Yang-Hua Lin

Effects of thermal therapy in improving the passive range of knee motion: comparison of cold and superficial heat applications:

Objective: To assess the effect of applying a hot pack followed by a cold pack (COLD) on the passive range of knee flexion in subjects with restricted knee motion, specifically comparing this treatment to the application of a hot pack (HEAT) alone. Design: Seventy-one subjects were randomized into two groups to conduct a clinical randomized before–after trial. Interventions: Each subject received either (1) cold pack or (2) hot pack during passive knee joint stretching. Main outcome measure: Goniometry was used to measure the passive knee flexion at the baseline (KROM1), before (KROM2) and after (KROM3) applications of a hot pack with/without a cold pack. Results: Repeated ANOVA measurements revealed a marked increase in the passive range of knee flexion in the two study groups (p < 0.001). Moreover, the paired t-test displayed statistical increments of knee flexion across the different measurement phases, except for the treatment phase without the cold pack. The range of knee flexion following the treatment with the application of a cold pack significantly exceeded that after treatment without a cold pack. Conclusion: Cold pack application had a limited but significant effect during mechanical stretching for restricted knee motion.

Relationships Between Gross Motor Functions and Health-Related Quality of Life of Taiwanese Children with Cerebral Palsy

Liu W-Y, Hou Y-J, Wong AMK, Lin P-S, Lin Y-H, Chen C-L: Relationships between gross motor functions and health-related quality of life of Taiwanese children with cerebral palsy. Objective:To examine the relationships between gross motor functions and physical and psychosocial components of the health-related quality of life of children with cerebral palsy. Design:Participants comprising 90 children (53 boys, 37 girls; mean age ± SD = 8.2 ± 2.4 yrs) with cerebral palsy were enrolled by a cross-sectional design. Gross motor function measure was used to quantify their gross motor functions. Their health-related quality of life was determined by the Child Health Questionnaire-Parent Form 50 (traditional Chinese version), completed by their caregivers. Results:A significant moderate positive correlation (r = 0.73, P < 0.01) existed between the physical summary scores of the Child Health Questionnaire-Parent Form 50 and gross motor function measure, 66 scores in Taiwanese children with cerebral palsy. There was no significant correlation between the psychosocial summary scores of Child Health Questionnaire-Parent Form 50 and gross motor function measure, 66 scores in cerebral palsy (r = −0.13, P = 0.23). Conclusions:Gross motor functions may be good predictors of the physical component of health-related quality of life, but they are poor predictors of the psychosocial component of health-related quality of life in children with cerebral palsy. In the future, more comprehensive information regarding children’s comorbidities may need to be objectively gathered to provide professionals a better understanding of their health-related quality of life.

Early Radiation Effects on Tongue Function for Patients with Nasopharyngeal Carcinoma: A Preliminary Study

The purpose of this study was to investigate early radiation effects on tongue function for patients with nasopharyngeal carcinoma (NPC) and to provide a scientific database for early intervention plans. Twelve subjects with NPC and 12 age- and sex-matched normal subjects were included. Tongue maximum isometric strength and endurance at 50% of maximum strength were obtained once from normal subjects with the Iowa Oral Performance Instrument (IOPI) and twice from the NPC subjects: before and 2 months after radiation treatment. No significant differences were found in tongue function evaluation for normal or NPC groups in either pre- or post-treatments. However, this study showed that significant decreases in tongue function may not start until 2 months after treatment.

The effect of lifting and lowering an external load on repositioning error of trunk flexion-extension in subjects with and without low back pain

Objective: To determine whether the repositioning error of trunk flexion-extension in individuals with low back pain is different from that in those not experiencing low back pain when lifting and lowering external loads. Design: A case-control study. Setting: Physical therapy department of a medical centre. Subjects: Twenty subjects with subacute low back pain and 20 control subjects without low back pain. Interventions: Tasks with and without lifting and lowering an external load. Main outcome measures: The trunk repositioning errors were measured with Measurand Shape Tape. Results: In subjects with low back pain, trunk repositioning errors were significantly reduced when lifting and lowering an external load in the direction of flexion (3.779 ±1.26 degrees in a loaded condition versus 4.82±2.97 degrees in an unloaded condition; P B< 0.05) and extension (3.17±2.15 degrees in a loaded condition versus 5.039±3.74 degrees in an unloaded condition; p < 0.05). In control subjects, trunk repositioning errors were not significantly changed when lifting and lowering an external load in the direction of flexion (2.80±1.39 degrees in a loaded condition versus 2.63±1.24 degrees in an unloaded condition; p < 0.05) and extension (2.87±1.40 degrees in a loaded condition versus 3.15±1.50 degrees in an unloaded condition; P>0.05). The direction of motion (trunk flexion or extension) was not shown to be significant in this study. Conclusion: Performing the task whilst lifting or lowering a submaximal load showed a reduced trunk repositioning error in subjects with subacute low back pain. Lifting and lowering a submaximal load might be considered as one of the rehabilitative strategies to hasten a return to work.

Bimanual gliding control for indoor power wheelchair driving

Power wheelchairs are essential for many individuals with mobility impairment. The objective of this study was to investigate the effectiveness of bimanual gliding (BG) and conventional joystick (CJ) control in an indoor environment, with application to (1) wheelchair driving performance (i.e., practice time, completion time, and driving deviation) and (2) muscle activity of the upper limbs. This study included 22 participants (11 experienced manual wheelchair users and 11 novice manual wheelchair users). Experienced wheelchair users who used the BG strategy needed less time to practice and complete the task. Muscle activity of the upper limbs was focused on the triceps brachii, with relatively less use of the wrist muscles while applying the BG strategy. In novice wheelchair users, wrist muscles were less involved when using the BG control compared with the CJ control. The findings imply that it is feasible to modify manual wheelchairs using BG and motors, which can serve as an alternative option for wheelchair users.

Joystick-controlled video console game practice for developing power wheelchairs users' indoor driving skills.

[Purpose] This study aimed to determine the effectiveness of joystick-controlled video console games in enhancing subjects’ ability to control power wheelchairs. [Subjects and Methods] Twenty healthy young adults without prior experience of driving power wheelchairs were recruited. Four commercially available video games were used as training programs to practice joystick control in catching falling objects, crossing a river, tracing the route while floating on a river, and navigating through a garden maze. An indoor power wheelchair driving test, including straight lines, and right and left turns, was completed before and after the video game practice, during which electromyographic signals of the upper limbs were recorded. The paired t-test was used to compare the differences in driving performance and muscle activities before and after the intervention. [Results] Following the video game intervention, participants took significantly less time to complete the course, with less lateral deviation when turning the indoor power wheelchair. However, muscle activation in the upper limbs was not significantly affected. [Conclusion] This study demonstrates the feasibility of using joystick-controlled commercial video games to train individuals in the control of indoor power wheelchairs.

Deficits in sensory organization for postural stability in children with Tourette syndrome

Tourette syndrome (TS) is a childhood-onset developmental disorder characterized by involuntary motor and vocal tics. Previous studies have indicated that children with TS demonstrate postural control anomalies when standing. The aim of this study was to compare postural stability under normal and altered sensory conditions in children with TS and healthy control (HC) children. A convenience sample of twelve children with TS (9 boys and 3 girls; 9.4 ± 1.1 yr) and 12 HC age- and gender-matched children (9.2 ± 1.1 yr) participated in this study. The Sensory Organization Test (SOT) was used to assess postural stability under six altered sensory conditions (1. normal vision, fixed support; 2. eyes closed, fixed support; 3. vision sway-referenced, fixed support; 4. normal vision, support sway-referenced; 5. eyes closed, support surface sway-referenced; 6. both vision and support surface sway-referenced) using the SMART Balance Master® 8.2 (NeuroCom® International, Inc, Clackamas, OR, USA). The results showed significant differences between the two groups in conditions 5 and 6 (p=0.003 and 0.002, respectively). The mean composite equilibrium score in children with TS was significantly lower than that of HC children (p<0.000). The results suggested that children with TS had greater difficulty in maintaining postural stability, especially when vestibular information was challenged. The results of this study provide supporting evidence for possible deficits in impaired access to vestibular information and sensorimotor integration of postural control in children with TS.

Within-session acquisition of anticipatory postural adjustments during forward reaching task.

OBJECTIVE To describe the acquisition of anticipatory postural adjustment (APA) in healthy adults during standing forward reaching. DESIGN Repeated-measures design Subjects/Patients: Ten healthy subjects. METHODS Within one day, all subjects practiced forward reaching to a moving target for sixty trials (10 trials, 6 blocks). APAs were recorded by electromyography (EMG), center of pressure (COP), and kinematic measurements. Repeated measure ANOVA was used to compare the changes of APA among the six blocks. RESULTS All subjects showed basic APA patterns in the beginning, such as posterior shift of COP and tibialis anterior firing first. The adults demonstrated significantly quicker onset of posterior shift of COP between block 2 and 6 (p<0.05) and decreased muscle activation of ispilateral tibialis anterior between block 1 and 3 (p=0.01). CONCLUSIONS The results suggested the acquisition process of APA could be observed after 50 trials of practice. Further study will need to verify the optimal practice trials in different populations with movement disorders.

A physical fitness follow-up in children with cerebral palsy receiving 12-week individualized exercise training

Physical fitness in children with cerebral palsy (CP) is lower than in their peers. A 12-week individualized home-based exercise program completed by 11 children with CP 10 years earlier showed a favorable effect on physical fitness performance. We follow-up the physical fitness of those 11 children with CP, and compare their physical fitness and health-related quality of life (HRQoL) to children with CP without exercise training matched with age and motor levels. Eleven children with CP in the 2003 program as a follow-up group (FUG) and 12 volunteers recruited as a control group (CG) participated in this study. Physical fitness measures, including cardiopulmonary endurance, muscle strength, body mass index (BMI), flexibility, agility, balance, and the SF-36 Taiwan version, were assessed in both groups. After 10 years, the FUG showed better physical fitness in cardiopulmonary endurance and muscle strength (p<.05). Compared to the CG, the FUG demonstrated better muscle strength, agility, and balance (p<.05). However, the HRQoL did not show a significant difference between the FUG and the CG. Individualized home-based exercise training is beneficial for children with CP. Over 10 years, the FUG was more devoted to physical activity than was the CG. Physical exercise may not directly affect the HRQoL in this study.

Human-centered wheelchairs: Bimanual gliding interface with heart rate monitoring

This paper presents a new wheelchair manipulation interface which is developed with bimanual gliding control interfaces. An important feature of the bimanual gliding control interface is performing intuitive manipulations when compared to conventional unilateral joystick interface. At the mean time, the bimanual gliding control interface also realizes the measurement of closed-line biopotential currents that flow in the thoracic volume conductor via a pair of surface electrodes placed on two gliding sensor modules. Therefore, the new designed bimanual gliding control interface does not only provide a feasible wheelchair manipulation interface, but also measure the users heart rate. Finally, a bimanual gliding (BG) wheelchair prototype is produced in this paper for performance evaluations.