Chia-Ling Lee

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

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.

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.

The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella

This randomized, controlled study was performed to compare the effects of extracorporeal shockwave therapy (ESWT) and ultrasound on the rehabilitation of knee osteoarthritis with popliteal cyamella. One hundred and twenty patients with bilateral moderate knee osteoarthritis (Altman III) and popliteal cyamella were selected and randomly assigned to four groups (GI–GIV). Patients in Groups I–III received isokinetic muscular strengthening exercises three times weekly for 8 weeks. Group II received pulse ultrasound treatment for popliteal cyamella three times weekly for 8 weeks, Group III received weekly shock wave therapy for popliteal cyamella for the first 6 weeks, and Group IV acted as controls. The therapeutic effects were evaluated by changes in the arthritic knees range of motion (ROM), visual analogue scale, Lequesnes index, and muscle peak torques after treatment and at follow‐up 6 months later. Each treated group exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at follow‐ups. However, only patients in Groups II and III showed significant improvements in ROM after treatment, and only participants in Group III showed immediate improvement in ROM after each treatment. Patients in Group III also showed the greatest increase in muscular strength and the greatest decrease in disability after treatment and at the follow‐ups. ESWT is better than pulse ultrasound in rehabilitation of patients with knee osteoarthritis and popliteal cyamella results in more functional improvements.

Ultrasonographic findings in hemiplegic shoulders of stroke patients.

Shoulder problems are frequently noted in hemiplegic shoulders and compromise rehabilitation. Many tools were used to evaluate the etiology of shoulder problems but most of them are either nonspecific to the evaluation of soft tissue or not convenient. In order to evaluate soft tissue and joint change in hemiplegic shoulders, 82 patients with hemiplegic shoulders caused by cerebral vascular accident (CVA) were collected and evaluated by ultrasonography with 5-12 MHz high-resolution electronic linear scanner (ATL ultrasound HDI 1500, USA). The non-hemiplegic shoulders were also studied as control group. The results showed that ultrasonographic changes were noted in 51 (62.2%) hemiplegic shoulders while changes only occurred in 17 (20.7%) non-hemiplegic shoulders. Effusion and tendinitis were the major changes showing statistical difference compared with non-hemiplegic shoulders, but there was no significant difference in the incidence of supraspinatus tendon tear between hemiplegic and non-hemiplegic shoulders. Further, the interval from the onset of CVA was not significantly correlated with the presence of positive ultrasonographic findings in hemiplegic shoulders. The results demonstrated that ultrasonography is a potential method in the evaluation of hemiplegic shoulder.

Effects of Noxious Versus Innocuous Thermal Stimulation on Lower Extremity Motor Recovery 3 Months After Stroke

OBJECTIVE To examine the effects of thermal stimulation (TS) on the lower extremity (LE) movement and function in patients with stroke. DESIGN A double-blinded randomized controlled trial. SETTING A university hospital. PARTICIPANTS Patients (N=34) at least 3 months after stroke were randomly assigned into the experimental and the control groups. INTERVENTIONS In addition to regular rehabilitation, the experimental group received a 30-minute noxious TS protocol (heat pain 46-47°C/cold pain 2-3°C) 3days/wk for 8 weeks, and the control group received a 30-minute innocuous TS protocol (heat 40-41°C/cold 23-24°C) 3d/wk for 8 weeks. MAIN OUTCOME MEASURES The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement (LE-STREAM), the Mobility subscale of STREAM (Mob-STREAM), the Functional Ambulation Category (FAC), the Barthel Index (BI), the Postural Assessment Scale for Stroke Patients (PASS), and the Modified Ashworth Scale (MAS) were administered by a blinded rater at baseline, posttreatment (8wk), and follow-up (12wk). RESULTS Twenty-three participants completed the study protocol and all outcome measurements. No preexisting group differences between the experimental group (n=11) and the control group (n=12) were found on demographic and clinical variables. Compared with baseline, the experimental group showed significant improvements at posttreatment and follow-up on the LE-STREAM, Mob-STREAM, FAC, and BI (P<.05) while the control group showed no significant improvements for all outcome measures. As for the between-group comparison, significant differences were seen at follow-up (12wk) on the LE-STREAM, Mob-STREAM, BI, and MAS. CONCLUSIONS Our findings indicate that an 8-week program of noxious TS combined with a traditional stroke rehabilitation program can improve the LE-related movement and function in patients with stroke for more than 3 months.

Effect of glycemic control on electrophysiologic changes of diabetic neuropathy in type 2 diabetic patients.

Diabetic neuropathy is a common complication of diabetes mellitus. Effective blood glucose control retards changes in nerve conduction velocity in type 1 diabetes. This study examined the relationship between glycemic control and electrophysiologic changes in diabetic neuropathy in 57 type 2 diabetic patients. Nerve conduction in the peroneal motor nerve, tibial motor nerve, and sural nerve were measured at study entry and at follow‐up 24 ± 3.12 months later. Changes in individual nerves are expressed as a percentage change (PC) and overall electrophysiologic changes are expressed as the sum of individual PCs. The PCs for peroneal motor nerve velocity, tibial motor nerve velocity, and sural nerve velocity were all lower in patients with a mean HbA1c of 8.5% or less compared with those in patients with a mean HbA1c of more than 8.5%, and SPCV (sum of PC in velocity) was significantly inversely correlated with mean HbA1c. However, there was no significant difference in SPCV in subjects with or without hypertension, hypertriglyceridemia, or low high‐density lipoprotein cholesterol concentration. In conclusion, hyperglycemia is the most important etiology for electrophysiologic progression in type 2 diabetic patients. Furthermore, a mean HbA1c of more than 8.5% will result in significant deterioration in electrophysiology.

Association Between the Severity of Femoral Condylar Cartilage Erosion Related to Knee Osteoarthritis by Ultrasonographic Evaluation and the Clinical Symptoms and Functions

OBJECTIVE To determine the association between the severity of femoral condylar cartilage erosion resulting from knee osteoarthritis (OA) by an ultrasonographic grading system and the clinical symptoms and functions. DESIGN Cross-sectional study. SETTING A tertiary center. PARTICIPANTS Participants (N=101) with and without subjective complaints of knee discomfort were consecutively enrolled. Patients who had ever received knee arthroplasty, who had inflammatory arthritis, and whose knee flexion range of motion was <90° were excluded. A total of 194 knees were evaluated. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A semiquantitative ultrasonographic grading system was used to evaluate the severity of femoral condylar cartilage erosion. The clinical symptoms and functions were evaluated with the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. The association of the VAS/WOMAC/Lequesne index with the ultrasonographic grading was assessed. RESULTS Positive linear associations were found between the ultrasonographic grading and the following: the VAS and the total scores and pain subscales of both the Lequesne index and WOMAC. Multivariate logistic regression analysis revealed grade-dependent association between VAS and ultrasonographic grading after adjusting for age, sex, and body mass index. The WOMAC and Lequesne index scores were associated with the ultrasonographic grading in more severe degrees, particularly in the pain subscales. CONCLUSIONS This semiquantitative ultrasonographic grading system may well reflect the clinical symptoms and functions related to knee OA as evaluated by the VAS, WOMAC, and Lequesne index. This method provides a more comprehensive description and measurement of knee OA.