the lower extremities was used and balance scores from the KAT 2000 software were obtained. The results revealed that the scores of patients wearing braces were significantly lower than those of patients without braces (p < 0.05). The finding of this study demonstrated that knee OApatients wearing knee sleeves could experience increased balance ability in both static and dynamic conditions. The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities.

Effects of a single session of whole body vibration on ankle plantarflexion spasticity and gait performance in patients with chronic stroke: a randomized controlled trial:

Objective: To investigate the effects of a single session of whole body vibration training on ankle plantarflexion spasticity and gait performance in chronic stroke patients. Design: Randomized controlled trial. Setting: Rehabilitation unit in university hospital. Participants: Thirty subjects with chronic stroke were randomized into either a control group (n = 15) or a group receiving a single session of whole body vibration (n = 15). Intervention: The intervention group was actually treated with whole body vibration while the control group was treated with placebo treatment. Main measures: The spastic changes were measured clinically and neurophysiologically. Subjective evaluation of ankle spasticity was performed via a visual analogue scale. Gait performances were evaluated by the timed up and go test, 10-meter walk test and cadence. A forceplate was used for measuring foot pressure. Results: The changes between whole body vibration and control groups were significantly different in Modified Ashworth Scale (1.33, 95% confidence interval (CI) = 1.06~1.60). The Hmax/Mmax ratio (0.14, 95% CI = 0.01~0.26) and visual analogue scale (1.87, 95% CI = 1.15~2.58) were significantly decreased. Whole body vibration could significantly improve gait velocity, timed up and go test (6.03, 95% CI = 3.17~8.89) and 10-meter walk test (1.99, 95% CI = 0.11~3.87). The uneven body weight posture on bilateral feet was also improved after vibration. Conclusion: These results suggest that a single session of whole body vibration training can reduce ankle plantarflexion spasticity in chronic stroke patients, thereby potentially increasing ambulatory capacity.

The Application of Infrared Thermography in the Assessment of Patients With Coccygodynia Before and After Manual Therapy Combined With Diathermy

OBJECTIVE This study examines the potential usefulness of a novel thermal imaging technique in the assessment of local physiologic responses before and after conservative therapies for coccygodynia. METHODS Patients with coccygodynia were selected on the basis of detailed history taking, clinical examination, and dynamic series radiography. They underwent therapeutic modalities consisting of 6 to 8 sessions of manual medicine treatments (massage of the levators followed by Maignes manipulative technique) and external physiotherapy (short-wave diathermy) 3 times a week for 8 weeks. We performed the assessments with numeric pain rating scale (NPRS) and infrared thermography (IRT) before treatment and at 12 weeks. RESULTS A total of 53 patients (6 males and 47 females) ranging from 18 to 71 years of age and clinically diagnosed with coccygodynia received the full course of therapy and assessments. There were significant differences in both NPRS and surface temperature obtained by IRT in the 12-week follow-up (P < .05). The correlation between NPRS improvement and temperature decrement was significantly high (r = 0.67, P < .01). CONCLUSIONS The study shows that IRT can objectively show the decrement of surface temperatures correlating with changes in subjective pain intensity after treatment of coccygodynia. With the advantages of being painless, noninvasive, and easy to repeat, IRT appears to be useful as a quantifiable tool for monitoring the dynamics of the disease activity in coccygodynia.

Relationship Between Carpal Tunnel Syndrome and Wrist Angle in Computer Workers

Carpal tunnel syndrome (CTS) is the most widely known entrapment neuropathy. The aim of this study was to assess the incidence of CTS in a group of computer workers by typical symptoms, median nerve conduction studies, and their combinations. The posture of extended wrists while typing on a computer keyboard seems to be a predisposing factor for CTS. However, the correlation between wrist extension angle and the incidence of CTS is not well known. Forty‐five subjects (mean age, 38.8 ± 7.8 years) who used a computer for more than 6 hours daily in a medical center in southern Taiwan were studied. All completed questionnaires to ascertain their age, employment duration, dominant hand, and the severity of symptoms. Physical examinations (Tinels sign and Phalens test) were performed by a physician. The maximal wrist extension angle when typing on a computer keyboard was also measured by the same physician. Nerve conduction studies were performed on each subject to determine the severity of CTS. Results showed that the incidence of CTS in the computer workers was 16.7% (15 of 90 hands). Twelve subjects showed electrodiagnostic evidence of CTS: it involved the dominant hand in seven, the non‐dominant hand in two, and bilateral hands in three. The severity of clinical symptoms was compatible with the findings of the nerve conduction studies. Among the major predisposing factors, we found significant correlation between CTS development and the wrist extension angle while typing on a computer keyboard. Computer workers who kept their wrists extended by more than 20° were at greater risk of developing CTS.

Effect on Spasticity after Performance of Dynamic-Repeated-Passive Ankle Joint Motion Exercise in Chronic Stroke Patients

Spasticity associated with abnormal muscle tone is a common motor disorder following stroke, and the spastic ankle may affect ambulatory function. The purpose of this study was to investigate the short‐term effect of dynamic‐repeated‐passive ankle movements with weight loading on ambulatory function and spastic hypertonia of chronic stroke patients. In this study, 12 chronic stroke patients with ankle spasticity and inefficient ambulatory ability were enrolled. Stretching of the plantar‐flexors of the ankle in the standing position for 15 minutes was performed passively by a constant‐speed and electrically powered device. The following evaluations were done before and immediately after the dynamic‐repeated‐passive ankle movements. Spastic hypertonia was assessed by the Modified Ashworth Scale (MAS; range, 0–4), Achilles tendon reflexes test (DTR; range, 0–4), and ankle clonus (range, 0–5). Improvement in ambulatory ability was determined by the timed up‐and‐go test (TUG), the 10‐minute walking test, and cadence (steps/minute). In addition, subjective experience of the influence of ankle spasticity on ambulation was scored by visual analog scale (VAS). Subjective satisfaction with the therapeutic effect of spasticity reduction was evaluated by a five‐point questionnaire (1 = very poor, 2 = poor, 3 = acceptable, 4 = good, 5 = very good). By comparison of the results before and after intervention, these 12 chronic stroke patients presented significant reduction in MAS and VAS for ankle spasticity, the time for TUG and 10‐minute walking speed (p < 0.01). The cadence also increased significantly (p < 0.05). In addition, subjective satisfaction with the short‐term therapeutic effect was mainly good (ranging from acceptable to very good). In conclusion, 15 minutes of dynamic‐repeated‐passive ankle joint motion exercise with weight loading in the standing position by this simple constant‐speed machine is effective in reducing ankle spasticity and improving ambulatory ability.

Low-Power GaAlAs Laser Irradiation Promotes the Proliferation and Osteogenic Differentiation of Stem Cells via IGF1 and BMP2

Low-power laser irradiation (LPLI) has been found to induce various biological effects and cellular processes. Also, LPLI has been shown to promote fracture repair. Until now, it has been unclear how LPLI promotes bone formation and fracture healing. The aim of this study was to investigate the potential mechanism of LPLI-mediated enhancement of bone formation using mouse bone marrow mesenchymal stem cells (D1 cells). D1 cells were irradiated daily with a gallium-aluminum-arsenide (GaAlAs) laser at dose of 0, 1, 2, or 4 J/cm2. The lactate dehydrogenase (LDH) assay showed no cytotoxic effects of LPLI on D1 cells, and instead, LPLI at 4 J/cm2 significantly promoted D1 cell proliferation. LPLI also enhanced osteogenic differentiation in a dose-dependent manner and moderately increased expression of osteogenic markers. The neutralization experiments indicated that LPLI regulated insulin-like growth factor 1 (IGF1) and bone morphogenetic protein 2 (BMP2) signaling to promote cell proliferation and/or osteogenic differentiation. In conclusion, our study suggests that LPLI may induce IGF1 expression to promote both the proliferation and osteogenic differentiation of D1 cells, whereas it may induce BMP2 expression primarily to enhance osteogenic differentiation.

Effect of biofeedback cycling training on functional recovery and walking ability of lower extremity in patients with stroke

This study aimed to investigate the effectiveness of biofeedback cycling training on lower limb functional recovery, walking endurance, and walking speed for patients with chronic stroke. Thirty‐one patients with stroke (stroke onset >3 months) were randomly assigned into two groups using a crossover design. One group (N = 16; mean: 53.6 ± 10.3 years) underwent conventional rehabilitation and cycling training (30 minutes/time, 5 times per week for 4 weeks), followed by only conventional rehabilitation for another 4 weeks. The other group (N = 15; mean: 54.5 ± 8.0 years) underwent the same training in reverse order. The bike used in this biofeedback cycling training was the MOTOmed viva2 Movement Trainer. Outcome measures included the lower extremity subscale of Fugl‐Meyer assessment (LE‐FMA), the 6‐minute walk test (6MWT), the 10‐meter walk test (10MWT), and the modified Ashworth scale (MAS). All participants were assessed at the beginning of the study, at the end of the 4th week, and at the end of the 8th week. Thirty participants completed the study, including the cycling training interventions and all assessments. The results showed that improvements in the period with cycling training were significantly better than the noncycling period in the LE‐FMA (p < 0.05), 6MWT (p < 0.001), 10MWT (p < 0.001), and MAS (p < 0.001) scores. No significant carryover effects were observed. The improvements on outcome measures were significantly different between the cycling period and the noncycling period after adjusting for potential confounding factors in the multivariate analysis of variance (p < 0.001). The study result indicates that the additional 4‐week biofeedback cycling training could lead to improved LE functional recovery, walking endurance, and speed for patients with chronic stroke.