Kwang-Ik Jung

Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT.

Measurement of synergy and spasticity during functional movement of the post-stoke hemiplegic upper limb.

The aim of the present study was to measure the muscle-contraction patterns of the hemiplegic upper limb using electromyography (EMG) and to investigate the relationship between muscle co-contraction and functional recovery in stroke patients presenting with synergy and spasticity. The muscle-contraction patterns of the upper limb of 12 chronic stroke patients and 10 normal volunteers were measured, and the co-contraction in the distal and proximal muscles was simultaneously quantified, while the participants performed hand-grasp and shoulder flexion tasks. The spasticity and hemiplegic arm function were evaluated, respectively, on a modified Ashworth scale (MAS) and by means of Fugl-Meyer motor assessment (FMA). The correlation between the MAS and FMA values was analyzed. Increased co-contraction (66-555%) was observed in both the proximal and distal upper limbs, and was positively correlated with spasticity of the elbow flexor (r = 0.944 on shoulder flexion, r = 0.741 on hand grasping, p < 0.01) and negatively correlated with functional recovery of the upper limb (r = -0.670 ∼ -0.884, p < 0.05). Specific movement patterns influenced by synergy and spasticity were confirmed by EMG. These results might prove useful to the formulation of appropriate management plans such as those involving botulinum toxin injection or nerve block.

The Effect of Bedside Exercise Program on Stroke Patients with Dysphagia

Objective To examine the effects of a bedside exercise program on the recovery of swallowing after a stroke. Method Fifty stroke patients with dysphagia (<6 months post-stroke) were enrolled and classified into two groups, the experimental (25 subjects) and control groups (25 subjects). The control group was treated with conventional swallowing therapy. The experimental group received additional bedside exercise training, which consisted of oral, pharyngeal, laryngeal, and respiratory exercises, 1 hour per day for 2 months, and they were instructed regarding this program through the nursing intervention. All patients were assessed for their swallowing function by Videofluoroscopic Swallowing Study (VFSS), using the New VFSS scale, the level of functional oral intake, the frequency of dysphagia complications, the presence (or not) of tube feeding, the mood state and quality of life before the treatment and at 2 months after the treatment. Results After 2 months of treatment, the experimental group showed a significant improvement in the swallowing function at the oral phase in the New VFSS Scale than that of the control group (p<0.05). Further, they also showed less depressive mood and better quality of life than the control group. However, there was no significant change in the incidence of dysphagia complication and the presence (or not) of tube feeding between the two groups. Conclusion Bedside exercise program showed an improvement of swallowing function and exhibited a positive secondary effect, such as mood state and quality of life, on subacute stroke patients with dysphagia. For improvement of rehabilitation results on subacute stroke patients with dysphagia, this study suggests that additional intensive bedside exercise would be necessary.

Reduction of Continuous Theta Burst Stimulation-Induced Motor Plasticity in Healthy Elderly With COMT Val158Met Polymorphism.

Objective To delineate whether cortical plasticity induced by continuous theta burst stimulation (cTBS) differed according to catechol-O-methyltransferase (COMT) gene polymorphism in healthy older adults. Methods Eighteen healthy older volunteers (mean age 73.78±5.04; 12 females and 6 males) were recruited. Volunteers randomly assigned in either a sham-first or real cTBS first group participated in two separate TMS visits with at least a 2-day wash-out period. Genotyping was carried out at baseline by a separate researcher who was blinded. cTBS was delivered in a hot spot over M1 at an active motor threshold of 80%. Motor evoked potentials (MEPs) were obtained at 120% of the resting motor threshold before and after sham/cTBS. Results The relative MEP to baseline was significantly decreased 0 and 10 minutes post-stimulation and increased 40 minutes post-stimulation, as compared with the sham condition. Immediately after cTBS, the Val/Val group had a significantly reduced relative MEP value, as compared with the MET carrier group. Conclusion In healthy older persons, cTBS-induced motor plasticity was reduced in the COMT Val/Val group as compared with the 158Met carrier group.

Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head

Objective To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head. Methods Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm2) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm2). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months. Results In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05). Conclusion Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

Novel Information on Anatomic Factors Causing Grasp Reflex in Frontal Lobe Infarction: A Case Report

We report a patient with a severe limitation of function in the right hand resulting from grasp reflex following a stroke affecting the left anterior cerebral artery region. We describe, using diffusion tensor tractography (DTT), a disconnection between the bilateral frontal lobes via the corpus callosum. The patient could not control his right hand at all, even though his bilateral corticospinal tracts were intact. We noted that over the infarcted lesion on DTT, the white matter was invisible from the corpus callosum to the prefrontal cortex. These findings reflected a unique pattern of white-matter disconnection between the ipsilateral medial frontal lobe and ipsilateral and contralateral frontal cortex causing hand function deterioration in the form of severe grasp reflex.

Effects of Repetitive Transcranial Magnetic Stimulation Over Trunk Motor Spot on Balance Function in Stroke Patients.

Objective To assess the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) on balance function in patients with chronic stroke. Methods Thirty participants with chronic stroke were enrolled in this study. High frequency (10 Hz) rTMS was delivered with butterfly-coil on trunk motor spot. Each patient received both real and sham rTMS in a random sequence. The rTMS cycles (real or sham) were composed of 10 sessions each, administered over two weeks, and separated by a 4-week washout period. Balance function was measured by Berg Balance Scale and computerized dynamic posturography to determine the effect of rTMS before and one day after the end of each treatment period, as well as at a 1-month follow-up. Results The balance function was significantly improved after high frequency rTMS as compared with that after sham rTMS (p<0.05). There was no serious adverse effect in patients during the treatment period. Conclusion In the chronic stroke patients, high frequency rTMS to the trunk motor area seems to be a helpful way to improve balance function without any specific adverse effects. Further studies are needed to identify the underlying mechanism and generate a detailed protocol.

Effects of Atrial Fibrillation on the Outcome of the Rehabilitation in Patients With Cerebral Infarction

Objective To evaluate the influence of atrial fibrillation (Af) on the clinical characteristics and rehabilitation outcomes of patients with cerebral infarction. Methods We evaluated 87 of 101 consecutive patients with cerebral infarction admitted to the department of physical medicine and rehabilitation during their rehabilitation period. The patients were divided into two groups, Af and non-Af groups. We estimated characteristics of patient demographic features, disease duration, length of hospital stay, other comorbidities and risk factors for stroke, and functional status at admission and at discharge and compared those in patients with and without Af. Functional Independence Measure (FIM), the Modified Barthel Index (MBI), and the PULSES profile (PULSES) were used to evaluate functional status. Results The number in the Af group was 20 (22.9%) and that of the non-Af group was 67 (77.1%). Demographic features, other comorbidities, motor function, cognitive function, neurological scales, and brain lesions did not differ significantly between the groups. The incidence of coronary artery disease and valvular heart disease were significantly correlated with the incidence of Af in multivariate analysis. Based on FIM, MBI, and PULSES scores, functional improvement in the Af group after rehabilitation was significantly less than that of the non-Af group. Conclusion Af was shown to be associated with a markedly negative result in rehabilitation in patients with cerebral infarction. Thus, early recognition and proper treatment of Af may help patients achieve more effective rehabilitation.

Videofluoroscopy-Guided Balloon Dilatation for the Opening Dysfunction of Upper Esophageal Sphincter by Postoperative Vagus Nerve Injury: A Report on Two Cases

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.

In Reply: Comment on “Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis”

ful for the comment. We evaluated and compared the effects and outcomes of the extracorporeal shock wave therapy and intra-articular injections of hyaluronic acid in patients with knee osteoarthritis using the visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, 40-meter fast-paced walk test, and stair-climb test. The Osteoarthritis Research Society International recommended performance-based tests to assess the physical function in patients with knee osteoarthritis [1]. Therefore, we conducted a 40-m fast-paced walk test and a stair-climb test to further evaluate the patient’s physical function. As is correct in your opinion assessment, the gait analysis evaluation is an objective instrumentation to support the effect of the extracorporeal shock wave therapy and the intra-articular injections of hyaluronic acid in patients with knee osteoarthritis. The pathology of the patient’s osteoarthritis is commonly degenerative and chronic. We agree that a long-term follow-up study is useful to achieve the management of knee osteoarthritis. We are going to apply it to the following study and will review the results of this follow-up effort.