Mao-Hsiung Huang

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.

Development of a Chinese Version of the Oswestry Disability Index Version 2.1

Study Design. Cross-cultural adaptation and cross-sectional psychometric testing in a convenience sample of patients with low back pain. Objective. To translate and culturally adapt the Oswestry Disability Index version 2.1 (ODI 2.1) into a Mandarin Chinese version and to assess its reliability and validity. Summary of Background Data. The Chinese ODI 2.1 has not been developed and validated. Methods. The ODI 2.1 was translated and culturally adapted to the Chinese version. The validity of the translated Chinese version was assessed by examining the relationship between the ODI and other well-known measures. Test–retest reliability was examined in 52 of these patients, who completed a second questionnaire within 1 week. Results. Internal consistency of the ODI 2.1 was excellent with Cronbach’s &agr; = 0.903. The intraclass correlation coefficient of test–retest reliability was 0.89. The minimal detectable change was 12.8. The convergent validity of the Chinese ODI is supported by its high correlation with other physical functional status measures (Roland Morris Disability Questionnaire and SF-36 physical functioning subscale, r = 0.76 and −0.75, respectively), and moderate correlation with other measures (Visual Analogue Scale, r = 0.68) and certain SF-36 subscales (role-physical, bodily pain, and social functioning, r range: −0.49 to −0.57). As expected, the ODI was least correlated with nonfunctional measures (SF-36 mental subscale and role-emotional subscale, r = −0.25 and −0.33, respectively). Conclusion. The results of this study indicate that the Chinese version of the ODI 2.1 is a reliable and valid instrument for the measurement of functional status in patients with low back pain.

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.

Prediction of functional outcomes in stroke inpatients receiving rehabilitation.

BACKGROUND AND PURPOSE Early identification of predictive factors relevant to functional outcomes for stroke patients is important to the establishment of an effective continuing care program. The objective of this study was to identify the predictive factors related to functional outcome at discharge after stroke rehabilitation therapy. METHODS 105 first-time stroke patients admitted to the inpatient rehabilitation department of a university-based medical center were recruited for this prospective study. The functional outcomes of the patients were assessed at admission and at discharge using the Functional Independence Measure (FIM). Severity of stroke was determined using the Canadian Neurological Scale (CNS). Age, gender, side of hemiplegia (SIDE), type of stroke (TYPE), onset to admission interval (OAI), and length of rehabilitation stay (LORS) were also included as predictor variables. RESULTS The mean (+/- SD) FIM score at discharge (76.6 +/- 26.4) correlated strongly (r = 0.78, p < 0.001) with the admission FIM score (56.3 +/- 24.1), moderately (r = 0.46, p < 0.001) with the admission CNS score (6.1 +/- 2.2), negatively (r = -0.38, p < 0.001) with age (63.2 +/- 12.3 years), negatively (r = -0.26, p = 0.009) with OAI (24.2 +/- 16.0 days), and negatively (r = -0.29, p = 0.002) with LORS (34.7 +/- 16.8 days). Stepwise regression analyses indicated that admission FIM score, age, and admission CNS score were the strongest predictors of functional outcome and accounted for 66% of the total variation in discharge FIM total score. The admission FIM score was the best predictor and accounted for 61% of the variation. CONCLUSIONS The findings of this study imply that the admission FIM scores for inpatients receiving stroke rehabilitation can be used to predict functional outcomes at discharge from hospital.

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.

Preliminary Study of Exercise Capacity in Post-Acute Stroke Survivors

The purpose of this study was to evaluate the feasibility and exercise capacity of cycle ergometry exercise testing and exercise performance in patients with post‐acute stroke. Nineteen male patients (mean age, 62.7 ± 9.2 years) with a post stroke interval of 9.9 ± 2.0 days underwent symptom‐ limited cardiopulmonary exercise testing. Peak exercise capacity was measured by open‐circuit spirometry during standard upright ergometer cycling. The mean peak oxygen uptake was 11.8 mL/kg/min, peak heart rate with age‐predicted maximal heart rate was 67.9 ± 3.4%, and peak oxygen pulse was 7.5 mL/beat. The anaerobic threshold was achieved with a mean peak oxygen uptake of 73.4%. Mean peak minute ventilation was 42.1 L/min, and ventilatory reserve was 48.1 ± 16.8%. Our findings confirm that cycle ergometry exercise testing is feasible and exercise capacity is compromised in post‐acute stroke survivors within 2 weeks after stroke. Respiratory impairments do not appear to contribute to the reduced exercise capacity post stroke.

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.