Tien-Yow Chuang

Virtual reality-based training improves community ambulation in individuals with stroke: A randomized controlled trial

This is a single blind randomized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke. Twenty subjects with stroke were assigned randomly to either the control group (n=9) or the experimental group (n=11). Subjects in the control group received the treadmill training. Subjects in the experimental group underwent the virtual reality-based treadmill training. Walking speed, community walking time, walking ability questionnaire (WAQ), and activities-specific balance confidence (ABC) scale were evaluated. Subjects in the experimental group improved significantly in walking speed, community walking time, and WAQ score at posttraining and 1-month follow-up periods. Their ABC score also significantly increased at posttraining but did not maintain at follow-up period. Regarding the between-group comparisons, the experimental group improved significantly more than control group in walking speed (P=0.03) and community walking time (P=0.04) at posttraining period and in WAQ score (P=0.03) at follow-up period. Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke.

Use of Virtual Reality to Improve Upper-Extremity Control in Children With Cerebral Palsy: A Single-Subject Design

Background and Purpose: Virtual reality (VR) creates an exercise environment in which the intensity of practice and positive feedback can be systematically manipulated in various contexts. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy (CP). Participants: Four children with spastic CP were recruited. Method: A single-subject design (A-B with follow-up) was used. All children were evaluated with 3 baseline, 4 intervention, and 2 follow-up measures. A 4-week individualized VR training program (2 hours per week) with 2 VR systems was applied to all children. The outcome measures included 4 kinematic parameters (movement time, path length, peak velocity, and number of movement units) for mail-delivery activities in 3 directions (neutral, outward, and inward) and the Fine Motor Domain of the Peabody Developmental Motor Scales–Second Edition (PDMS-2). Visual inspection and the 2-standard-deviation–band method were used to compare the outcome measures. Results: Three children who had normal cognition showed improvements in some aspects of reaching kinematics, and 2 children’s change scores on the PDMS-2 reached the minimal detectable change during the intervention. The improvements in kinematics were partially maintained during follow-up. Discussion and Conclusion: A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP, especially in children with normal cognition and good cooperation. The training effects were retained in some children after the intervention.

Neurourological changes before and after radical hysterectomy in patients with cervical cancer

Background.  The severity of bladder dysfunction in patients receiving radical hysterectomy for cervical cancer has been related to the delicacy and the degree of radicality of the hysterectomy. Our goal was to evaluate the effect of modified radical hysterectomy on the storage and evacuation of the lower urinary tract.

Virtual reality serves as a support technology in cardiopulmonary exercise testing

The purpose of this study was to develop a virtual cycling system and examine the influence of virtual reality (VR) on test performance during clinical exercise testing. We aimed to compare the physiological responses of the cardiovascular and ventilatory systems during incremental exercise testing with or without VR, and to measure VR effects on the ratings of perceived exertion (RPE) and cycling duration throughout the test. Twelve healthy senior citizens (ten men and two women) with a mean age of 74.5-4.7 years participated in the study. The codes of behavior for this study included a maximum graded exercise tolerance test, a submaximal endurance VR exercise, and a submaximal endurance non-VR exercise. A friction-braked cycle ergometer was used to conduct the exercise tests. For the subjects movement speed to create an appropriate environment flow on the display screen, the bike was connected to a personal computer. The cardiorespiratory and hemodynamic parameters were evaluated at both peak and submaximal exertion. The results show that the VR versus non-VR programs did not differ on submaximal and peak exercise responses during the cycling test. However, significant differences were observed between the mean values for cycling duration, distance, and energy consumption. The difference between RPE curves for VR and non-VR protocols revealed promising results within 45 min. of cycling (Breslow test, p = .06); however, no statistical significance was achieved at the test termination (log rank test, p =.17). In conclusion, this study found that the maintenance of endurance, the increase in target intensity, and total energy consumption in exercise programs may be assisted by introducing VR technology. In addition, the activities taking place in virtual environments can be performed in complete safety.

Cervical root repair in adult rats after transection: recovery of forelimb motor function

Functional recovery was achieved in rats after repairing the transected left sixth and seventh cervical roots. Intercostal nerves were used for reanastomosis between the transected roots and the spinal cord, and acidic fibroblast growth factor with fibrin glue was applied. Experimental rats showed relevant functional recovery of gait and grooming reflexes. Electromyography demonstrated less denervation and more regeneration. Horseradish peroxidase retrograde axonal tracing disclosed a statistically significant increase of motor neuron survival, suggesting that motor neuron survival was significantly correlated with functional recovery. It is our belief that this novel treatment strategy may help patients with similar injuries in the future.

The study of auditory and haptic signals in a virtual reality-based hand rehabilitation system

The purpose of the present study is to assess the influence of auditory and haptic signals on the manipulation performance in a virtual reality-based hand rehabilitation system. A personal computer, a tracker, and a data glove were included in this system. Three-dimensional virtual environments were developed. Forty volunteers were recruited to participate in a pick-and-place procedure, with three levels of difficulty and four feedback modes. Task time and collision frequency were the parameters used to evaluate their manipulation performance. It can be concluded that the haptics is a significant signal for improving a subjects performance at the high difficulty level.

A virtual reality-based system for hand function analysis

The goal of this study was to demonstrate the usability and usefulness of virtual reality technology in assessing hand functions. Ten healthy, non-disabled right-handed adult volunteers were recruited. Each volunteer used a dataglove to insert three-dimensional virtual representations of a cylinder and a prism into the target holes. To verify the reliability of the tests, each subject was retested twice. The performance testing assessed the visual-motor coordination a person needs to achieve a task accurately and within a set time. For each trial, the root mean square (RMS) value of the hand movement trajectory was projected onto the X, Y, and Z axes. This projection enabled us to measure the extent of the genuine, summative displacement of the manipulating hand. The reproducibility of the virtual reality assessment was analyzed using the intraclass correlation (ICC) approach. The total ICC values of 10 subjects demonstrated a high task completion time and RMS on the X and Z axes for the transferring of the prism. However, the values were low for the transferring of the cylinder. Because the individual coefficients of variations (CVs) varied widely in the moving of both the cylinder and the prism, the total (CVs) showed a high reading for the task completion time. Although rehabilitation clinics routinely carry out peg-moving exercises for disabled patients, our model provides a valuable quantitative real time and off-line measure of whole hand functions.

Effects of intravascular laser irradiation of blood in mitochondria dysfunction and oxidative stress in adults with chronic spinal cord injury.

OBJECTIVE This study investigated the clinical effects of intravascular laser irradiation of blood (ILIB) therapy on oxidative stress and mitochondrial dysfunction in subjects with chronic spinal cord injury (SCI) resulting from trauma. BACKGROUND DATA Little is known about how ILIB may generate antioxidant defenses in humans, and there is still a lack of randomized, sham-control studies to indicate its influence on different metabolic pathways. METHODS Twenty-four chronic SCI subjects (assigned to a sham and a study group), and 12 normal subjects were recruited. The study group underwent 1 h daily of ILIB for 15 days over 3 weeks. The sham group underwent ILIB with no laser power. RESULTS Baseline measurements established higher oxidative stress and mitochondrial dysfunction in the SCI subjects than in the normal subjects. At day 15 of therapy, the study group revealed a significantly higher mitochondrial DNA (mtDNA) copy number, white blood cell adenosine triphosphate (WBC ATP) synthesis, and total antioxidant capacity (TAC) with significantly reduced malondialdehyde (MDA), than did the sham group. The study group intragroup comparison revealed significantly increased mtDNA copy numbers, WBC ATP synthesis, and TAC, with significantly reduced MDA, compared with its baseline measurements. The sham group intragroup comparisons demonstrated no statistical differences. Low-density lipoprotein (LDL) in the study group was significantly reduced at days 10 and 15, with significantly higher high-density lipoprotein (HDL) at day 45. CONCLUSIONS Our study results contribute to the knowledge about the effectiveness of ILIB in alleviating oxidative stress and mitochondrial dysfunction in chronic SCI patients.

Functional recovery of chronic complete idiopathic transverse myelitis after administration of neurotrophic factors

Study design:Case report.Objective:To evaluate the functional recovery of chronic complete idiopathic transverse myelitis (ITM) after administration of acidic fibroblast growth factor (aFGF).Methods:A 28-year-old woman presented with a 4-year history of spastic paralysis, sensory level at T10, urinary retention and constipation due to ITM. In all, 20 μg aFGF bolus injection was applied via intradural lumbar puncture, which was repeated every 5 months for 15 months.Results:At 3 weeks after first injection, the patient experienced vague sensation at approximately T12–L1 dermatomes. At 2 months after the second injection, muscle activities and gait pattern were recorded in bilateral gluteus and hip abductors as she ambulated with long leg brace and axillary crutches. Increased walking speeds, reduced pelvic tilting and reduced compensatory trunk rotation during the swing phase were also demonstrated as compared to the initial gait analysis. At 18 months after injection, motor evoked potentials were obtained in hip abductors of both legs.Conclusions:aFGF may increase the efficacy of spinal reactivation/regeneration and is a potential remedy for chronic transverse myelitis.

Spinal Cord Implantation with Acidic Fibroblast Growth Factor as a Treatment for Root Avulsion in Obstetric Brachial Plexus Palsy

Nerve root avulsion carries the worst prognosis among brachial plexus injuries and remains a great challenge for surgeons to repair. In this case, a boy with complete avulsion of the left-side C6 root presented with flaccid paralysis of the left arm after birth. As there was no significant spontaneous recovery, the patient underwent operation when he was 6 months old. One end of the nerve graft from the sural nerve was anastomosed with the avulsed C6 root, and the other end was implanted into the ventrolateral aspect of the spinal cord with fibrin glue containing acidic fibroblast growth factor. After 2 years of follow-up, there has been significant improvement in motor function and in electrophysiologic studies over the left upper limb.