Shiau-yee Chen

Mobilization Techniques in Subjects With Frozen Shoulder Syndrome: Randomized Multiple-Treatment Trial

Background and Purpose: The purpose of this study was to compare the use of 3 mobilization techniques—end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM)—in the management of subjects with frozen shoulder syndrome (FSS). Subjects: Twenty-eight subjects with FSS were recruited. Methods: A multiple-treatment trial on 2 groups (A-B-A-C and A-C-A-B, where A=MRM, B=ERM, and C=MWM) was carried out. The duration of each treatment was 3 weeks, for a total of 12 weeks. Outcome measures included the functional score and shoulder kinematics. Results: Overall, subjects in both groups improved over the 12 weeks. Statistically significant improvements were found in ERM and MWM. Additionally, MWM corrected scapulohumeral rhythm significantly better than ERM did. Discussion and Conclusion: In subjects with FSS, ERM and MWM were more effective than MRM in increasing mobility and functional ability. Movement strategies in terms of scapulohumeral rhythm improved after 3 weeks of MWM.

Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome

This aim of this study was to characterize upper and lower trapezius muscle activity for patients experiencing frozen shoulder syndrome (FSS) compared to asymptomatic subjects. Fifteen patients suffering from unilateral FSS and 15 asymptomatic subjects voluntarily participated in this study. Data were gathered on electromyographic (EMG) activity obtained from the upper and lower trapezius muscles during maximal static arm elevations at six different testing positions: 60 and 120° of flexion, abduction in the frontal plane, and abduction in the scapular plane. The group with FSS revealed increased upper trapezius EMG activity at the 60° (mean difference=12%, p<0.003) and 120° (mean difference=24%, p<0.004) testing positions, and increased lower trapezius EMG activity at the 120° testing positions (mean difference=6%, p<0.002), compared to asymptomatic subjects. Higher ratios of the upper trapezius to lower trapezius EMG activity were also found in the patient group (p<0.0005) compared to asymptomatic subjects. The results of this study indicate that the increased trapezius muscle activity may contribute to scapular substitution movement in compensation for impaired glenohumeral motion in patients with FSS. The insufficiency of the increased lower trapezius muscle activity should be an important consideration in the rehabilitation of patients experiencing FSS.

Proprioception assessment in subjects with idiopathic loss of shoulder range of motion: joint position sense and a novel proprioceptive feedback index.

We examined the effects of elevation range and plane on shoulder joint proprioception in subjects with idiopathic loss of shoulder range of motion (ROM). Joint position sense (JPS) and a novel proprioceptive feedback index (PFI), including difference magnitude and the similarity index, were used to assess proprioception. Twelve subjects (eight male, four female) with involved stiff shoulders and normal opposite shoulders were recruited from a university hospital. Subjects attempted to repeat six target positions. Target positions consisted of arm elevation in three planes (frontal, scapular, and sagittal planes) and two ranges (end/mid range). Six trials of each target position were used to determine acceptable trials for stabilization of the data, less than 5% of the cumulative mean values for at least three successive trials. The data stabilized at the sixth repetition. Compared to control shoulders, involved shoulders had enhanced proprioception during end range movements (pu2009<u20090.05). The magnitude of the repositioning error and difference magnitude decreased (1.6°–3.5° for repositioning error and 22.2°–62.1° for difference magnitude), whereas similarity index improved at end range movements compared to mid range movements (pu2009<u20090.05) in involved stiff shoulders. Results of JPS and PFI suggest that both capsuloligamentous and musculotendinous mechanoreceptors play an important role in proprioception feedback during active movements in subjects with idiopathic loss of shoulder ROM.

Quantification of shoulder tightness and associated shoulder kinematics and functional deficits in patients with stiff shoulders.

Measurement of anterior/posterior shoulder tightness, humeral external/internal rotation range of motion (ROM), scapular upward rotation/tipping ROM, and functional limitations were made in 46 patients with unilateral stiff shoulders (SSs) using a clinical measurement (shoulder tightness), a three-dimensional electromagnetic tracking device (shoulder ROM), and self-reports of function. Patients with SSs in their dominant shoulder demonstrated statistically greater posterior shoulder tightness compared to nondominant shoulder. Control dominant shoulders demonstrated decreased internal ROM as compared with control nondominant shoulders (p=0.021). In SSs, significant relationships were found between humeral internal rotation ROM and posterior shoulder tightness (R=0.49, p<0.0005), humeral external rotation ROM and anterior shoulder tightness (R=0.59, p=0.0002), scapular tipping and anterior shoulder tightness (R=0.57, p=0.004). Specifically, in patients with dominant SSs, posterior shoulder tightness and functional limitation were related (R=0.56, p=0.002). In patients with dominant involved shoulders, emphasise on posterior tightness stretch may improve functional ability directly. In addition to stretching program in patients with SSs, internal rotation ROM of control dominant shoulder is also important to consider in the rehabilitation of patients with SSs.

Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness.

BackgroundClinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness.MethodsA randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive.ResultsFifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage.ConclusionsMassage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness.Trial registrationThis clinical trial is registered at Trial Registration Trial registration: Clinicaltrials.gov NCT01022827.

Test-retest reliability and responsiveness of the Barthel Index-based Supplementary Scales in patients with stroke.

BACKGROUNDnA lack of evidence on the test-retest reliability and responsiveness limits the utility of the BI-based Supplementary Scales (BI-SS) in both clinical and research settings.nnnAIMnTo examine the test-retest reliability and responsiveness of the BI-based Supplementary Scales (BI-SS) in patients with stroke.nnnDESIGNnA repeated-assessments design (1 week apart) was used to examine the test-retest reliability of the BI-SS. For the responsiveness study, the participants were assessed with the BI-SS and BI (treated as an external criterion) at admission to and discharge from rehabilitation wards.nnnSETTINGnSeven outpatient rehabilitation units and one inpatient rehabilitation unit.nnnPOPULATIONnOutpatients with chronic stroke.nnnMETHODSnEighty-four outpatients with chronic stroke participated in the test-retest reliability study. Fifty-seven inpatients completed baseline and follow-up assessments in the responsiveness study.nnnRESULTSnFor the test-retest reliability study, the values of the intra-class correlation coefficient and the overall percentage of minimal detectable change for the Ability Scale and Self-perceived Difficulty Scale were 0.97, 12.8%, and 0.78, 35.8%, respectively. For the responsiveness study, the standardized effect size and standardized response mean (representing internal responsiveness) of the Ability Scale and Self-perceived Difficulty Scale were 1.17 and 1.56, and 0.78 and 0.89, respectively. Regarding external responsiveness, the change in score of the Ability Scale had significant and moderate association with that of the BI (r=0.61, P<0.001). The change in score of the Self-perceived Difficulty Scale had non-significant and weak association with that of the BI (r=0.23, P=0.080).nnnCONCLUSIONSnThe Ability Scale of the BI-SS has satisfactory test-retest reliability and sufficient responsiveness for patients with stroke. However, the Self-perceived Difficulty Scale of the BI-SS has substantial random measurement error and insufficient external responsiveness, which may affect its utility in clinical settings.nnnCLINICAL REHABILITATION IMPACTnThe findings of this study provide empirical evidence of psychometric properties of the BI-SS for assessing ability and self-perceived difficulty of ADL in patients with stroke.

The Role of the Six-minute Walk Test, Pulmonary Function Test, and Asthma Control Test in Asthmatic Patients-a Preliminary Report

Purpose: Asthma control is the main concern for related professionals when approaching asthmatic patients. In this study, we selected three different tools to understand asthma control status in patients with asthma. Methods: Twenty-six patients with asthma were recruited in the study. These patients underwent pulmonary function testing with spirometry and the six-minute walk test, and completed an asthma control questionnaire (Asthma Control Test, ACT). In statistical analysis, the Spearman rank correlation and Pearson correlation coefficient were used for correlation between measured variables. For explanation, potential prediction variables were entered into a stepwise regression. Results: Our results showed that ACT score was significantly correlated with forced vital capacity (FVC) % of the predicted value (r=0.273, p=0.177); forced expiratory volume at one second (FEV1) % of the predicted value (r=0.209, p=0.017); resting Borg score (Rborg; r=-0.281, p=0.156); and resting oxygen saturation (RSpO2; r=0.390, p=0.049). The result of multiple linear regression with the ACT score as the dependent variable revealed only FEV1% of the predicted value was left in these patients (p=0.017, adjusted r square=0.182). Conclusion: We applied multiple measures in evaluating asthmatic patients with more objective tools. This information should be useful for clinical professionals.

The Effects of Indirect Shortwave Diathermy on Peripheral Circulation

Shortwave diathermy (SWD) has been used widely to relieve pain and improve circulation in physical therapy practice. Indirect heating with SWD applied on the torso was recommended for patients with peripheral arterial insufficiency. This study was designed to investigate the effects of indirect heating on peripheral circulation in normal subjects and to detect whether any differences existed between the forearm and the lower leg. Twenty-nine normal healthy volunteers, 10 males and 19 females, participated and completed the study. Subjects were randomly assigned into placebo or experimental group. The subjects in the experimental group received condensor pad type SWD 20 minutes over the lumbar area. Laser doppler flowmetry (LDF) was used to measure the skin temperature and cutaneous blood flow of right lower leg and forearm, while venous occlusion plethysmography (VOP) used to measure the total blood flow of that body segment before and after shortwave treatment. Linear regression model was used for data analysis. Our results showed that only the hyperemic-state alternating blood flow revealed significant difference between the two groups (p＜0.05). Changes in the majority of the variables derived from LDF and VOP were not correlated with either treatment received or extremities measured, but were correlated with the baseline data.