Lin-Yi Wang

Sonography of the shoulder in hemiplegic patients undergoing rehabilitation after a recent stroke.

To examine the hemiplegic shoulders for soft‐tissue injury by musculoskeletal sonography and to determine the relationship between the motor functions of the upper extremity and these injuries, which play an important role in hemiplegic shoulder pain and may impede rehabilitation.

Sonography and physical findings in stroke patients with hemiplegic shoulders: a longitudinal study.

OBJECTIVE To investigate the correlation between hemiplegic shoulder pain factors during the acute and chronic stages of stroke recovery. DESIGN A prospective longitudinal study. SUBJECTS Seventy-six stroke patients with hemiplegic shoulders. METHODS Hemiplegic shoulder pain and clinical, physical, and sonography results were recorded at admission and during both acute (before discharge) and chronic stages (6 months after discharge). RESULTS During the acute stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level and range of motion limitations. During the chronic stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level, range of motion limitations, spasticity and abnormal sonographic findings. Higher incidence (p=0.014) of hemiplegic shoulder pain and pain scores (p<0.01) were noted and abnormal sonographic findings of the biceps tendon long head (p=0.01) and subscapularis tendon (p=0.01) were higher during the chronic stage. Effusion, tenosynovitis or tendinopathy of the biceps tendon long head, and supraspinatus tendinopathy were notable during both stages. CONCLUSION Hemiplegic shoulder pain was correlated with lower motor function level and shoulder range of motion limitation in both stages. Shoulder spasticity and abnormal sonographic findings were correlated with hemiplegic shoulder pain during the chronic stage.

Inspiratory muscle training in stroke patients with congestive heart failure: A CONSORT-compliant prospective randomized single-blind controlled trial

Background Cardiopulmonary function can be adversely affected after a cerebrovascular accident in patients with congestive heart failure (CHF). The aim of this study was to investigate the efficacy and feasibility of inspiratory muscle training (IMT) for stroke patients with CHF. Methods A prospective randomized single-blind controlled trial was conducted in a single tertiary medical center in southern Taiwan between May 2011 and July 2015. Forty-one patients were enrolled, of whom 21 completed the study (IMT group n = 11 and control group n = 10). Both groups participated in a conventional stroke rehabilitation program. Patients in the IMT group received an additional IMT program beginning with an intensity of 30% maximal inspiratory pressure (MIP), then increased by 2cmH2O each week for 30 minutes daily for at least 5 days a week for 10 weeks. MIP, maximal expiratory pressure, spirometry, resting oxyhemoglobin saturation, modified Borg Scale, Fatigue Assessment Scale, and Barthel Index were assessed in each patient. Results There were significant differences from baseline in MIP (P = 0.008), percent predicted forced vital capacity (P = 0.033), forced expiratory volume in 1 second (FEV1) (P = 0.008), percent predicted FEV1 (P = 0.008), and Barthel Index (P = 0.012) in the IMT group, and Barthel Index (P = 0.027) in the control group. There were significant differences between groups in MIP (20.91 ± 19.73 vs −9.00 ± 26.01, adjusted P value = 0.023) and Barthel Index (24.55 ± 22.30 vs 7.50 ± 8.25, adjusted P value = 0.044). Conclusion The 10-week IMT was feasible and effective in improving inspiratory force and activities of daily living for the stroke patients with CHF.

The effects of hyaluronic acid on hemiplegic shoulder injury and pain in patients with subacute stroke: A randomized controlled pilot study

Background: Hemiplegic shoulder pain (HSP) is one of the most common comorbidities in stroke patients with flaccid shoulders. The pain limits functional motor recovery and affects the activities of daily living after acute stroke. This study investigated the effects of hyaluronic acid (HA) injection on pain reduction and motor function in subacute stroke patients with HSP and injury. Methods: A randomized, double-blinded controlled trial was conducted in a medical center. Twenty-six subacute stroke patients were enrolled and randomly divided into 2 groups: the experimental group (n = 16) received ultrasound-guided, subacromial HA injections once per week for 3 weeks and conventional rehabilitation, whereas the control group (n = 10) received 0.9% sodium chloride injections once per week for 3 weeks and conventional rehabilitation. Shoulder pain and motor function were evaluated before and after the intervention using the visual analog scale (VAS) and the Fugl–Meyer assessment for the upper extremity (FMA-UE), respectively. Results: In the experimental group, significant differences were found in VAS (P = 0.003), shoulder flexion (P = 0.03) and abduction (P = 0.02), and FMA-UE (P = 0.003) after treatment. In the control group, there were significant differences in VAS (P = 0.007), shoulder flexion (P = 0.035), and FMA-UE (P = 0.042) after treatment. The comparison of the changes in the parameters between the experimental and control groups, after each intervention, revealed a significant difference in VAS (P = 0.001). Conclusion: Subacromial HA injection could result in positive effects on shoulder pain and shoulder abduction in subacute stroke patients with HSP and injury.

Effectiveness of ultrasound-guided vs direct approach corticosteroid injections for carpal tunnel syndrome: A double-blind randomized controlled trial

OBJECTIVE To compare the outcomes of ultrasound-guided vs direct approach corticosteroid injection in patients with idiopathic carpal tunnel syndrome. METHODS A double-blind randomized controlled study. Wrists affected by carpal tunnel syndrome were randomized to the ultrasound-guided (n = 22 wrists) or direct approach injection group (n = 17 wrists) before receiving 1 ml Betamethasone. Outcome measures were physical findings and electrodiagnostic parameters assessed at 1, 3 and 6 months after injection. Complications were also recorded. RESULTS Both groups showed improvement through-out the follow-up period after injections, in physical findings and in most electrodiagnostic parameters (all p<0.05). The ultrasound-guided injection group showed greater improvements in the Semmes-Weinstein Monofilament test result (p = 0.004), sensory nerve conduction velocity (p = 0.038), and digit-4 comparison study result (p = 0.046). Three wrists with weakness were found in the direct approach injection group, yet none were noted in the ultrasound-guided injection group (p=0.040). CONCLUSION Both ultrasound-guided and direct approach corticosteroid injection protocols improved clinical symptoms and signs, physical function, and most electrodiagnostic parameters of patients with carpal tunnel syndrome throughout the follow-up period. However, the ultrasound-guided injection group showed greater improvements in the Semmes-Weinstein Monofilament test, sensory nerve conduction velocity, and digit-4 comparison study.

Preliminary investigation of cardiopulmonary function in stroke patients with stable heart failure and exertional dyspnea.

AbstractThe aim of this study was to investigate the relationships between pulmonary function, respiratory muscle strength, perceived dyspnea, degree of fatigue, and activity of daily living with motor function and neurological status in stroke patients with stable congestive heart failure (CHF).This was a cohort study in a tertiary care medical center. Stroke patients with CHF and exertional dyspnea (New York Heart Association class I–III) were recruited. The baseline characteristics included duration of disease, Brunnstrom stage, spirometry, resting heart rate, resting oxyhemoglobin saturation (SpO2), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Borg scale, fatigue scale, and Barthel index.A total of 47 stroke patients (24 males, 23 females, mean age 65.9 ± 11.5 years) were included. The average Brunnstrom stages of affected limbs were 3.6 ± 1.3 over the proximal parts and 3.5 ± 1.4 over the distal parts of upper limbs, and 3.9 ± 0.9 over lower limbs. The average forced vital capacity (FVC) was 2.0 ± 0.8 L, with a predicted FVC% of 67.9 ± 18.8%, forced expiratory volume in the first second (FEV1) of 1.6 ± 0.7 L, predicted FEV1% of 70.6 ± 20.1%, FEV1/FVC of 84.2 ± 10.5%, and maximum mid-expiratory flow of 65.4 ± 29.5%. The average MIP and MEP were −52.9 ± 33.3 cmH2O and 60.8 ± 29.0 cmH2O, respectively. The Borg scale was 1.5 ± 0.8. MIP was negatively associated with the average Brunnstrom stage of the proximal (r = −0.318, P < 0.05) and distal (r = −0.391, P < 0.01) parts of the upper extremities and lower extremities (r = −0.288, P < 0.05), FVC (r = −0.471, P < 0.01), predicted FVC% (r = −0.299, P < 0.05), and FEV1 (r = −0.397, P < 0.01). MEP was positively associated with average Brunnstrom stage of the distal area of the upper extremities (r = 0.351, P < 0.05), FVC (r = 0.526, P < 0.01), FEV1 (r = 0.429, P < 0.01), and FEV1/FVC (r = −0.482, P < 0.01). FEV1/FVC was negatively associated with the average Brunnstrom stage over the proximal (r = −0.414, P < 0.01) and distal (r = −0.422, P < 0.01) parts of the upper extremities and lower extremities (r = −0.311, P < 0.05) and Barthel index (r = −0.313, P < 0.05).Stroke patients with stable CHF and exertional dyspnea had restrictive lung disorder and respiratory muscle weakness, which were associated with the neurological status of the affected limbs. FVC was more strongly associated with MIP and MEP than predicted FVC%. FEV1/FVC may be used as a reference for the pulmonary dysfunction.

The Utility of Semmes-Weinstein Monofilament Test in Detecting Carpal Tunnel Syndrome with Clinical Stage, Nerve Conduction Study, and Sonography Correlations

Background and purpose: Nerve conduction study (NCS) and ultrasonography (US) are used to support the diagnosis of carpal tunnel syndrome (CTS). The ability of the Semmes-Weinstein monofilament test (SWMT), a sensibility threshold test, to detect CTS, and its relationship to clinical severity, NCS, and US, remain controversial. We conducted this study to address this controversy. Method: Thirty-three patients presenting with typical symptoms and signs of CTS and 20 normal subjects were enrolled. SWMT on the index finger, NCS, and US of the cross-sectional area of the median nerve at the pisiform level (PCSA) were performed. Receiver operating characteristic (ROC) curves of SWMT, variables of NCS, and PCSA were plotted to analyze their discriminative utilities. The diagnostic agreement for CTS among SWMT, NCS, and PCSA were analyzed by kappa statistics. Sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV), and accuracies, as well as the correlation coefficients among SWMT, NCS measures, and PCSA, were calculated. Results: The areas under the ROC curve (AUC) for SWMT and PCSA were 0.852 and 0.71, respectively. AUCs for three NCS variables ranged from 0.822 to 0.902. All these variables were discriminative for CTS and were not significantly different in their discriminative power. SWMT yielded sensitivity, specificity, PPV, NPV, and accuracy of 82%, 70%, 82%, 70%, and 77%, respectively. There is significant agreement in detection of CTS using SWMT and NCS (kappa=0.575, p＜0.001). The kappas between SWMT and PCSA, as well as NCS and PCSA, were 0.305 and 0.427, respectively (p=0.025 and 0.002). SWMT significantly correlates with not only clinical stage, but also NCS measures and PCSA (r ranged from 0.381 to 0.581, p＜0.01). Conclusion: SWMT shows discriminative power similar to NCS and US for detection of CTS. SWMT also has a moderate correlation with clinical stage, NCS measures, and PCSA on US. As a painless, convenient, and inexpensive modality, SWMT may have the ability to diagnose CTS, but further research is needed.