Pao-Tsai Cheng

Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery.

Chen CL, Chen HC, Tang SFT, Wu CY, Cheng PT, Hong WH: Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 2003;82:925–935. ObjectiveGait patterns vary among stroke patients. This study attempted to discover gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. DesignData were gathered from 35 stroke patients and 15 healthy subjects. Gait performance and motor recovery were assessed 6 mos after stroke. Stroke patients further were divided into poor and good groups. The walking velocity was correlated with Brunnström’s stages, and the temporal stride and motion variables of the two groups were compared. ResultsWalking velocity was positively correlated with the Brunnström’s stages of the proximal lower limb. The poor group displayed slower walking velocity and shorter single-support time compared with the good group. Both groups displayed low maximum excursion of hip extension and ankle plantarflexion during the stance phase and low maximum excursion of hip and knee flexion and ankle dorsiflexion during the swing phase. Moreover, both groups displayed excessive pelvic tilts during the stance and swing phases. However, the poor group displayed different pelvic motion and timing sequences to each peak joint angle from normal subjects and the good group. Peak hip and knee angles of the affected limb during the stance phase occurred almost simultaneously in this group. ConclusionsSelective control of the proximal lower limb may be the main determinant of walking velocity. The compensatory adaptations were similar, except for pelvic motion, in stroke patients with different levels of motor recovery, whereas the poor group walked with synergistic mass patterns and reduced stability.

Resistive inspiratory muscle training: Its effectiveness in patients with acute complete cervical cord injury

OBJECTIVE To evaluate if resistive inspiratory muscle training (RIMT) can improve lung function in patients with complete tetraplegia within half a year after trauma. DESIGN A prospective study. The experimental patients received training with a Diemolding Healthcare Division inspiratory muscle trainer for 15 to 20 minutes per session, twice per day, 7 days a week for 6 weeks. SETTING Hospital-based rehabilitation units. PATIENTS Twenty patients who were in their first 6 months of complete cervical cord injury were randomly enrolled into RIMT (10 patients) and control (10 patients) groups. MAIN OUTCOME MEASURE Spirometry, lung volume test, maximal inspiratory pressure, maximal expiratory pressure, and modified Borg scale measurements at rest were performed before training and at the end of 6 weeks of training. RESULTS Most of the pulmonary parameters showed statistically significant improvements within the RIMT and control groups, but the improvements were greater in the RIMT group. In addition, the improvements in total lung capacity, total lung capacity predicted percentage, vital capacity, minute ventilation, forced expiratory volume in 1 second predicted percentage, and the resting Borg scale in the RIMT group showed significantly greater improvement. CONCLUSION RIMT can improve ventilatory function, respiratory endurance, and the perceived difficulty of breathing in patients with complete cervical spinal cord injury within half a year after trauma.

Leg muscle activation patterns of sit-to-stand movement in stroke patients

Cheng PT, Chen CL, Wang CM, Hong WH: Leg muscle activation patterns of sit-to-stand movement in stroke patients. Am J Phys Med Rehabil 2004;83:10–16. ObjectiveTo describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients during the movement of rising from a chair and to determine the differences of leg muscle activation patterns between stroke fallers and nonfallers. DesignSubjects stood up from an armless chair at a comfortable, self-paced speed. Leg muscle activation time and patterns during the sit-to-stand movement were analyzed using multichannel surface electromyography and a force platform. The differences between stroke fallers and nonfallers were compared. ResultsThe mean onset time of muscle activity in the affected limbs of stroke fallers was markedly delayed for the tibialis anterior muscle and earlier for the soleus muscle. The muscle activation patterns in the affected side of the stroke fallers exhibited a wide range of variation. Seventy percent of our stroke fallers exhibited no or merely low-amplitude activity in their tibialis anterior muscle when the patients were rising from a chair. Half of the stroke fallers exhibited premature or excessive activation of their soleus muscle when the rising activity was initiated. ConclusionsStroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling.

Correlation of polyelectromyographic patterns and clinical motor manifestations in children with cerebral palsy.

Chen CL, Wu CY, Wong AMK, Cheng PT, Hong WH, Chen HS: Correlation of polyelectromyographic patterns and clinical motor manifestations in children with cerebral palsy. Am J Phys Med Rehabil 2003;82:627–635. ObjectiveWe investigated the correlation between movement patterns, measured by polyelectromyography (PEMG), and clinical motor manifestations in children with cerebral palsy. DesignSubjects included 53 children with spastic cerebral palsy (diplegic [n = 43] and quadriplegic [n = 10] groups) and 18 normal children. All children underwent PEMG assessments, recorded from pairs of flexor/extensor muscles during voluntary movement. We correlated PEMG patterns with clinical motor assessments, including muscle tone, range of motion, and ambulatory and functional capacities in the children with cerebral palsy. ResultsChildren with cerebral palsy exhibited four distinct PEMG patterns, ranging from partial reciprocal to complete synchrony. Lower PEMG pattern scores were significantly associated with better ambulatory (rho = 0.88, P < 0.01) and functional (rho = 0.78, P < 0.01) capacities. PEMG patterns also had weakly positive relationships with muscle tone (rho > 0.33, P < 0.01) and range of motion of both lower limbs (rho > 0.31, P < 0.01). Most children of spastic diplegia with PEMG patterns II and III had independent ambulatory capacities and mild limitation of functional capacity, whereas most children with pattern of IV and V had no ambulatory abilities and no independent functional capacities (P < 0.01). ConclusionsThese findings suggest that PEMG patterns correlate with clinical motor deficits and may allow us to plan treatment strategies based on underlying motor control in cerebral palsy.

Transsubmental tongue-base suspension in treating patients with severe obstructive sleep apnoea after failed uvulopalatopharyngoplasty: our experience.

Dear Editor, Snoring and obstructive sleep apnoea is largely owing to narrowed upper airway and abnormal collapsibility during sleep. More than 90% of apneic patients have single obstruction in the retropalatal level, whereas 40–50% of those have obstruction in multiple sites, including retropalatal space, retrolingual space and hypopharynx. 1 Successful surgical management of obstructive sleep apnoea requires various procedures to address these multiple levels of airway obstruction. Although uvulopalatopharyngoplasty is commonly performed in treating snoring or obstructive sleep apnoea patients, the success rate of uvulopalatopharyngoplasty is as low as 5–10% in severe obstructive sleep apnoea patients with retrolingual obstruction. 2 Traditional tongue-base suspension with Repose System (Metronic Xomed, Jacksonville, FL, USA), first described by DeRowe et al., 3 is a minimally invasive surgery to prevent retrolingual collapse during sleep. However, the effectiveness of tongue-base suspension in treating severe obstructive sleep apnoea patients with failed uvulopalatopharyngoplasty remains unexplored. Additionally, traditional tongue-base suspension with the transoral approach causes significant postoperative morbidity, e.g., teeth numbness, sialoadenitis, sublingual hematoma and sublingual gland obstruction. 3 The aim of this study is to investigate the role of newly designed transsubmental tongue-base suspension in treating severe obstructive sleep apnoea patients while uvulopalatopharyngoplasty has failed. Exactly how the sleep position affects the efficacy of transsubmental tongue-base suspension is also analysed. Patients and methods

Prognostic impact of pre-treatment neutrophil-to-lymphocyte ratio (NLR) in nasopharyngeal carcinoma: A retrospective study of 180 Taiwanese patients

Nasopharyngeal cancer (NPC) is an endemic disease in Taiwan. Prognostic factors the anatomical TNM stage are important for its prognostic stratification. An elevated neutrophil‐to‐lymphocyte ratio (NLR) has been reported to be associated with poor prognosis in various solid tumours. In this study, we analysed the prognostic impact of the NLR in NPC in Taiwan.

Spontaneous electromyographic potentials in cervical cord-injured patients are related to dysesthetic pain.

A total of 61 traumatic cervical cord-injured patients were included in this study. Needle electromyography and nerve conduction study were performed at 6 to 24 weeks postinjury. Correlation between the presence of spontaneous electromyographic potentials and the presence of dysesthetic pain, as well as other clinical characteristics including age, gender, level of injury, severity of injury, spasticity, duration of injury, and performance of spinal surgery was statistically analyzed. Of the 31 patients who had spontaneous electromyographic potentials in their hands, 27 (87%) had dysesthetic pain in their limbs. Only 9 (30%) of the other 30 patients without spontaneous potentials developed dysesthetic pain. A significant correlation (P < 0.001) between the presence of spontaneous electromyographic potential and dysesthetic pain was found. The presence of spontaneous electromyographic potentials was also significantly (P < 0.05) correlated with severity of injury but not with age, gender, injury level, duration of injury, operation, and spasticity. In conclusion, the presence of spontaneous electromyographic potentials in cervical cord-injured patients was significantly related to the presence of dysesthetic pain. They occurred more often in patients with more severe injury.

Effects of comorbidity and medication use on the haemodynamic status during office-based laryngeal procedures: a prospective cohort study

Office‐based laryngeal procedures (OBLPs) are emerging as effective alternative modalities for vocal disorders. This study systematically investigates the haemodynamic status of patients, specifically focusing on the potential effects of underlying comorbidity and medication use.

A real-time prediction model for post-irradiation malignant cervical lymph nodes

To establish a real‐time predictive scoring model based on sonographic characteristics for identifying malignant cervical lymph nodes (LNs) in cancer patients after neck irradiation.

Powered saline irrigation is useful for endoscopic removal of fungus balls in maxillary sinuses: our experience in fifty patients.

rhinitis as the excised portion of the inferior turbinate was on the posterior third away from the nasal valve area, and the excision was partial so that the volume of the turbinate was not seriously reduced. Postoperative changes in the saccharin test were insignificant, reflecting the return of nasociliary movement to normal. This result is further evidence of the physiologic advantages of this procedure.