Publications by authors named "Gi-Wook Kim"

40 Publications

The efficacy of low-intensity pulsed ultrasound on articular cartilage and clinical evaluations in patients with knee osteoarthritis.

J Back Musculoskelet Rehabil 2022 Jun 17. Epub 2022 Jun 17.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea.

Background: While a number of preclinical studies have examined the effectiveness of low-intensity pulsed ultrasound (LIPUS) as a potential treatment for knee osteoarthritis (OA), there have been few clinical studies which have indirectly confirmed cartilage regeneration by magnetic resonance imaging (MRI).

Objective: The aim of this clinical trial was to investigate whether LIPUS effectively increased knee cartilage thickness and improved pain and function in knee OA patients.

Methods: This study was a prospective, single-group, home-based self-therapy trial. We included patients (n= 20) with OA pain. Each patient used an ultrasonic stimulation device (BODITREK JOINT™) for more than 20 sessions. Outcomes were assessed by MRI, Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the 36-Item Short Form Survey (SF-36) for assessing quality of life.

Results: Nineteen subjects completed this study. There was no significant increase in the cartilage thickness measured by MRI after LIPUS treatment. LIPUS therapy significantly decreased VAS score and WOMAC score, and significantly increased SF-36 score. The subgroup analysis in patients with knee OA showed that LIPUS treatment showed better for older patients with lower Kellgren-Lawrence grades.

Conclusion: Pain, function, and quality of life improved after LIPUS, but there was no significant increase in cartilage thickness through MRI.
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http://dx.doi.org/10.3233/BMR-210357DOI Listing
June 2022

Association of bladder trabeculation and neurogenic bladder with spinal cord injury.

J Int Med Res 2022 Jun;50(6):3000605221104768

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.

Objective: To compare clinical findings and urodynamic parameters according to trabeculation grade and analyze their correlations with trabeculation severity in neurogenic bladder caused by suprasacral spinal cord injury (SCI).

Methods: A retrospective chart review was performed of neurogenic bladder caused by SCI. Bladder trabeculation grade was compared with SCI-related clinical parameters and bladder-related urodynamic parameters.

Results: In SCI patients, factors such as disease duration, bladder capacity, detrusor pressure, peak detrusor pressure values, and compliance were significantly different between different grades of bladder trabeculation, while neurological level of injury, completeness, and detrusor sphincter dyssynergia had no clear relationship with bladder trabeculation grade. In the correlation analysis, vesicoureteral reflux was moderately correlated with trabeculation grade (correlation coefficient 0.433), while the correlation coefficients of disease duration, involuntary detrusor contraction, and bladder filling volume were between 0.3 and 0.4.

Conclusion: Bladder trabeculation with suprasacral-type neurogenic bladder was graded. Although disease duration was positively correlated with bladder trabeculation grade, differences in the neurological level of injury or American Spinal Injury Association Impairment Scale score were not observed. Bladder volume, peak detrusor pressure, compliance, reflex volume, and vesicoureteral reflux also showed significant differences according to trabeculation grade. Vesicoureteral reflux was moderately correlated with trabeculation grade.
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http://dx.doi.org/10.1177/03000605221104768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9189534PMC
June 2022

Effects of Low-Frequency Whole-Body Vibration on Muscle Activation, Fatigue, and Oxygen Consumption in Healthy Young Adults: A Single-Group Repeated-Measures Controlled Trial.

J Sport Rehabil 2022 May 16:1-9. Epub 2022 May 16.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju,Korea.

Context: Whole-body vibration (WBV) training improves muscle strength and balance. Few studies have focused on the effects of WBV frequencies below 30 Hz. We aimed to investigate the effect of low-frequency WBV training on muscle activity, fatigue recovery, and oxygen consumption (VO2).

Design: Prospective single-group, repeated-measures study.

Methods: In this controlled laboratory setting study, 20 healthy adults (age 23.26 [1.66] y) performed half squats at 0, 4, 6, 8, 12, 16, 20, 24, and 30-Hz WBV. Muscle activity was evaluated using the root mean square and peak electromyography amplitude of 6 muscles (iliocostalis, rectus abdominis, rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius) obtained via surface electromyography. VO2 was measured during the squats using a gas analyzer, and fatigue recovery was evaluated using measurements of lactate after the squats and after a recovery period. Statistical significance was set at P < .05, and analysis of variance was conducted to determine differences in muscle activity, fatigue, recovery, and VO2, with post hoc analyses as appropriate.

Results: Of the 6 muscles measured, the muscle activity of the gastrocnemius alone significantly increased from 0 Hz at 4, 8, 12, 16, 24, and 30 Hz based on the root mean square values and at 4, 8, 12, and 30 Hz based on the peak electromyography amplitude values. There were no significant differences in the other muscles. There were no significant differences in VO2 or in lactate levels.

Conclusions: Low-frequency WBV during squat exercises significantly increased the activity of the gastrocnemius medialis only at specific frequencies in healthy young adults. Low-frequency WBV is safe and has the potential to increase muscle activity.
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http://dx.doi.org/10.1123/jsr.2021-0170DOI Listing
May 2022

Technical Report of Color Doppler Ultrasonography-Assisted Lumbar Spinal Interventions.

Ultrasound Q 2022 Mar;38(1):53-58

Abstract: Ultrasonography (US) has recently been used more frequently during interventions involving the lumbar spine. However, physicians who are more familiar with musculoskeletal US targeting muscles, tendons, and nerves may find it challenging to perform US-guided lumbar spine interventions using only bony landmarks. This study described the use of color Doppler US for the visualization of the lumbar spinal blood supply to identify vascular landmarks in addition to bony landmarks and thus more easily and accurately perform lumbar spine interventions.
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http://dx.doi.org/10.1097/RUQ.0000000000000575DOI Listing
March 2022

Bilateral multifocal muscular hemorrhage in the triceps surae during antiplatelet therapy: a case report.

J Int Med Res 2021 Dec;49(12):3000605211064391

Department of Physical Medicine & Rehabilitation, 90158Jeonbuk National University Medical School, Jeonbuk National University Medical School, Jeonju, Republic of Korea.

Hemorrhagic complications are often reported following antiplatelet therapy; however, simultaneous multifocal hemorrhages in both legs are uncommon. The patient was a 75-year-old man diagnosed with ST elevation myocardial infarction who underwent percutaneous coronary intervention in the right coronary artery. He was prescribed oral acetylsalicylic acid and ticagrelor. Three days after initial drug treatment, he complained of bilateral leg pain that was aggravated by walking and moving his ankle across a broad range of motion. No deep vein thrombosis was detected on Doppler ultrasonography; however, muscular hemorrhage was suspected according to musculoskeletal ultrasonography. Multifocal muscular hemorrhage was confirmed in the soleus and gastrocnemius muscles on magnetic resonance imaging. To reduce the risk of bleeding, we changed the medication from ticagrelor to clopidogrel. The patient performed leg elevation exercises, compression, and applied an ice pack. He also performed range of motion exercises and gait training in addition to receiving drug treatment. With these therapies, his pain score improved from 5 to 3 on a visual analog scale, without further complications. Multifocal muscular hemorrhage rarely occurs bilaterally; however, when it does occur, an appropriate treatment plan can be developed based on musculoskeletal ultrasonography.
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http://dx.doi.org/10.1177/03000605211064391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721707PMC
December 2021

The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series.

J Back Musculoskelet Rehabil 2022 ;35(4):743-748

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea.

Background: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA.

Objective: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations.

Case Description: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects.

Conclusion: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.
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http://dx.doi.org/10.3233/BMR-210043DOI Listing
July 2022

Disruption of sensation-dependent bladder emptying due to bladder overdistension in a complete spinal cord injury: A case report.

World J Clin Cases 2021 Oct;9(29):8946-8952

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea.

Background: Autonomic dysreflexia (AD) can be a life-threatening condition in patients with spinal cord injury. It is important to prevent bladder overdistension in these patients as it may trigger AD. Sensation-dependent bladder emptying (SDBE), as a method of bladder management, improves the quality of life and allows physiologic voiding. In this study, we report disruption of the SDBE habit after bladder overdistension leading to AD with chest pain.

Case Summary: A 47-year-old male with a diagnosis of C4 American Spinal Cord Injury Association impairment scale A had been emptying his bladder using the clean intermittent catheterization method with an itchy sensation in the nose as a sensory indication for a full bladder for 23 years, and the usual urine volume was about 300-400 mL. At the time of this study, the patient had delayed catheterization for approximately five hours. He developed severe abdominal pain and headache and had to visit the emergency room for bladder overdistension (800 mL) and a high systolic blood pressure (205 mmHg). After control of AD, a hypersensitive bladder was observed despite using anticholinergic agents. The sensation indicating bladder fullness changed from nose itching to pain in the abdomen and precordial area. Moreover, the volume of the painful bladder filling sensation became highly variable and was noted when the bladder urine volume exceeded only 100 mL. The patient refused intermittent clean catheterization. Finally, a cystostomy was performed, which relieved the symptoms.

Conclusion: Patients using physiologic feedback, such as SDBE, for bladder management are recommended to avoid bladder overdistension.
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http://dx.doi.org/10.12998/wjcc.v9.i29.8946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546819PMC
October 2021

Diagnosis and Simultaneous Treatment of Musculoskeletal Injury Using HO-Triggered Echogenic Antioxidant Polymer Nanoparticles in a Rat Model of Contusion Injury.

Nanomaterials (Basel) 2021 Sep 30;11(10). Epub 2021 Sep 30.

Department of Bionanotechnology and Bioconvergence Engineering, Jeonbuk National University, Jeonju 54896, Korea.

Ultrasound is clinically used for diagnosis and interventions for musculoskeletal injuries like muscle contusion, but contrast of ultrasonography still remains a challenge in the field of the musculoskeletal system. A level of hydrogen peroxide (HO) is known to be elevated during mechanical tissue damage and therefore HO can be exploited as a diagnostic and therapeutic marker for mechanical injuries in the musculoskeletal system. We previously developed poly(vanillin-oxalate) (PVO) as an inflammation-responsive polymeric prodrug of vanillin, which is designed to rapidly respond to HO and exert antioxidant and anti-inflammatory activities. The primary aim of this study is to verify whether PVO nanoparticles could serve as contrast agents as well as therapeutic agents for musculoskeletal injuries simultaneously. In a rat model of contusion-induced muscle injury, PVO nanoparticles generated CO bubbles to enhance the ultrasound contrast in the injury site. A single intramuscular injection of PVO nanoparticles also suppressed contusion-induced muscle damages by inhibiting the expression of pro-inflammatory cytokines and inflammatory cell infiltration. We, therefore, anticipate that PVO nanoparticles have great translational potential as not only ultrasound imaging agents but also therapeutic agents for the musculoskeletal disorders such as contusion.
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http://dx.doi.org/10.3390/nano11102571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537538PMC
September 2021

Timing-Dependent Effects of Transcranial Direct Current Stimulation on Hand Motor Function in Healthy Individuals: A Randomized Controlled Study.

Brain Sci 2021 Oct 6;11(10). Epub 2021 Oct 6.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Geonjiro 20, Deokjin-gu, Jeonju 54097, Korea.

The timing of transcranial direct current stimulation (tDCS) is essential for enhancing motor skill learning. Previously, tDCS, before or concurrently, with motor training was evaluated in healthy volunteers or elderly patients, but the optimal timing of stimulation has not been determined. In this study, we aimed to optimize the existing tDCS protocols by exploring the timing-dependent stimulation effects on finger movements in healthy individuals. We conducted a single-center, prospective, randomized controlled trial. The study participants (n = 39) were randomly assigned into three groups: tDCS concurrently with finger tapping training (CON), tDCS prior to finger tapping training (PRI), and SHAM-tDCS simultaneously with finger tapping training (SHAM). In all groups, the subjects participated in five 40-min training sessions for one week. Motor performance was measured before and after treatment using the finger-tapping task (FTT), the grooved pegboard test (GPT), and hand strength tests. tDCS treatment prior to finger tapping training significantly improved motor skill learning, as indicated by the GPT and hand strength measurements. In all groups, the treatment improved the FTT performance. Our results indicate that applying tDCS before training could be optimal for enhancing motor skill learning. Further research is required to confirm these findings.
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http://dx.doi.org/10.3390/brainsci11101325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534210PMC
October 2021

Motor Organization in Schizencephaly: Outcomes of Transcranial Magnetic Stimulation and Diffusion Tensor Imaging of Motor Tract Projections Correlate with the Different Domains of Hand Function.

Biomed Res Int 2021 6;2021:9956609. Epub 2021 Sep 6.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.

Objective: Schizencephaly is a rare congenital malformation that causes motor impairment. To determine the treatment strategy, each domain of the motor functions should be appropriately evaluated. We correlated a color map of diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) with the hand function test (HFT) to identify the type of hand function that each test (DTI and TMS) reflects. Further, we attempted to demonstrate the motor neuron organization in schizencephaly.

Method: This retrospective study was conducted on 12 patients with schizencephaly. TMS was conducted in the first dorsal interosseous (FDI), biceps (BB), and deltoid muscles of the upper extremity, and contralateral MEP (cMEP) and ipsilateral MEP (iMEP) were recorded. The HFT included the grip strength, box and block (B&B), and 9-hole peg test. The schizencephalic cleft was confirmed using magnetic resonance imaging, and the corticospinal tract (CST) was identified using the color map of DTI. The symmetry indices for the peduncle and CST at pons level were calculated as the ratios of the cross-sectional area of the less-affected side and that of the more-affected side.

Result: In the more-affected hemisphere TMS, no iMEP was obtained. In the less-affected hemisphere TMS, the iMEP response was detected in 9 patients and cMEP in all patients, which was similar to the pattern observed in unilateral lesion. Paretic hand grip strength was strongly correlated with the presence of iMEP ( = 0.044). The symmetry index of the color map of DTI was significantly correlated with the B&B ( = 0.008, = 0.416), whereas the symmetry index of the peduncle was not correlated with all HFTs.

Conclusion: In patients with schizencephaly, the iMEP response rate is correlated with the hand function related to strength, while the symmetricity of the CST by the color map of DTI is correlated with the hand function associated with dexterity. Additionally, we suggest the possible motor organization pattern of schizencephaly following interhemispheric competition.
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http://dx.doi.org/10.1155/2021/9956609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437638PMC
September 2021

Efficacy of an Integrated Training Device in Improving Muscle Strength, Balance, and Cognitive Ability in Older Adults.

Ann Rehabil Med 2021 Aug 30;45(4):314-324. Epub 2021 Aug 30.

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea.

Objective: To determine the effects of an integrated training device for strength and balance on extremity muscle strength, postural balance, and cognition in older adults using a combination with various rehabilitation training games, in which balance, strength, and cognitive training were configured in a single device.

Methods: This prospective study included 20 healthy participants aged 65-85 years. Participants trained for 30 minutes daily, 3 days weekly, for 6 weeks with an integrated training device for strength and balance (SBT-120; Man&Tel Inc., Gumi, Korea). Main outcomes were measured using the Korean Mini-Mental State Examination (K-MMSE), Korean version of the Montreal Cognitive Assessment (K-MoCA), Timed Up and Go Test (TUG), Functional Reach Test (FRT), Berg Balance Scale (BBS), and Manual Muscle Test. Measurements were taken at three time points: T0 (pretreatment), T1 (immediately after treatment), and T2 (4 weeks after treatment).

Results: All 20 patients completed the training, and TUG, FRT, and BBS scores significantly improved at T1 and T2 compared to T0. Mean TUG scores decreased by 0.99±2.00 at T1 and 1.05±1.55 at T2 compared to T0. Mean FRT scores increased by 6.13±4.26 at T1 and 6.75±4.79 at T2 compared to T0. BBS scores increased by 0.60±0.94 at T1 and 0.45±1.15 at T2 compared to T0. Moreover, muscle strength and cognition (K-MMSE and K-MoCA scores) increased after training.

Conclusion: Our findings suggest that an integrated training device for strength and balance can be a safe and useful tool for older adults.
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http://dx.doi.org/10.5535/arm.21072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435467PMC
August 2021

Diagnostic Implication and Clinical Relevance of Dermatomal Somatosensory Evoked Potentials in Patients with Radiculopathy: A Retrospective Study.

Pain Res Manag 2021 1;2021:8850281. Epub 2021 Jun 1.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea.

Objective: Dermatomal somatosensory evoked potentials (DSEPs) are used to evaluate abnormalities of the somatosensory tract. There have been some studies on the diagnostic value of DSEP in radiculopathy, but it is still controversial. The purpose of our study is to evaluate the diagnostic implication and clinical relevance of DSEPs in patients with radiculopathy by comparing DSEP findings to radiculopathy symptoms and intervertebral foramen (IVF) or spinal canal stenosis in lumbar magnetic resonance imaging (MRI).

Methods: This retrospective study reviewed the medical records of patients ( = 59) who were examined by DSEP (each L4 and L5 dermatome) and lumbar MRI. Radiculopathy symptoms and DSEPs results were compared. For the evaluation of IVF and spinal canal size, sagittal (each bilateral L4/5 and L5/S1 IVF) and axial MR images were selected at the most stenotic level. The sizes of the IVF and spinal canal were measured by the pixel counts of selected MR images. In addition, stenosis severity was morphologically graded on a 4-point scale. DSEP results were compared with the size and grade of the IVF or spinal canal stenosis.

Results: DSEPs showed high sensitivity for radiculopathy symptoms. The IVF size at L4/5 and L5/S1 (pixel counts) was significantly related to either L4 or L5 dermatomal somatosensory pathway dysfunction, respectively. However, spinal stenosis (pixel counts and grade) and IVF stenosis grade were not significantly related to DSEPs.

Conclusion: This paper could be helpful in the electrophysiologic diagnosis of lumbar radiculopathy.
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http://dx.doi.org/10.1155/2021/8850281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187040PMC
July 2021

Diagnostic and therapeutic value of ultrasonography in the detection of paralabral ganglion cysts with a curved array transducer: A case report.

J Back Musculoskelet Rehabil 2021 ;34(6):951-956

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, 54907, Korea.

Background: Paralabral cysts are a rare cause of shoulder pain. Linear ultrasound transducers are often used for musculoskeletal evaluation and intervention. However, the use of linear transducer is limited when the target structure is located deep and blocked by bony barriers, as is the case of paralabral ganglion cysts.

Objective: This case report aims to describe a beneficial role of using a convex transducer on the evaluation and ultrasonography-guided intervention of paralabral cysts below the acromion.

Case Description: Two patients visiting the outpatient clinic of Physical Medicine and Rehabilitation complained of severe pain during shoulder movement. Ultrasound scans with linear transducer detected rotator cuff lesions. Shoulder magnetic resonance imaging was done because of the persistent pain despite therapeutic interventions for the rotator cuff lesion, and confirmed paralabral cysts. Although a linear array transducer could not visualize the cystic lesion but could only perform suprascapular nerve block and intra-articular injection, the use of a convex array transducer improved the visualization of the cystic lesion which we treated using ultrasound-guided aspiration and intra-cystic injection. Visual analog scale and Shoulder Pain and Disability Index were checked to assess the treatment effect of each intervention. The intra-cystic injection with aspiration and intra-articular injection showed minimal to moderate improvement of pain score.

Conclusion: In pain related to shoulder movement, especially pain that continues despite appropriate treatment for rotator cuff lesions, ultrasound diagnosis of paralabral ganglion cysts using convex transducers will improve the diagnostic value and accuracy of intervention.
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http://dx.doi.org/10.3233/BMR-200281DOI Listing
November 2021

Effectiveness of Whole-Body Vibration Training to Improve Muscle Strength and Physical Performance in Older Adults: Prospective, Single-Blinded, Randomized Controlled Trial.

Healthcare (Basel) 2021 May 31;9(6). Epub 2021 May 31.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea.

Whole-body vibration training (WBVT) is emerging as an alternative exercise method that be easily performed by older adults. This clinical trial investigates the efficacy of WBVT in improving muscle strength and physical performance before resistance exercise, in comparison to conventional resistance exercise after stretching exercise in older adults. The WBVT group ( = 20) performed WBVT using a vibrating platform (SW-VC15™), followed by strengthening exercises. The control group ( = 20) performed stretching instead of WBVT. Both groups underwent a total of 12 sessions (50 min per session). The primary outcome was isokinetic dynamometer. The secondary outcomes were grip strength, short physical performance battery (SPPB), a 36-Item Short Form Survey (SF-36), and body composition analysis. In all results, only the time effect was significant, and the group effect or time x group effect was not. Both groups showed a significant increase in isokinetic dynamometer. Although there was no significant group effect, the increase in mean peak torque was greater in the WBVT group. The only WBVT group showed significant improvement in SPPB. In SF-36, only the control group showed significant improvements. WBVT can be safely performed by older adults and may be an alternative exercise method to boost the effect of strengthening exercise.
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http://dx.doi.org/10.3390/healthcare9060652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226869PMC
May 2021

Prediction of Aphasia Severity in Patients with Stroke Using Diffusion Tensor Imaging.

Brain Sci 2021 Feb 27;11(3). Epub 2021 Feb 27.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea.

This study classified the severity of aphasia through the Western Aphasia Battery and determined the optimal cut-off value for each Language-Related White Matter fiber and their combinations, we further examined the correlations between Language-Related White Matter and Western Aphasia Battery subscores. This retrospective study recruited 64 patients with aphasia. Mild/moderate and severe aphasia were classified according to cut-off Aphasia Quotient score of 51 points. Diffusion tensor imaging and fractional anisotropy reconstructed Language-Related White Matter in multiple fasciculi. We determined the area under the covariate-adjusted receiver operating characteristic curve to evaluate the accuracy of predicting aphasia severity. The optimal fractional-anisotropy cut-off values for the individual fibers of the Language-Related White Matter and their combinations were determined. Their correlations with Western Aphasia Battery subscores were analyzed. The arcuate and superior longitudinal fasciculi showed fair accuracy, the inferior frontal occipital fasciculus poor accuracy, and their combinations fair accuracy. Correlations between Language-Related White Matter parameters and Western Aphasia Battery subscores were found between the arcuate, superior longitudinal, and inferior frontal occipital fasciculi and spontaneous speech, auditory verbal comprehension, repetition, and naming. Diffusion-tensor-imaging-based language-Related White Matter analysis may help predict the severity of language impairment in patients with aphasia following stroke.
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http://dx.doi.org/10.3390/brainsci11030304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997243PMC
February 2021

Comparing the Efficacy of Combined Treatment with Medial Branch Block and Facet Joint Injection in Axial Low Back Pain.

Pain Res Manag 2021 7;2021:1343891. Epub 2021 Jan 7.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea.

Introduction: Medial branch nerve block (MBB) and facet joint injections (FJIs) can be used to manage axial low back pain. Although there have been studies comparing the MBB and FJI effects, a few studies have compared the therapeutic effects of both interventions combined with each separate intervention. This study aimed to compare the pain relief effect of MBB, FJI, and combined treatment with MBB and FJI in patients with axial low back pain.

Methods: We conducted a retrospective review of patients with axial low back pain who had chart records of the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) scores measured before treatment and within 6 weeks after treatment. The proportion of patients with successful responses (>30%) was calculated and is presented with Wald confidence intervals.

Results: We included 66 patients (33, 17, and 16 patients in the MBB, FJI, and combined treatment with MBB and FJI groups). All the patient groups showed significant posttreatment improvements in the NRS [(proportion >30% decrease: MBB 24.2% (9.6-38.9), FJI 29.4% (7.8-51.1), and MBB + FJI 25.0% (3.8-46.2)] scores and the ODI [proportion >30% decrease: MBB 39.4% (22.7-56.1), FJI 23.5% (3.4-43.7), and MBB + FJI 37.5% (13.8-61.2)] scores. Furthermore, there was no significant among-group difference in the ODI and NRS scores.

Conclusion: MBB, FJI, and combined treatment with MBB and FJI can reduce axial low back pain and improve secondary functional degradation. Although combined treatment with MBB and FJI required a longer intervention time, it did not have a pain relief effect superior to that of MBB or FJI alone.
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http://dx.doi.org/10.1155/2021/1343891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808813PMC
June 2021

Changes in Diffuse Tensor Imaging and Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation in Traumatic Brain Injury with Central Pain.

Brain Sci 2020 Dec 2;10(12). Epub 2020 Dec 2.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea.

Post-trauma chronic pain characterized by central pain is a symptom following traumatic brain injury (TBI). Studies on the effect of repetitive transcranial magnetic stimulation (rTMS) on central pain and the association between central pain and spinothalamic tract (STT) have been reported, but few studies have examined the effect of rTMS in patients with mild TBI with central pain through changes in diffusion tensor imaging (DTI)-based metrics of STT before and after rTMS. This case series aimed to investigate the therapeutic effect of rTMS in TBI with central pain and the changes in diffusion tensor imaging (DTI)-based metrics of the spinothalamic tract (STT) before and after rTMS. This study included four patients who complained of severe pain in the left or right side of the body below the neck area after a car accident. We performed numeric rating scale (NRS), bedside sensory examination, electrodiagnostic study, and DTI-based metrics of the STT before and after rTMS. According to the guidelines of the diagnosis and grading for neuropathic pain, all patients had neuropathic pain corresponding to "probable grade." In all patients, rTMS was applied to the contralateral M1 cortex on the more painful side. There were no medication changes and other interventions during the rTMS. After rTMS, NRS decreased, bed sensory testing improved, and DTI-based STT metrics increased in all patients compared to before rTMS.
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http://dx.doi.org/10.3390/brainsci10120929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759834PMC
December 2020

Differences in Electrophysiologic Values between Preoperative and Intraoperative Neurophysiologic Monitoring.

Turk Neurosurg 2021 ;31(1):51-58

Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Department of Physical Medicine and Rehabilitation, Jeonju, South Korea.

Aim: To compare preoperative and intraoperative electrophysiologic values in patients who underwent brain and spine surgeries.

Material And Methods: A retrospective medical record review was conducted on patients who underwent brain and spine surgery between January 2014 and July 2018. Patients underwent preoperative electrophysiologic monitoring within a week before the operation and intraoperative monitoring during the surgery. Monitoring parameters included the onset latency (msec) and amplitude (mV) of motor evoked potential (MEP), somatosensory evoked potential (SEP), electroneuronography, and brainstem auditory evoked potential (BAEP).

Results: The latency of the MEP and SEP were significantly prolonged while the amplitude was decreased during operation. Specifically, patients with abnormal findings in their preoperative assessments showed more prominent differences compared to those with normal findings. However, there was no significant difference between preoperative and intraoperative results based on which side of the hemisphere was affected or unaffected. Unlike the MEP and SEP parameters, there were no significant changes in the facial electroneuronography and BAEP parameters.

Conclusion: There were differences in the preoperative and intraoperative monitoring parameters. Further studies are necessary to understand the underlying mechanisms behind these changes during surgery.
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http://dx.doi.org/10.5137/1019-5149.JTN.28409-19.2DOI Listing
March 2021

Transdermal opioid patch in treatment of paroxysmal autonomic instability with dystonia with multiple cerebral insults: A case report.

Medicine (Baltimore) 2020 Oct;99(40):e22536

Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School.

Rationale: Paroxysmal autonomic instability with dystonia (PAID) is an underdiagnosed syndrome that describes a collection of symptoms following diverse cerebral insults, such as traumatic brain injury, hydrocephalus, hemorrhagic stroke, or brain anoxia. It is manifested by systemic high blood pressure, hyperthermia, tachycardia, tachypnea, diaphoresis, intermittent agitation, and certain forms of dystonia.

Patient Concerns: A semi-comatose 46-year-old man was transferred from the regional rehabilitation hospital with various complaints involving fluctuating vital signs, including uncontrolled hyperthermia, hypertension, tachycardia, and tachypnea, and dystonia in all extremities. The patient underwent brain surgery for astrocytoma in 1996. The patient also had a history of first ischemic stroke on the basal ganglia in 2008 and a second one in the same area in 2017.

Diagnosis: The laboratory, electrocardiography, and radiologic findings were normal. Brain imaging indicated an old infarction on the basal ganglia with hydrocephalus. Tractography using diffusion tensor imaging showed discontinuity of multiple tracts, and electrophysiologic tests, such as evoked potentials, displayed an absent response. Based on the dysautonomic symptoms and brain evaluations, the physiatrist diagnosed the patient with PAID.

Interventions: Bromocriptine, propranolol, and clonazepam were administered sequentially, but autonomic instability persisted. Then, intravenous opioid was administered, and fluctuations in body temperature, heart rate, and respiratory rate, as well as decerebrate-type dystonia were improved. However, simultaneously, drug-induced severe hypotension developed (systolic blood pressure, 57 mm Hg). Subsequently, a transdermal opioid (fentanyl) patch for PAID was applied once every 3 days.

Outcomes: Ultimately, all vital signs and dystonia were managed without further complications, and the patient was discharged.

Lessons: A patient diagnosed with PAID following multiple cerebral insults was observed, whose condition was controlled by application of opioid patch rather than by intravenous or oral routes. A transdermal opioid patch, such as fentanyl patch, can thus be effective in the treatment of patients with PAID following multiple cerebral insults.
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http://dx.doi.org/10.1097/MD.0000000000022536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535696PMC
October 2020

Measurement of Nasalance Scores Without Touching the Philtrum for Better Comfort During Speech Assessment and Therapy: A Preliminary Study.

Cleft Palate Craniofac J 2021 04 14;58(4):446-454. Epub 2020 Sep 14.

Department of Physical Medicine and Rehabilitation, 90158Chonbuk National University Medical School, Jeonju, Republic of Korea.

Objective: The Kay Pentax nasometer uses a separator plate that touches the philtrum of a patient to separate the nasal and oral sound energies for nasalance measurement. However, the separator plate can restrict the natural movement of the patient's upper lip and generate unpleasant pressure on the patient's philtrum. The present study was intended to measure nasalance scores without touching the philtrum for better comfort during speech assessment and therapy.

Methods: Nasalance scores of 10 males and 10 females having no speech disorders were measured under 4 levels (0, 5, 10, and 15 mm) of the gap between the plate and the philtrum (denoted as plate-to-philtrum gap) using Nasometer II 6450 for nasal (Nasal Sentences) and oral (Zoo Passage) stimuli. Regression formulas were established to examine the relationships between nasalance score and plate-to-philtrum gap for the stimuli. To provide nasalance scores equivalent to those measured for the contact condition, compensation factors for the 5 mm plate-to-philtrum gap measurement condition were identified for the stimuli.

Results: The nasalance scores were significantly different between the 4 different plate-to-philtrum gaps for the stimuli. Compensation factors for the Nasal Sentences and the Zoo Passage were identified as 1.17 and 0.71, respectively.

Conclusions: The 5 mm plate-to-philtrum gap condition after multiplying the compensation factors can provide equivalent nasalance scores to the conventional contact measurement condition which may provide better comfort in speech assessment and therapy.
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http://dx.doi.org/10.1177/1055665620953340DOI Listing
April 2021

An Unusual, Intermediate-Sized Lesion Affecting Motor Organization in a Patient With Schizencephaly: A Case Report.

Front Hum Neurosci 2020 10;14:258. Epub 2020 Jul 10.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Hospital, Jeonju, South Korea.

Schizencephalies are abnormal clefts of the cerebral hemispheres that result from abnormal late neuronal migration and cortical organization. In the present study, we report a different type of unusual motor organization in a patient with a schizencephalic cleft in the right hemisphere and polymicrogyria in the opposite hemisphere. Despite similar brain pathology affecting the sensorimotor cortex, motor organization differed from previously known bilateral congenital brain lesions. We conducted a transcranial magnetic stimulation (TMS) and diffusion tensor image (DTI) study to confirm the motor organization. In this case, ipsilateral corticospinal projections to the paretic hands were observed during TMS of the less affected hemisphere, along with polymicrogyria, similar to the previous study. However, a crossed corticospinal tract to the paretic hand from the more severely affected hemisphere was observed in this case-a pattern of motor organization that has yet to be reported in this patient population. Our findings indicate that motor organization after early brain injury may be affected by the interhemispheric competition of the corticospinal system and bilateral brain lesions, thereby resulting in unilateral hemiparesis.
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http://dx.doi.org/10.3389/fnhum.2020.00258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381274PMC
July 2020

Effect of postural training using a whole-body tilt apparatus in subacute stroke patients with lateropulsion: A single-blinded randomized controlled trial.

Ann Phys Rehabil Med 2021 Mar 14;64(2):101393. Epub 2020 Oct 14.

Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, 20, Geonjiro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea; Translational Research & Clinical Trial Center for Medical Device, Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea. Electronic address:

Background: Lateropulsion after stroke is defined as a postural bias toward the paretic side and push away from the non-paretic side. New rehabilitation techniques and programs should be designed to attenuate lateropulsion and improve functions of balance and gait.

Objective: This study aimed to determine the effects of whole-body tilting postural training (WTPT) using a Spine Balance 3D on lateropulsion and postural control as compared with general postural training (GPT). Postural training was performed and involved a whole-body tilt apparatus that enables postural training in the tilted position, in multiple directions.

Methods: This was a pragmatic, single-blind, randomized controlled trial conducted between June 2018 and May 2019. We randomly allocated 30 patients with subacute stroke and lateropulsion based on the Scale of Contraversive Pushing (SCP score>0) to experimental (n=15) and control (n=15) groups. The experimental group received WTPT with a whole-body tilt apparatus, and the control group GPT. WTPT was performed with the Spine Balance 3D and GPT with postural training commonly applied in the clinic. All participants received treatment for 30min/session, 2 times/day, 5 days/week for 3 weeks. The primary outcome measure was lateropulsion assessed with the Burke Lateropulsion Scale (BLS). Secondary outcome measures were postural control ability, activities of daily living, Postural Assessment Scale for Stroke (PASS) score, Berg Balance Scale (BBS) score, Korea-modified Barthel index (K-MBI), and Fugl-Meyer Motor Assessment-Lower Extremity (FMA-L) score.

Results: For the primary outcome, after training, BLS scores were decreased more for the experimental than control group (Δ=-5.8 vs. Δ=-4.2, P=0.002). For secondary outcomes, scores were improved more for the experimental than control group: PASS (Δ=13.8 vs. Δ=8.5, P<0.001), BBS (Δ=20.1 vs. Δ=11.1, P=0.001), K-MBI (Δ=27.0 vs. Δ=20.1, P=0.005), and FMA-L (Δ=10.2 vs. Δ=6.3, P=0.002).

Conclusions: WTPT is a potentially effective therapeutic intervention for lateropulsion recovery in patients with subacute stroke. It may be useful for improving postural control and activities of daily living.
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http://dx.doi.org/10.1016/j.rehab.2020.05.001DOI Listing
March 2021

Clinical evaluation of the effectiveness of a new orthotic device for the non-operative treatment of scoliosis.

Technol Health Care 2020 ;28(S1):229-236

Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Korea.

Background: Bracing is one of the oldest non-operative treatments for patients with scoliosis. However, a wide variety of braces is used, and some show no effect, while others show conflicting results.

Objective: We aimed to evaluate the effectiveness of a new orthotic device for the treatment of adult scoliosis.

Methods: Twenty adult patients who were diagnosed with scoliosis and qualified for the study were selected and all participants were treated for 12 hours/day for 12 weeks using a new orthotic device. Various efficacy assessments (Cobb's angle, spine length, pelvic angle, shoulder angle, thoracic angle, lumbar angle, pelvic sacral angle) were performed before and after the 12-week treatment. The values at each time point were compared.

Results: There were significant treatment effects in a time-dependent manner on every efficacy assessment (p< 0.05) after 12 weeks of bracing.

Conclusion: In this clinical study, it was demonstrated that a new brace that is more comfortable for the wearer reduced scoliosis and may be a useful option for non-operative treatment of scoliosis.
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http://dx.doi.org/10.3233/THC-209023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369089PMC
April 2021

The effect of exercise load deviations in whole body vibration on improving muscle strength imbalance in the lower limb.

Technol Health Care 2020 ;28(S1):103-114

Division of Biomedical Engineering, Chonbuk National University, Jeonju, Jeonbuk, Korea.

Background: The amount of patients with muscle imbalance of the left and right side increases rapidly due to an incorrect lifestyle.

Objective: We investigated the optimal exercise load required to improve muscle imbalance.

Methods: Thirty participants were enrolled in the study. They performed squat exercises according to a whole body vibration (WBV) frequency protocol over a period of eight weeks. The exercises were performed three days a week and comprised five sets of fifteen trials per set per day. We validated muscle imbalance improvement using WBV by comparing and analyzing the results at different vibration frequencies. The participants were divided into three WBV protocol groups: no WBV, low-frequency WBV (25 Hz and 5 mm amplitude), and high-frequency WBV (50 Hz and 5 mm amplitude). We estimated the isokinetic muscle functions of the hip, knee, and ankle joints using BIODEX system 3. Ultimately, low-frequency WBV improved balance 10.2 ∼ 26.5% more than high-frequency WBV.

Results: Continuous load-deviation motions during low-frequency WBV were more effective at improving muscle imbalance than high-frequency WBV. WBV load variation methods improved muscle function and contractility more than external weights or loads by directly transferring kinetic energy into the body.

Conclusion: In this clinical study, we demonstrated that low-frequency WBV was more effective at improving muscle imbalance. The WBV protocol can be used in rehabilitation programs to improve imbalance without requiring elderly or physically decompensated patients to participate in excessive exercise.
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http://dx.doi.org/10.3233/THC-20900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369121PMC
April 2021

Ten-Year Follow-Up of Transcranial Magnetic Stimulation Study in a Patient With Congenital Mirror Movements: A Case Report.

Ann Rehabil Med 2019 Aug 31;43(4):524-529. Epub 2019 Aug 31.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea.

Most studies concerning congenital mirror movements (CMMs) have been focused on the motor organization in the distal hand muscles exclusively. To the best of our knowledge, there is no data on motor organization pattern of lower extremities, and a scarcity of data on the significance of forearm and arm muscles in CMMs. Here, we describe the case of a 19-year-old boy presenting mirror movements. In these terms, a 10-year transcranial magnetic stimulation study demonstrated that the motor organization pattern of the arm muscles was different from that of distal hand and forearm muscles even in the same upper extremity, and that the lower extremities showed the same pathways as healthy children. Moreover, in this case, an ipsilateral motor evoked potentials (MEPs) for distal hand muscles increased in amplitude with age, even though the intensity of mirror movements decreased. In the arm muscles, however, it was concluded that the contralateral MEPs increased in amplitude with age.
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http://dx.doi.org/10.5535/arm.2019.43.4.524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734025PMC
August 2019

Efficacy and Safety of a Stimulator Using Low-Intensity Pulsed Ultrasound Combined with Transcutaneous Electrical Nerve Stimulation in Patients with Painful Knee Osteoarthritis.

Pain Res Manag 2019 16;2019:7964897. Epub 2019 Jun 16.

Department of Physical Medicine & Rehabilitation, Chonbuk National University Medical School, Jeonju 54907, Republic of Korea.

Objective: Studies regarding the combination of ultrasound and transcutaneous electrical nerve stimulation (TENS) are rarely reported. In this study, we aimed to elucidate the efficacy and safety of a stimulator using low-intensity pulsed ultrasound (LIPUS) combined with TENS in patients with painful knee osteoarthritis (OA). We evaluated the effectiveness of this therapy against pain, physical function, and cartilage regeneration. Moreover, we aim to prove the superiority of the effects of LIPUS combined with TENS therapy compared with only TENS therapy.

Methods: Of the 40 included patients, aged 45-85 years with painful knee OA, 20 patients received only TENS therapy and 20 patients received LIPUS combined with TENS therapy for 8 weeks (a total of more than 80 treatment sessions). We evaluated visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, MOS 36-Item Short-Form Health Survey (SF-36), and femoral articular cartilage (FAC) thickness. The evaluation was performed at three visits: visit 1 (V1, pretreatment, within 28 days after screening), visit 2 (V2, posttreatment period 1, ±3 days after treatment), and visit 3 (V3, posttreatment period 2, 21 ± 3 days after treatment).

Results: We expected that LIPUS combined with TENS therapy would be superior to only TENS therapy. However, there was no significant difference between the two therapies. In the within-group comparison, both treatments (only TENS therapy and LIPUS with TENS therapy) demonstrated statistical differences from baseline values for pain and physical function outcomes. FAC thickness showed no significant differences after treatment in both groups.

Conclusion: The effects of a stimulator using LIPUS with TENS on pain relief and functional improvement were not superior to the only TENS therapy. Cartilage regeneration, which was expected as an additional benefit of LIPUS, was also not significantly evident. Therefore, further investigation is warranted to determine whether the combination therapy is beneficial. This trial is registered with KCT0003883.
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http://dx.doi.org/10.1155/2019/7964897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604342PMC
December 2019

Effects of a Newly Developed Therapeutic Deep Heating Device Using High Frequency in Patients with Shoulder Pain and Disability: A Pilot Study.

Pain Res Manag 2019 2;2019:8215371. Epub 2019 May 2.

Department of Physical Medicine & Rehabilitation, Chonbuk National University Medical School, Jeonju 54907, Republic of Korea.

Objectives: The newly developed therapeutic deep heating device can generate deep heat in focal tissue using high-frequency wave stimulation. The objective of this study was to evaluate and compare the effectiveness of this deep heating device (HIPER-500®) with ultrasound in alleviating pain and improving function in patients with shoulder disability.

Methods: This noninferiority trial was designed to compare the treatment effect of HIPER-500® to that of SonoStim® (ultrasound) on shoulder pain and disability. Thirty-eight patients with shoulder problems were assigned to either the HIPER-500® or SonoStim® group, and each participated in 10 min therapy sessions, five days a week for two weeks (for a total of ten sessions). Shoulder pain and disability were evaluated using the Visual Analogue Scale (VAS), the University of California at Los Angeles score (UCLA score), the Shoulder Pain and Disability Index (SPADI), and the Constant score in both groups before, immediately after, and four weeks after treatment. Statistical analysis was performed to compare the effects of treatment within and between the groups.

Results: A total of 34 patients completed the study. The 18 patients in the HIPER-500® group and 16 patients in the SonoStim® group all showed significant improvements in shoulder pain and function when comparing pretreatment values with the results immediately after treatment and four weeks later. The results before and after treatment did not show a statistically significant difference between the two groups.

Conclusions: The newly developed HIPER-500® for high-frequency deep heat therapy showed similar effects to those of SonoStim® for relieving pain and improving physical performance in the patients of this study. HIPER-500® may be a useful modality for treating shoulder pain and improving physical activity in patients with shoulder disease.
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http://dx.doi.org/10.1155/2019/8215371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525801PMC
December 2019

Efficacy of Virtual Reality Combined With Real Instrument Training for Patients With Stroke: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2019 08 16;100(8):1400-1408. Epub 2019 Apr 16.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Republic of Korea; Translational Research and Clinical Trials Center for Medical Devices, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea. Electronic address:

Objective: To investigate the efficacy of real instrument training in virtual reality (VR) environment for improving upper-extremity and cognitive function after stroke.

Design: Single-blind, randomized trial.

Setting: Medical center.

Participants: Enrolled subjects (N=31) were first-episode stroke, assessed for a period of 6 months after stroke onset; age between 20 and 85 years; patients with unilateral paralysis and a Fugl-Meyer assessment upper-extremity scale score >18.

Interventions: Both groups were trained 30 minutes per day, 3 days a week, for 6 weeks, with the experimental group performing the VR combined real instrument training and the control group performing conventional occupational therapy.

Main Outcome Measures: Manual Muscle Test, modified Ashworth scale, Fugl-Meyer upper motor scale, hand grip, Box and Block, 9-Hole Peg Test (9-HPT), Korean Mini-Mental State Examination, and Korean-Montreal Cognitive Assessment.

Results: The experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and Box and Block Tests. Patients in the experimental group, but not the control group, also showed significant improvements on the lateral, palmar, and tip pinch power, Box and Block, and 9-HPTs from before to immediately after training. Significantly greater improvements in the tip pinch power immediately after training and spasticity of elbow flexion 4 weeks after training completion were noted in the experimental group.

Conclusions: VR combined real instrument training was effective at promoting recovery of patients' upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke.
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http://dx.doi.org/10.1016/j.apmr.2019.03.013DOI Listing
August 2019

Hydrogen peroxide-activatable polymeric prodrug of curcumin for ultrasound imaging and therapy of acute liver failure.

Nanomedicine 2019 02 13;16:45-55. Epub 2018 Nov 13.

Department of BIN Convergence Technology, Chonbuk National University, Jeonju, Chonbuk, Republic of Korea; Department of Polymer·Nano Science and Technology, Chonbuk National University, Jeonju, Chonbuk, Republic of Korea. Electronic address:

Curcumin is a major active phenolic component of turmeric and has gained great attention in pharmaceutics due to its potent antioxidant, anti-inflammatory and anticancer activity. Here, we developed poly(oxalate-co-curcumin) (POC) as a hydrogen peroxide (HO)-activatable polymeric prodrug of curcumin by incorporating curcumin in the backbone of HO-responsive polyoxalate. POC particles effectively scavenged HO and released curcumin in a HO-triggered manner. POC particles exhibited excellent antioxidant and anti-inflammatory activity in activated cells. POC particles intravenously administrated into acetaminophen-intoxicated mice remarkably suppressed the level of alanine transaminase and inhibited apoptotic cell death in liver. Interestingly, POC particles could also enhance the ultrasound contrast in the intoxicated liver due to CO bubble generation through HO-triggered oxidation of peroxalate esters. Given their HO-responsiveness and highly potent antioxidant activity, POC particles hold great translational potential as theranostic agents for HO-associated diseases.
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http://dx.doi.org/10.1016/j.nano.2018.11.003DOI Listing
February 2019

Changes in Intracortical Excitability of Affected and Unaffected Hemispheres After Stroke Evaluated by Paired-Pulse Transcranial Magnetic Stimulation.

Ann Rehabil Med 2018 Aug 31;42(4):495-501. Epub 2018 Aug 31.

Department of Physical Medicine and Rehabilitation, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.

Objective: To assess the altered pattern of intracortical excitability of the affected and unaffected hemispheres in stroke patients using paired-pulse transcranial magnetic stimulation (TMS).

Methods: We evaluated intracortical inhibition (ICI) and intracortical facilitation (ICF) in both hemispheres at acute and subacute stages of 103 stroke patients using paired-pulse TMS. The patients were divided into two groups: mild-to-moderate patients whose motor evoked potential (MEP) was recorded in the affected hemisphere; and severe patients whose MEP was not recorded in the affected hemisphere.

Results: In mild-to-moderate patients, the value of ICI in the affected hemisphere was increased from 70.3% to 77.9% and the value of ICI in the unaffected hemisphere was decreased from 74.8% to 70.3% with eventual progression in acute to subacute stages of stroke. In severe patients, the value of ICI in the unaffected hemisphere was increased from 65.4% to 75.6%. The changes in ICF were not significantly different in this study.

Conclusion: We conclude that the unaffected hemisphere was more disinhibited than the affected hemisphere in acute phase of mild-to-moderate stroke, and the affected hemisphere was more disinhibited in the subacute stage. The unaffected hemisphere was inhibited in severe cases in acute-to-subacute phases of stroke. This finding facilitates appropriate neuromodulation of acute-to-subacute phases in mild-to-severe stroke patients.
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http://dx.doi.org/10.5535/arm.2018.42.4.495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129700PMC
August 2018
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