Publications by authors named "Li-Wei Chou"

109 Publications

Shifted Firefighter Health Investigation by Personal Health Insurance Record in Taiwan.

Risk Manag Healthc Policy 2021 16;14:665-673. Epub 2021 Feb 16.

Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan.

Introduction: Taiwan's firefighters use a shift rotation system with 2 days of work and 1 day of rest. Numerous papers have already explored the risks of shift work to the body. However, little data concern the impact of shift work on health as reflected in medical visits. This study used individuals' medical visit record in Taiwan's health insurance system. The locally called "health bank" contains individuals' medical visit record, health insurance payment points and the medicine used.

Methods: Consent was obtained from 150 firefighters who were serving under the shift rotation system to obtain their 2015 individual "My Health Bank" medical data. Comparisons were made between national health insurance data norm.

Results: Firefighters make significantly more visits for Western medicine than the annual average (firefighters 6.27 vs norm 5.24, P = 0.04142), more total number of medical visits (9.57 vs 7.75, P = 0.0102), more annual average payment points for Western medicine (4079 vs 2741, P = 0.003151), and a greater average number of total annual medical visit points (7003 vs 4940, p = 0.0003157). Firefighters had significantly higher incidents of respiratory diseases, urogenital diseases, skin and subcutaneous tissue diseases, musculoskeletal system and connective tissue diseases, injuries, and illness from poisoning than did the norm (P<0.05).

Conclusion: A persuasive health-survey-based method for workers in high occupational hazard industries was proposed in this study, and the result was highly correlated with risk factors of fireworkers. The proposed study method is potential to investigate risk factors of other working.
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http://dx.doi.org/10.2147/RMHP.S285729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896789PMC
February 2021

Effects of 4-Week Inspiratory Muscle Training on Sport Performance in College 800-Meter Track Runners.

Medicina (Kaunas) 2021 Jan 15;57(1). Epub 2021 Jan 15.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 112, Taiwan.

Respiratory muscle fatigue is one of the important factors limiting sports performance due to the metaboreflex. This reflex will cause a decrease in blood flow to the extremities and accelerate exercising limb fatigue. Previous studies found that inspiratory muscle training (IMT) can effectively enhance the respiratory muscle endurance and reduce fatigue during long-duration exercise or aerobic exercise, thereby enhancing athletic performance. However, the mechanism between inspiratory muscle strength, change of limb blood flow and sports performance still requires investigation, especially in short-duration exercise, anaerobic or both aerobic and anaerobic exercise. The purpose of this study was to investigate the effects of 4-week inspiratory muscle training on respiratory muscle strength, limb blood flow change rate and sports performance in recreational 800-m college runners. Twenty healthy 800-m college runners randomized into the IMT group (11 subjects) and control group (9 subjects). IMT consisted of 30 inspiratory efforts twice daily, 5 days a week, with intensity at 50%, 60%, 70% and 80% of maximum inspiratory pressure (MIP) for 4 weeks, while a control group kept 50% of MIP for 4 weeks. An 800-m trial test, limb blood flow change rate by using Impedance Plethysmography, and MIP were as the outcome measured variables and be evaluated. All measured variables were assessed before and after 4-week IMT training. Two-way ANOVA was conducted for statistical analysis. The results showed significantly interaction between groups and pre-posttest. IMT group significantly decreased limb blood flow change rate from 19.91 ± 11.65% to 9.63 ± 7.62% after received the IMT training program ( < 0.05). The MIP significantly improved from 112.95 ± 27.13 cmHO to 131.09 ± 28.20 cm HO in IMT group, and the 800-m trial test also shorted the running time from 162.97 ± 24.96 s to 156.75 ± 20.73 s. But the control group no significantly changed in MIP and 800-m trial test. Our results indicated that the 4-week IMT training (twice a day, 5 days a week) significantly improves participants' inspiratory muscle strength, 800-m running performance and decreases the limb blood flow change rate.
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http://dx.doi.org/10.3390/medicina57010072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830231PMC
January 2021

Changes in Balance, Gait and Electroencephalography Oscillations after Robot-Assisted Gait Training: An Exploratory Study in People with Chronic Stroke.

Brain Sci 2020 Nov 6;10(11). Epub 2020 Nov 6.

Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan.

Robot-assisted gait training (RAGT) systems offer the advantages of standard rehabilitation and provide precise and quantifiable control of therapy. We examined the clinical outcome of RAGT and analyzed the correlations between gait analysis data and event-related desynchronization (ERD) and event-related synchronization (ERS) in patients with chronic stroke. We applied the Berg balance scale (BBS) and analyzed gait parameters and the ERD and ERS of self-paced voluntary leg movements performed by patients with chronic stroke before and after undergoing RAGT. A significant change was observed in BBS ( = 0.011). We also showed preliminary outcomes of changes in gait cycle duration ( = 0.015) and in ipsilesional ERS in the low-beta ( = 0.033) and high-beta ( = 0.034) frequency bands before and after RAGT. In addition, correlations were observed between BBS and ipsilesional ERS in the alpha and low-beta bands ( = -0.52, = 0.039; = -0.52, = 0.040). The study demonstrated that RAGT can improve balance and provided an idea of the possible role of brain oscillation and clinical outcomes in affecting stroke rehabilitation.
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http://dx.doi.org/10.3390/brainsci10110821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694605PMC
November 2020

Noisy Galvanic Vestibular Stimulation (Stochastic Resonance) Changes Electroencephalography Activities and Postural Control in Patients with Bilateral Vestibular Hypofunction.

Brain Sci 2020 Oct 15;10(10). Epub 2020 Oct 15.

Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Chiao Tung University, Hsinchu 300, Taiwan.

Patients with bilateral vestibular hypofunction (BVH) often suffer from imbalance, gait problems, and oscillopsia. Noisy galvanic vestibular stimulation (GVS), a technique that non-invasively stimulates the vestibular afferents, has been shown to enhance postural and walking stability. However, no study has investigated how it affects stability and neural activities while standing and walking with a 2 Hz head yaw turning. Herein, we investigated this issue by comparing differences in neural activities during standing and walking with a 2 Hz head turning, before and after noisy GVS. We applied zero-mean gaussian white noise signal stimulations in the mastoid processes of 10 healthy individuals and seven patients with BVH, and simultaneously recorded electroencephalography (EEG) signals with 32 channels. We analyzed the root mean square (RMS) of the center of pressure (COP) sway during 30 s of standing, utilizing AMTI force plates (Advanced Mechanical Technology Inc., Watertown, MA, USA). Head rotation quality when walking with a 2 Hz head yaw, with and without GVS, was analyzed using a VICON system (Vicon Motion Systems Ltd., Oxford, UK) to evaluate GVS effects on static and dynamic postural control. The RMS of COP sway was significantly reduced during GVS while standing, for both patients and healthy subjects. During walking, 2 Hz head yaw movements was significantly improved by noisy GVS in both groups. Accordingly, the EEG power of theta, alpha, beta, and gamma bands significantly increased in the left parietal lobe after noisy GVS during walking and standing in both groups. GVS post-stimulation effect changed EEG activities in the left and right precentral gyrus, and the right parietal lobe. After stimulation, EEG activity changes were greater in healthy subjects than in patients. Our findings reveal noisy GVS as a non-invasive therapeutic alternative to improve postural stability in patients with BVH. This novel approach provides insight to clinicians and researchers on brain activities during noisy GVS in standing and walking conditions in both healthy and BVH patients.
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http://dx.doi.org/10.3390/brainsci10100740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602631PMC
October 2020

The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis.

Evid Based Complement Alternat Med 2020 25;2020:9790470. Epub 2020 Sep 25.

Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan.

Background: Frozen shoulder (FS) is associated with pain, reduced range of motion (ROM), and shoulder function. The condition occurs in 2-5% of the population, and it is especially common around the age of 50 years. FS symptoms will recover after 1-4 years. Many patients turn to acupuncture in order to alleviate the FS symptoms.

Objective: In this review, we will investigate the efficiency of acupuncture as a FS treatment.

Methods: A literature search of acupuncture and FS-related keywords was performed in the following databases: PubMed, Cochrane Library, Embase, and Web of Science. Thirteen publications were included for a systematic review, and a meta-analysis was done using the following measurements: visual analogue scale (VAS) for pain, Constant-Murley Shoulder Outcome Score (CMS) for shoulder function, and active shoulder ROM including flexion, abduction, and external rotation. The Cochrane Collaboration's risk of bias tool and quality of evidence GRADE recommendations and STRICTA 2010 were used to grade the included publications.

Results: A meta-analysis on VAS pain score showed significant pain reduction, restoring CMS shoulder function, and flexion ROM in favor of acupuncture versus the control. In external rotation and abduction ROM, a meta-analysis was not significant. The most used acupoints are Jian Yu (LI15) and Jian Liao (TB14).

Conclusions: The results indicate that acupuncture could be safe and effective for pain reduction, restoring shoulder function, and restoring flexion ROM for FS patients in the short term and midterm. However, the level of evidence was very low. More high-quality and longer studies are needed in order to robust the evidence.
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http://dx.doi.org/10.1155/2020/9790470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532995PMC
September 2020

Efficacy of Acupoints Dual-Frequency Low-Level Laser Therapy on Knee Osteoarthritis.

Evid Based Complement Alternat Med 2020 24;2020:6979105. Epub 2020 Sep 24.

Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 40432, Taiwan.

Background: Knee osteoarthritis (OA) presented with knee pain and limitation of mobility is common, and it may become a chronic problem resulting in major loss of function, with related impaired activity of daily living. Current traditional therapy for knee OA includes pharmacological treatment and physiotherapy, but the efficacies are limited. An alternative noninvasive treatment low-level laser therapy (LLLT) applied to acupoints is still contradictory and the efficacy needs to be assessed.

Methods And Materials: We conduct the randomized double-blind control study to investigate the efficacy of a dual-frequency LLLT (combines red light (780 nm) and near-infrared light (830 nm)) in patients suffering knee OA. Participates were randomly assigned into active laser therapy (ALT) and placebo laser therapy (PLT) groups. Subjects in the ALT group were separately treated by laser apparatus at the three acupoints (SP9, SP10, and EX-LE2) on their knee joints under continuous radiation for 15 min at the maximum intensity, three times per week for four weeks. The PLT group used laser apparatus of the same model according to similar procedures without laser light emission. Outcome Measurements including visual analog scale (VAS), pain pressure threshold (PPT), and Lequesne index were used.

Results: A total of 30 subjects with two-sided knee OA in both groups completed the experiment. Statistically significant decreases were observed in the Lequesne index (5.27 ± 3.26 vs. 10.83 ± 3.83), conscious VAS 4 weeks after treatment (moving: 2.87 ± 1.13 vs. 5.67 ± 1.72; resting: 0.33 ± 0.62 vs. 2.67 ± 1.29), and the increase was noted in PPT (21.23 ± 1.82 kg vs. 13.02 ± 1.46 kg) in the ALT group compared with the PLT group.

Conclusion: It appears that the knee OA pain and disability can be decreased after a dual-frequency LLLT applied to acupoints (SP9, SP10, and EX-LE2). The clinical efficacy of LLLT is highly related to the therapeutic settings of the laser apparatus; hence, more clinical trials with diffident parameter settings are needed to be further clarified.
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http://dx.doi.org/10.1155/2020/6979105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532399PMC
September 2020

Deep-learning-based human motion tracking for rehabilitation applications using 3D image features.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:803-807

Motion rehabilitation is increasingly required owing to an aging population and suffering of stroke, which means human motion analysis must be valued. Based on the concept mentioned above, a deep-learning-based system is proposed to track human motion based on three-dimensional (3D) images in this work; meanwhile, the features of traditional red green blue (RGB) images, known as two-dimensional (2D) images, were used as a comparison. The results indicate that 3D images have an advantage over 2D images due to the information of spatial relationships, which implies that the proposed system can be a potential technology for human motion analysis applications.
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http://dx.doi.org/10.1109/EMBC44109.2020.9176120DOI Listing
July 2020

Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation.

J Formos Med Assoc 2021 Jan 17;120(1 Pt 1):83-92. Epub 2020 Aug 17.

Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan, Taiwan; Center of General Education, Southern Taiwan University of Science and Technology, No. 1, Nan-Tai Street, Yongkang Dist., Tainan, Taiwan. Electronic address:

The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice.
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http://dx.doi.org/10.1016/j.jfma.2020.08.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430281PMC
January 2021

A critical overview of the current myofascial pain literature - July 2020.

J Bodyw Mov Ther 2020 07 17;24(3):307-320. Epub 2020 Jul 17.

China Medical University, Taichung, Taiwan. Electronic address:

We are sad to report that following this issue, Dr. Li-Wei Chou will no longer be able to contribute to this quarterly literature overview. Unfortunately, his work responsibilities have increased to such an extent that they need to take priority. On behalf of the team, we would like to thank Dr. Chou for his thoughtful and balanced reviews during the past few years. Not only were we able to include an occasional Chinese-language study, he also was able to assist us in interpreting more complex medical studies. Li-Wei, we wish you all the best professionally and personally, and of course, we cannot wait until our paths will cross again sometime in the future! You may have noted that this overview article was missing from the January 2020 issue of the journal due to an administrative mix up. With the current issue we aimed to catch up and therefore, you will find a greater number of reviewed articles than usual. It becomes increasingly challenging to cover the wide range of the published myofascial pain and trigger point (TrP) literature just due to its volume. In this edition, we included 10 basic research articles, 4 reviews, 14 articles on dry needling (DN), acupuncture, and injections, 3 on manual therapies, and 4 on other clinical approaches.
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http://dx.doi.org/10.1016/j.jbmt.2020.07.001DOI Listing
July 2020

Therapeutic effects of acupuncture on sensory ataxia after a cerebral hemorrhage: A case report.

Medicine (Baltimore) 2020 Jul;99(29):e21124

Department of Physical Medicine and Rehabilitation, China Medical University Hospital.

Introduction: Sensory ataxia is a dysfunction of dynamic balance due to impairment of sensory input into the control of movement. The sequelae of stroke, such as hemiplegia, somatosensory impairment, and impaired balance may cause significant disability and may affect patients' quality of life. In addition to rehabilitation programs, acupuncture therapy has been applied to stroke patients and is recommended as a complementary therapy in stroke rehabilitation.

Patient Concerns: A 70-year-old male had a sudden onset of conscious loss. The brain computed tomography showed intracerebral hemorrhage with subdural hemorrhage and subarachnoid hemorrhage.

Diagnosis: Intracerebral hemorrhagic stroke was diagnosed.

Interventions: He received craniotomy with hematoma evacuation immediately and waked up 3 weeks with bilateral hemiparesis (right side weaker than left), impaired position sensation and tactile perception in the right lower limb. He then began to receive rehabilitation therapy and had significant improvement in muscle strength and static balance, but no improvement in tactile perception of position sense in the right lower limbs and reached plateau. Then he received acupuncture therapies to Yongquan (KI1), Tongtien (BL7) and Houxi (SI3).

Outcomes: The patient's walking ability recovered after receiving rehabilitation programs for 3 years, but the impairment in proprioception and dynamic balance persisted. The perception and dynamic balance had significantly improved after patient received acupuncture therapy, especially the acupuncture point of Yongquan (KI1).

Conclusion: The clinical effect of acupuncture in combination with conventional rehabilitation therapy for neurological impairment recovery, improving activity of daily living performance and improving post-stroke imbalance was explored. We hope that this report can facilitate further well controlled quantitative objective studies on a big size of samples.
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http://dx.doi.org/10.1097/MD.0000000000021124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373561PMC
July 2020

Fu's subcutaneous needling for subcutaneous adhesions and scar hyperplasia in the neck region: A case report.

Medicine (Baltimore) 2020 Jul;99(29):e21103

Department of Physical Medicine and Rehabilitation, China Medical University Hospital.

Rationale: Lymphadenectomy for tongue cancer in the neck region is often accompanied by local impaired mobility, gland damage, difficult in swallowing, and postoperative complication and seriously affects patients life quality. We reported a case of subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy for tongue lesions accompanied by impaired neck mobility and difficult in swallowing was treated using Fu's subcutaneous needling (FSN) treatment.

Patient Concerns: A 55-year-old male with tongue cancer received surgical intervention with lymphadenectomy 8 years ago was revealed a 15 cm-long curved surgical incision in the neck region and surrounded by numerous scar tissues.

Diagnosis: Post-operation subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy was diagnosed.

Interventions: FSN treatment was performed 2 to 3 times per week for 1 month to sway the affected tightened muscle and dissociate the superficial fascia beneath the scar resulted in a considerable improvement in neck movement.

Outcomes: The Vancouver Scar Scale (VSS) was as follows: color (M) - 1; vascular distribution (V) - 0, thickness (H) - 2, and flexibility (P) - 4, with a total of 7 points before FSN treatment. The VSS after 1 month of FSN treatment was as follows: M1, V0, H2, and P2, with a total of 5 points. Neck mobility in different directions, i.e., stretching to the back of the neck and laterally bending the neck to the left and/or right side, was improved (P < .05).

Lessons: At present, treatment of chronic scar hyperplasia has certain side effects and limitations. FSN is safe and convenient, with minimal destruction of the superficial fascia, having evident effects of dissociating tissue adhesion under scars and compensating for deficiencies in scar hyperplasia treatment. It can provide new ideas for future treatments.
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http://dx.doi.org/10.1097/MD.0000000000021103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373534PMC
July 2020

Development of a Computerized Device for Evaluating Vestibular Function in Locomotion: A New Evaluation Tool of Vestibular Hypofunction.

Front Neurol 2020 12;11:485. Epub 2020 Jun 12.

Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.

To evaluate vestibular function in the clinic, current assessments are applied under static conditions, such as with the subject in a sitting or supine position. Considering the complexities of daily activities, the combination of dynamic activities, dynamic visual acuity (DVA) and postural control could produce an evaluation that better reflects vestibular function in daily activities. To develop a novel sensor-based system to investigate DVA, walking trajectory, head and trunk movements and the chest-pelvis rotation ratio during forward and backward overground walking in both healthy individuals and patients with vestibular hypofunction. Fifteen healthy subjects and 7 patients with bilateral vestibular hypofunction (BVH) were recruited for this study. Inertial measurement units were placed on each subject's head and torso. Each subject walked forward and backward for 5 m twice with 2 Hz head yaw. Our experiment comprised 2 stages. In stage 1, we measured forward (FW), backward (BW), and medial-lateral (MLW) walking trajectories; head and trunk movements; and the chest-pelvis rotation ratio. In stage 2, we measured standing and locomotion DVA (loDVA). Using Mann-Whitney -test, we compared the abovementioned parameters between the 2 groups. Patients exhibited an in-phase chest/pelvis reciprocal rotation ratio only in FW. The walking trajectory deviation, calculated by normalizing the summation of medial-lateral swaying with 1/2 body height (%), was significantly larger (FW mean ± standard deviation: 20.4 ± 7.1% (median (M)/interquartile range (IQR): 19.3/14.4-25.2)in healthy vs. 43.9 ± 27. 3% (M/IQR: 36.9/21.3-56.9) in patients, = 0.020)/(BW mean ± standard deviation: 19.2 ± 11.5% (M/IQR: 13.6/10.4-25.3) in healthy vs. 29.3 ± 6.4% (M/IQR: 27.7/26.5-34.4) in patients, = 0.026), and the walking DVA was also significantly higher (LogMAR score in the patient group [FW LogMAR: rightDVA: mean ± standard deviation:0.127 ± 0.081 (M/IQR: 0.127/0.036-0.159) in healthy vs. 0.243 ± 0.101 (M/IQR: 0.247/0.143-0.337) in patients ( = 0.013) and leftDVA: 0.136 ± 0.096 (M/IQR: 0.127/0.036-0.176) in healthy vs. 0.258 ± 0.092 (M/IQR: 0.247/0.176-0.301) in patients ( = 0.016); BW LogMAR: rightDVA: mean ± standard deviation: 0.162 ± 0.097 (M/IQR: 0.159/0.097-0.273) in healthy vs. 0.281 ± 0.130 (M/IQR: 0.273/0.176-0.418) in patients( = 0.047) and leftDVA: 0.156 ± 0.101 (M/IQR: 0.159/0.097-0.198) in healthy vs. 0.298 ± 0.153 (M/IQR: 0.2730/0.159-0.484) in patients ( = 0.038)]. Our sensor-based vestibular evaluation system provided a more functionally relevant assessment for the identification of BVH patients.
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http://dx.doi.org/10.3389/fneur.2020.00485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303327PMC
June 2020

A critical overview of the current myofascial pain literature - January 2020.

J Bodyw Mov Ther 2020 04 29;24(2):213-224. Epub 2020 Apr 29.

Myopain Seminars, Bethesda, MD, USA; New Orleans Pelicans, New Orleans, LA, USA. Electronic address:

We are starting 2020 with 6 basic research studies, 9 review articles, 14 dry needling/injection studies, and one manual therapy paper for a total of 30 new papers. Topics range from studies on mechanisms, inflammatory mediators in myofascial pain, fascia, screening, Platelet-rich plasma intramuscular injections, and temporal summation to clinical studies on patients with tension-type headache, chronic pelvic pain, knee osteoarthritis, plantar fasciitis, generalized musculoskeletal pain, neck pain, breast cancer, tendinopathies, thoracic outlet syndrome, and canine dry needling, among others.
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http://dx.doi.org/10.1016/j.jbmt.2020.04.001DOI Listing
April 2020

Mechanical punctate pain threshold is associated with headache frequency and phase in patients with migraine.

Cephalalgia 2020 08 16;40(9):990-997. Epub 2020 May 16.

Brain Research Center, National Yang-Ming University, Taipei, Taiwan.

Objective: Previous studies regarding the quantitative sensory testing are inconsistent in migraine. We hypothesized that the quantitative sensory testing results were influenced by headache frequency or migraine phase.

Methods: This study recruited chronic and episodic migraine patients as well as healthy controls. Participants underwent quantitative sensory testing, including heat, cold, and mechanical punctate pain thresholds at the supraorbital area (V1 dermatome) and the forearm (T1 dermatome). Prospective headache diaries were used for headache frequency and migraine phase when quantitative sensory testing was performed.

Results: Twenty-eight chronic migraine, 64 episodic migraine and 32 healthy controls completed the study. Significant higher mechanical punctate pain thresholds were found in episodic migraine but not chronic migraine when compared with healthy controls. The mechanical punctate pain thresholds decreased as headache frequency increased then nadired. In episodic migraine, mechanical punctate pain thresholds were highest ( < 0.05) in those in the interictal phase and declined when approaching the ictal phase in both V1 and T1 dermatomes. Linear regression analyses showed that in those with episodic migraine, headache frequency and phase were independently associated with mechanical punctate pain thresholds and accounted for 29.7% and 38.9% of the variance in V1 ( = 0.003) and T1 ( < 0.001) respectively. Of note, unlike mechanical punctate pain thresholds, our study did not demonstrate similar findings for heat pain thresholds and cold pain thresholds in migraine.

Conclusion: Our study provides new insights into the dynamic changes of quantitative sensory testing, especially mechanical punctate pain thresholds in patients with migraine. Mechanical punctate pain thresholds vary depending on headache frequency and migraine phase, providing an explanation for the inconsistency across studies.
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http://dx.doi.org/10.1177/0333102420925540DOI Listing
August 2020

Comparison of Functional Movement Screen, Star Excursion Balance Test, and Physical Fitness in Junior Athletes with Different Sports Injury Risk.

Biomed Res Int 2020 25;2020:8690540. Epub 2020 Mar 25.

Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan.

Objectives: The aim of this study was to assess the relationships between functional movement screen (FMS), star excursion balance test (SEBT), agility test, and vertical jump test scores and sports injury risk in junior athletes. We compared these assessments and the differences between groups with high and low risks of sports injury. . Eleven volleyball, 12 basketball, and 9 handball athletes were recruited. All participants followed the routine training in school sports teams. Weekly training schedules followed a similar pattern. The 32 junior athletes (age = 16.06 ± 0.21 years; height = 167.28 ± 6.32 cm; and body mass = 68.45 ± 9.67 kg) were assessed using the FMS, SEBT, agility test, and vertical jump test in random order. The correlations of composite and individual item scores of these assessments were analyzed, and the differences between groups with high and low risks of sports injury were compared.

Results: All participants completed the study protocol. No significant differences were observed between FMS, SEBT, agility test, and vertical jump test scores in groups with high and low risks of sports injuries. Fair and moderate-to-good correlations were observed for anterior reach maximum of SEBT and deep squat ( = 0.47, = 0.02) as well as inline lunge ( = 0.53, = 0.01) of FMS. The hurdle step of FMS also exhibited moderate-to-good ( = 0.52, = 0.01) and fair ( = 0.42, = 0.04) correlations with posterior medial and posterior lateral reach maximum of SEBT, respectively. A fair correlation was observed between posterior lateral reach maximum of SEBT and rotary stability of FMS ( = -0.23, = 0.03). Fair and moderate-to-good correlations were identified for agility test and maximum anterior reach in the SEBT ( = -0.42, = 0.04) and trunk stability push-up in the FMS, respectively ( = -0.57 and = 0.006).

Conclusions: Junior athletes with a high risk of sports injury did not exhibit differences in terms of FMS, SEBT, and physical fitness test scores. Deep squat, hurdle step, inline lunge, and rotary stability scores in the FMS were correlated with the item scores in the SEBT, which may be due to the use of similar movement patterns. Scores for anterior reach maximum in the SEBT and trunk stability push-up in the FMS were correlated with agility test scores, suggesting a similar task requirement of trunk stability and dynamic weight shifting ability.
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http://dx.doi.org/10.1155/2020/8690540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136771PMC
January 2021

Drug Abuse Research Trend Investigation with Text Mining.

Comput Math Methods Med 2020 1;2020:1030815. Epub 2020 Feb 1.

Information System Study Program, Faculty of Science and Technology, Universitas Airlangga, Surabaya, Indonesia.

Drug abuse poses great physical and psychological harm to humans, thereby attracting scholarly attention. It often requires experience and time for a researcher, just entering this field, to find an appropriate method to study drug abuse issue. It is crucial for researchers to rapidly understand the existing research on a particular topic and be able to propose an effective new research method. Text mining analysis has been widely applied in recent years, and this study integrated the text mining method into a review of drug abuse research. Through searches for keywords related to the drug abuse, all related publications were identified and downloaded from PubMed. After removing the duplicate and incomplete literature, the retained data were imported for analysis through text mining. A total of 19,843 papers were analyzed, and the text mining technique was used to search for keyword and questionnaire types. The results showed the associations between these questionnaires, with the top five being the Addiction Severity Index (16.44%), the Quality of Life survey (5.01%), the Beck Depression Inventory (3.24%), the Addiction Research Center Inventory (2.81%), and the Profile of Mood States (1.10%). Specifically, the Addiction Severity Index was most commonly used in combination with Quality of Life scales. In conclusion, association analysis is useful to extract core knowledge. Researchers can learn and visualize the latest research trend.
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http://dx.doi.org/10.1155/2020/1030815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016473PMC
January 2021

Biomechanical Evaluation and Strength Test of 3D-Printed Foot Orthoses.

Appl Bionics Biomech 2019 7;2019:4989534. Epub 2019 Dec 7.

Department of Rehabilitation Medicine, Taipei City Hospital, Taipei, Taiwan.

Foot orthoses (FOs) are commonly used as interventions for individuals with flatfoot. Advances in technologies such as three-dimensional (3D) scanning and 3D printing have facilitated the fabrication of custom FOs. However, few studies have been conducted on the mechanical properties and biomechanical effects of 3D-printed FOs. The purposes of this study were to evaluate the mechanical properties of 3D-printed FOs and determine their biomechanical effects in individuals with flexible flatfoot. During mechanical testing, a total of 18 FO samples with three orientations (0°, 45°, and 90°) were fabricated and tested. The maximum compressive load and stiffness were calculated. During a motion capture experiment, 12 individuals with flatfoot were enrolled, and the 3D-printed FOs were used as interventions. Kinematic and kinetic data were collected during walking by using an optical motion capture system. A one-way analysis of variance was performed to compare the mechanical parameters among the three build orientations. A paired -test was conducted to compare the biomechanical variables under two conditions: walking in standard shoes (Shoe) and walking in shoes embedded with FOs (Shoe+FO). The results indicated that the 45° build orientation produced the strongest FOs. In addition, the maximum ankle evertor and external rotator moments under the Shoe+FO condition were significantly reduced by 35% and 16%, respectively, but the maximum ankle plantar flexor moments increased by 3%, compared with the Shoe condition. No significant difference in ground reaction force was observed between the two conditions. This study demonstrated that 3D-printed FOs could alter the ankle joint moments during gait.
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http://dx.doi.org/10.1155/2019/4989534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925755PMC
December 2019

Myofascial pain and treatment: Editorial a critical overview of the current myofascial pain literature - August 2019.

J Bodyw Mov Ther 2019 10 4;23(4):773-784. Epub 2019 Oct 4.

Myopain Seminars, Bethesda, MD, USA; Charleston Southern University, North Charleston, SC, USA. Electronic address:

This quarter's overview of the myofascial pain literature includes quite a few basic research papers in addition to the usual high quantity of dry needling (DN) papers. Of particular interest are a study by Fischer and colleagues studying the role of mitochondrial functions in chronic trigger points (TrPs) (Fischer et al 2018), a study by Li and associates who conducted a quantitative proteomics analysis to identify biomarkers of chronic myofascial pain and therapeutic targets of dry needling in a rat model of TrPs (Li et al 2019), and a sonography study by Mitchell et al. looking into the distances from the skin to the pleura in the context of DN (Mitchell et al 2019). A total of 33 papers are included in this overview article. We welcome Dr. Jacob Thorp to our team of authors. Dr. Thorp is a US-based physical therapist. He is Professor and Founding Director of the Physical Therapy Program at Charleston Southern University in North Charleston, SC.
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http://dx.doi.org/10.1016/j.jbmt.2019.10.001DOI Listing
October 2019

Characteristics of Traditional Chinese Medicine Use for Carpal Tunnel Syndrome.

Int J Environ Res Public Health 2019 10 24;16(21). Epub 2019 Oct 24.

Department of Sport and Health Management, Da-Yeh University, Changhua 51591, Taiwan.

Carpal tunnel syndrome (CTS) is a common musculoskeletal disorder and an occupational disease caused by repeated exercise or overuse of the hand. We investigated the characteristics of traditional Chinese medicine (TCM) use by practitioners in CTS patients, including demographic variables, socioeconomic status, previous medical conditions, health care use, and hospital characteristics for TCM health care. This cross-sectional study identified 25,965 patients newly diagnosed with CTS based on the first medical diagnosis recorded between 1999 and 2013 in the nationwide representative insurance database of Taiwan. The date of initial CTS diagnosis in outpatient data was defined as the index date, and four patients were excluded because of missing gender-related information. Patients who used TCM care as the first option at their diagnosis were classified as TCM users ( = 677; 2.61%), and all others were TCM non-users ( = 25,288; 97.4%). In the all variables-adjusted model, female patients had an adjusted odds ratio (OR; 95% CI) of TCM use of 1.35 (1.11-1.66). National Health Insurance (NHI) registration was associated with higher odds ratios of TCM use in central, southern, and eastern Taiwan than in northern Taiwan (ORs = 1.43, 1.86, and 1.82, respectively). NHI registration was associated with higher odds ratios of TCM use in rural cities than in urban cities (OR (95% CI) = 1.33 (1.02-1.72)). The TCM group had a 20% less likelihood of exhibiting symptoms, signs, and ill-defined conditions and injury and poisoning. The TCM group had a 56% lower likelihood of having diseases of the musculoskeletal system and connective tissue. Multi-level model outcomes were similar to the results of the all variables-adjusted model, except for the NHI registration outcome in rural and urban cities (OR [95% CI] = 1.33 [0.98-1.81]). Significant associations between the number of TCM visits and TCM use were observed in all logistic regression models. The study presented key demographic characteristics, health care use, and medical conditions associated with TCM use for CTS. Previous experience of TCM use may affect the use of TCM for CTS treatment. This information provides a reference for the allocations of relevant medical resources and health care providers.
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http://dx.doi.org/10.3390/ijerph16214086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862695PMC
October 2019

Myofascial pain and treatment: Editorial.

J Bodyw Mov Ther 2019 07 14;23(3):521-531. Epub 2019 Jun 14.

Myopain Seminars, Bethesda, MD, USA; ProMove PT Pain Specialists, Bethesda, MD, USA. Electronic address:

The first article featured in this quarter's overview deserves special attention. Margalef and colleagues developed the first viable animal model of trigger points (TrPs). They also provided evidence of glycosaminoglycans (GAGs) near TrPs, which is a new finding that deserves further scientific inquiry (Margalef et al 2019). In 2011, Stecco et al. already mentioned a possible role of hyaluronan, which constitutes a subgroup of GAGs, in the etiology of myofascial pain (Stecco et al 2011). Mayoral Del Moral and colleagues published an excellent study that showed very good inter-examiner reliability for identifying subjects with MPS for identifying specific muscles (Mayoral Del Moral et al 2018). Sollmann and colleagues described a new and objective method to identify TrPs, using T2 mapping with quantitative MRI-based techniques (Sollmann et al 2016). As usual, many new dry needling (DN) studies, reviews, manual TrP papers and case reports are included. Finally, we would like to thank Dr. Michelle Finnegan for her contributions to this overview paper during the past 5 years. Dr. Finnegan will be focusing on other professional endeavors and she will not return as a contributing author.
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http://dx.doi.org/10.1016/j.jbmt.2019.06.009DOI Listing
July 2019

Acupuncture and related interventions for carpal tunnel syndrome: systematic review.

Clin Rehabil 2020 Jan 26;34(1):34-44. Epub 2019 Sep 26.

Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.

Objective: To synthesize evidence on the effectiveness of acupuncture and related therapies for primary carpal tunnel syndrome (CTS) by conducting a systematic review of randomized controlled trials (RCTs).

Data Sources: Nine databases were searched for potential RCTs from their inception till July 2019.

Review Methods: RCTs which reported at least one of the three outcomes were included: symptom severity, functional status and pain. Included RCTs were appraised using the Cochrane Risk of Bias Tool.

Results: A total of 10 RCTs (728 participants) were included. Majority were at high risk of bias for blinding of participants, personnel and outcome assessors. When compared to conventional medications, manual acupuncture showed significant superior effect in reducing symptom than ibuprofen (mean difference (MD) on Symptom Severity Scale (SSS)) = -5.80, 95% confidence interval (CI): -7.95 to -3.65) and prednisolone (MD = -6.50, 95% CI: -10.1, -2.86). Electroacupuncture plus splinting was more effective in reducing symptom severity than splinting alone (SSS score: MD = -0.20, 95% CI: -0.36 to -0.03). Manual acupuncture showed significantly superior effect than ibuprofen in improving functional status (Functional Status Scale (FSS): MD = -1.84, 95% CI: -2.66 to -1.02). The combination of electroacupuncture and splinting showed more improvement in functional status compared to splinting alone (FSS: MD = -6.22, 95%CI: -10.7 to -1.71). Triple treatment of acupuncture, magnetic spectrum heat lamp and splinting showed stronger pain relief than splinting alone.

Conclusion: For both symptom relief and function improvement, manual acupuncture is superior to ibuprofen while electroacupuncture plus splinting outperforms splinting alone. Limited evidence showed electroacupuncture's potential role in pain reduction.
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http://dx.doi.org/10.1177/0269215519877511DOI Listing
January 2020

A critical overview of the current myofascial pain literature - February 2019.

J Bodyw Mov Ther 2019 04 23;23(2):295-305. Epub 2019 Feb 23.

Myopain Seminars, Bethesda, MD, USA; New Orleans Pelicans, New Orleans, LA, USA. Electronic address:

This edition of the overview of current myofascial pain literature features several interesting and important publications. From Australia, Braithwaite and colleagues completed an outstanding systematic review of blinding procedures used in dry needling (DN) studies. Other papers tackled the interrater reliability of the identification of trigger points (TrP), the presence of muscle hardness related to latent TrPs, pelvic floor examination techniques, and the links between TrPs, headaches and shoulder pain. Israeli researchers developed a theoretical model challenging the contributions of the Cinderella Hypothesis to the development of TrPs. As in almost all issues, we included many DN, injection and acupuncture studies, which continue to be the focus of researchers all over the world.
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http://dx.doi.org/10.1016/j.jbmt.2019.02.017DOI Listing
April 2019

A biomechanical approach to investigate swing characteristics in elite golfers.

J Chin Med Assoc 2019 Jul;82(7):589-594

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC.

Background: The current study aims to compare the variability of positional control of the club in the starting period of downswing and the orientation of the clubface during impact in elite and intermediate golfers.

Methods: Seven elite and 13 intermediate golfers were recorded by an eight-camera VICON motion capture system while putting with a pitch club. Six retro-reflective markers were attached to the club to build a biomechanical model for analyzing swinging movements. Group comparisons of outcome variables regarding the turning point, sweet spot, elevation angle (EA), and azimuth angle (AA) of the club head were made between the elite and intermediate players.

Results: There were significant differences between groups in SDs of the location of the club tail along the x, y, and z axes at the turning point (x, p = 0.004; y, p = 0.015; and z, p = 0.035); the minimum distance between the center of the sweet spot and the ball at impact (p = 0.007); the EA (p = 0.001); and the AA (p = 0.001) of the club head. Results showed that the elite players displayed more converged locations of turning points, shorter distances between the center of the sweet spot and the ball at impact, greater EAs, and smaller AAs compared with those of the intermediate players.

Conclusion: These findings proposed a biomechanical approach of a practical way to observe swing behaviors. These findings suggest that the stability of locations of turning points is a golden reference for differentiating levels of golfers' performance.
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http://dx.doi.org/10.1097/JCMA.0000000000000121DOI Listing
July 2019

H-reflex in abductor hallucis and postural performance between flexible flatfoot and normal foot.

Phys Ther Sport 2019 May 19;37:27-33. Epub 2019 Feb 19.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3, No.17, Xuzhou Rd., Zhongzheng District, Taipei City, 100, Taiwan, ROC; Department of Physical Education, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205, Taiwan, ROC. Electronic address:

Objective: Morphological changes of the abductor hallucis muscle (AbH) in flexible flatfoot (FF) individuals influence regulations of the medial longitudinal arch (MLA). Prolonged and repeated stretching of AbH in flexible flatfoot may cause changes in muscle reflex properties and further influence postural performance. However, AbH muscle reflex under different postural conditions have never been examined. The purpose of this study was to investigate differences in AbH H-reflex and postural performance between individuals with normal foot (NF) alignment and FF under prone, double-leg stance (DLS), and single-leg stance (SLS) conditions.

Design: Cross-sectional study.

Setting: University laboratory.

Participants: Individuals with FF (n = 12) and NF (n = 12).

Main Outcome Measures: AbH H-reflex, AbH EMG and center of pressure (CoP) displacement.

Results: Under all postural conditions, AbH H-reflex was significantly lower in the FF group (P < .05). Under the SLS condition, AbH EMG was significantly higher in the FF group (P < .05), and CoP displacement for the medial-lateral and anterior-posterior directions were significantly higher in the FF group (P < .05).

Conclusions: With increased postural demand, FF individuals maintained their postural stability by recruiting greater AbH activities than through automatic stretch reflex, but FF individuals still showed inferior posture stability.
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http://dx.doi.org/10.1016/j.ptsp.2019.02.004DOI Listing
May 2019

A critical overview of the current myofascial pain literature - November 2018.

J Bodyw Mov Ther 2019 01 15;23(1):65-73. Epub 2018 Nov 15.

Myopain Seminars, Bethesda, MD, USA; ProMove PT Pain Specialists, Bethesda, MD, USA. Electronic address:

This is the first issue of this review column since the passing of Dr. Leon Chaitow. We would like to take a brief moment to acknowledge how much his mentorship, friendship, and confidence have meant to us. Leon was a force in osteopathic and naturopathic medicine and his influence reaches to all corners of the musculoskeletal realm crossing over many disciplines through his lectures, workshops, and of course, his many books, editorials, and articles. In the foreword to one of his books, Jan Dommerholt wrote that "Leon Chaitow […] continued the work of Travell and Simons, but also of many others, whose contributions he has skillfully woven into an intricate tapestry of clinical pearls, practical tips, and solid evidence-informed research." Dr. Chaitow was a synthesizer, who always considered what different clinicians and researchers could possibly contribute to a better understanding of pain and dysfunction and provide real solutions to real problems. Even when he would not necessarily agree with all suggested remedies, he maintained an open mind and was able to take a step back and consider the bigger picture. For example, Leon was not a big fan of dry needling, yet, he valued the importance of this approach and encouraged the inclusion of dry needling papers in this review article and in his journal. The Journal of Bodywork and Movement Therapies became his baby and, considering the growth of the journal, there is no question that Leon's intense focus and efforts are appreciated by many around the globe. We wish to extend our condolences to Leon's wife Alkmini and daughter Sasha. He will surely be missed, but we can find peace in knowing that his legacy will stay with us forever. In this issue, we have included several basic myofascial pain research articles. As usual, dry needling (DN) studies and case reports are the most commonly referenced papers, but we also included neuroscience and electromyography studies, sleep studies, interrater reliability studies, and case reports of adverse events.
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http://dx.doi.org/10.1016/j.jbmt.2018.11.002DOI Listing
January 2019

Association of Depression and Cervical Spondylosis: A Nationwide Retrospective Propensity Score-Matched Cohort Study.

J Clin Med 2018 Oct 25;7(11). Epub 2018 Oct 25.

Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung 404, Taiwan.

: Depression is a psychiatric disorder associated with poorer health outcomes. Inappropriate mechanical stress and aging are factors associated with developing cervical spondylosis. The connection between cervical spondylosis and depression is not developed. : From the health insurance claims data of Taiwan, we identified 34,166 persons newly diagnosed with depression in 2000⁻2010 and 34,166 persons without the disorder frequency matched by sex, age and diagnosis year. Both cohorts were followed up to the end of 2013 to estimate incident cervical spondylosis. We further examined the risk of cervical spondylosis in depressed people taking antidepressants. : The incidence of cervical spondylosis was 1.8-fold greater in the depression cohort than in comparison cohort (9.46 vs. 5.36 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.79 (95% confidence interval (CI) = 1.66⁻1.92). The incidence of cervical spondylosis increased in patients who had taken medications of serotonin-specific reuptake inhibitors (SSRIs) or of non-SSRIs than in those without these medicines (9.13 or 11.5 vs. 6.54 per 1000 person-years, respectively). : Patients with depression are at an increased risk of developing cervical spondylosis. Additional efforts in reducing the risk of cervical spondylosis might be required in depressed individuals undergoing anti-depressive therapy.
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http://dx.doi.org/10.3390/jcm7110387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262285PMC
October 2018

Dual-frequency whole body vibration enhances vertical jumping and change-of-direction ability in rugby players.

J Sport Health Sci 2017 Sep 24;6(3):346-351. Epub 2015 Dec 24.

Graduate Institute of Sports Equipment Technology, University of Taipei, Taipei 111, Taiwan, China.

Background: Traditional vertical and side-alternating whole body vibrations (WBV) can effectively improve muscle power performance but have a limited efficacy for enhancing change-of-direction (COD) ability. Novel dual-plate WBV uniquely providing various directions of movements with higher and distinctive frequencies for each leg may cause better acute effect on muscle power and stretch-shortening cycle efficacy contributing to COD ability. Therefore, the purpose of this study was to investigate the acute effect of dual- or single-frequency WBV on squat jumps (SJs), countermovement jumps (CMJs), eccentric utilization ratios (EURs), and COD ability in rugby players.

Methods: Fourteen male rugby players were recruited and performed a 4 min partial squat with 3 types of WBV protocols on a dual-plate WBV machine, including 1 dual-frequency WBV protocol (DFW) with the dominant leg receiving 35 Hz and the non-dominant leg receiving 45 Hz, and 2 single-frequency WBV protocols (SFWs) with 35 Hz or 45 Hz provided to both legs (SFW35Hz and SFW45Hz) on 3 different days.

Results: The results showed that all the vibration protocols significantly improved SJ and CMJ performances (SJ:  = 0.008; CMJ:  < 0.001), but did not significantly change EURs ( > 0.05). In addition, only the DFW significantly improved COD ability ( = 0.001 for the pre-post comparison).

Conclusion: A 4 min dual-frequency WBV session improved both vertical jumping and COD ability in rugby players, suggesting that this could be a potential warm-up protocol for athletes.
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http://dx.doi.org/10.1016/j.jshs.2015.12.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189261PMC
September 2017

A critical overview of the current myofascial pain literature - July 2018.

J Bodyw Mov Ther 2018 07 27;22(3):673-684. Epub 2018 Jun 27.

China Medical University, Taichung, Taiwan. Electronic address:

In the current issue of this clinical overview, we are pleased to include several basic research studies ranging from the differentiation of radicular and non-radicular low back pain based on the presence of trigger points (TrPs) to the role of TrPs in patients with osteoarthritis, the diagnostic criteria of TrP, the accurate placement of needles in the piriformis muscle with dry needling (DN), and the reliability of TrP identification, among others. As usual, there are many new DN studies, but also several review papers, and manual TrP research. Contributing authors come from as many as 15 different countries!
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http://dx.doi.org/10.1016/j.jbmt.2018.06.005DOI Listing
July 2018

Impact of putamen stroke on task context updating: Evidence from P300 brain waves.

J Clin Neurosci 2018 Sep 1;55:45-51. Epub 2018 Aug 1.

Department of Psychology, Chung Shan Medical University, Taiwan; Clinical Psychological Room, Chung Shan Medical University Hospital, Taiwan. Electronic address:

According to the context updating theory, the oddball P300 component indexes brain activities underlying revision of the mental representation induced by incoming stimuli. It involves an attention-driven comparison process that evaluates the representation of the previous event in working memory. Delayed latencies have been reported for various types of stroke such as unilateral thalamic stroke. We investigated memory updating effects in patients with putamen stroke. Two groups of patients with putamen and thalamic stroke were recruited along with two control groups of young and old healthy participants. Auditory and visual P300 were elicited respectively in a two-stimulus oddball paradigm. The auditory P300 peak latencies were significantly longer in patients with a putamen lesion than in the aged and young control groups and the same pattern was found in the thalamus-lesioned patient. The delayed auditory P300 component in both patient groups but neither control group suggests impairment of memory updating in patients with putamen stroke comparable with thalamic stroke. Our study illustrates the important role of subcortical structures subserved in context updating.
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http://dx.doi.org/10.1016/j.jocn.2018.07.004DOI Listing
September 2018

Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke.

Sci Rep 2018 06 15;8(1):9217. Epub 2018 Jun 15.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.

The peripheral sensory system is critical to regulating motor plasticity and motor recovery. Peripheral electrical stimulation (ES) can generate constant and adequate sensory input to influence the excitability of the motor cortex. The aim of this proof of concept study was to assess whether ES prior to each hand function training session for eight weeks can better improve neuromuscular control and hand function in chronic stroke individuals and change electroencephalography-electromyography (EEG-EMG) coherence, as compared to the control (sham ES). We recruited twelve subjects and randomly assigned them into ES and control groups. Both groups received 20-minute hand function training twice a week, and the ES group received 40-minute ES on the median nerve of the affected side before each training session. The control group received sham ES. EEG, EMG and Fugl-Meyer Assessment (FMA) were collected at four different time points. The corticomuscular coherence (CMC) in the ES group at fourth weeks was significantly higher (p = 0.004) as compared to the control group. The notable increment of FMA at eight weeks and follow-up was found only in the ES group. The eight-week rehabilitation program that implemented peripheral ES sessions prior to function training has a potential to improve neuromuscular control and hand function in chronic stroke individuals.
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http://dx.doi.org/10.1038/s41598-018-27553-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003966PMC
June 2018