Publications by authors named "Myoung-Hwan Ko"

80 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

Home-Based Intermittent Pneumatic Compression Therapy: The Impact in Chronic Leg Lymphedema in Patients Treated for Gynecologic Cancer.

Healthcare (Basel) 2022 Mar 28;10(4). Epub 2022 Mar 28.

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea.

We conducted a prospective study of cancer patients to investigate the efficacy, quality of life, satisfaction, and safety of a home-based intermittent pneumatic compression (IPC) device during the maintenance phase of lower extremity lymphedema. This device has a unique mode designed to mimic the manual lymphatic drainage (MLD) technique and thereby gently facilitate lymphatic draining of proximal extremities. Thirty patients with stage 3 chronic secondary unilateral leg lymphedema in the maintenance phase underwent IPC and conventional compression therapy for 4 weeks at home. The participants were guided to use 1 h course (30 min of MLD-mimicking mode and 30 min of conventional mode) of IPC device twice a day for 4 weeks. We assessed the patients' limb-volume measurement, quality of life (QOL), and satisfaction four times. There were no significant time-dependent interactions in the inter-limb volume difference ratio (V). In a subgroup analysis, participants who used the home-based IPC device and maintained their routine self-maintenance program of short-stretch bandages (group B, = 21) showed a more significant decline in V than those who did not maintained their routine care (group A, = 9). All scores of QOL decreased significantly after the intervention without subgroup difference. All participants were satisfied with the 4-week intervention. This study demonstrated that a home-based IPC device with an MLD-mimicking program is a useful option for maintaining the volume of limbs and improving the QOL of patients with stage 3 chronic leg lymphedema during the maintenance phase.
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http://dx.doi.org/10.3390/healthcare10040638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032801PMC
March 2022

Effects of Personal Low-Frequency Stimulation Device on Myalgia: A Randomized Controlled Trial.

Int J Environ Res Public Health 2022 01 10;19(2). Epub 2022 Jan 10.

Department of Physical Education, Sungkyul University, 53, Seonggyeoldaehak-ro, Manan-gu, Anyang-si 14097, Korea.

Electrotherapy is commonly used for myalgia alleviation. Low-frequency stimulation (LFS) is primarily used for controlling acute and chronic pain and is a non-invasive therapy that can be easily performed with electric stimulation applied on the skin. However, little evidence exists regarding the pain alleviation effects of personal low-frequency stimulation device for home use. Moreover, no studies have compared myalgia alleviation effects between personal low-frequency stimulation (PLS) and physical therapy (PT), which are most commonly used for patients with myalgia in hospitals and clinics. Therefore, we aimed to investigate the pain alleviation effects of PLS in patients with myalgia and compare these effects with those of conventional PT (transcutaneous electrical nerve stimulation + ultrasound). In total, 39 patients with myalgia in the neck, shoulder, back, and waist areas were randomly assigned to the personal low-frequency stimulation group (PLSG: = 20) and physical therapy group (PTG: = 19). Both groups were treated for 3 weeks (20 min per session and 5 sessions per week). Patients were assessed for pain intensity by surface electromyography (sEMG), visual analogue scale (VAS) and a short-form McGill pain questionnaire (SF-MPQ) before and after the intervention period. Our results showed that PLSG showed a tendency of muscle relaxation with a significant decrease in sEMG in the neck ( = 0.0425), shoulder ( = 0.0425), and back ( = 0.0046) areas compared to the control group. However, there was no significant difference in waist area. Additionally, VAS scores significantly decreased between pre- and post-treatment in both PTG ( = 0.0098), and PLSG ( = 0.0304) groups, but there was no significance difference between the groups. With respect to SF-MPQ, the PLSG showed greater pain alleviation (5.23 ± 0.25) effects than the PTG (6.23 ± 0.25). Accordingly, our results suggest that PLS treatment using a home device might offer positive assistance in pain alleviation for patients with myalgia that is as equally effective as conventional PT treatment. However, further detailed studies are required considering larger samples to fully claim the effectiveness of this device.
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http://dx.doi.org/10.3390/ijerph19020735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775751PMC
January 2022

Efficacy of Electromechanically-Assisted Rehabilitation of Upper Limb Function in Post-Stroke Patients: A Randomized Controlled Study.

J Rehabil Med Clin Commun 2021 24;4:1000074. Epub 2021 Nov 24.

Department of Rehabilitation Medicine, Graduate School of Dongguk University, Seoul, Republic of Korea.

Objective: To investigate the efficacy of electromechanically-assisted rehabilitation of upper limb function in post-stroke patients.

Design: Randomized controlled trial.

Subjects: Forty-eight stroke patients.

Methods: Patients were randomly assigned to control and experimental groups. The control group underwent occupational therapy training with conventional methods. The experimental group underwent electromechanically-assisted training using an end effector robot (Camillo®). Interventions were provided for 30 min per day, 5 days a week, for 4 weeks. Primary outcome was change in Fugl-Meyer Assessment (FMA) before and after training. Secondary outcomes were changes in hand function, upper limb strength, spasticity, mental status and quality of life.

Results: Mean improvement in FMA was 1.17 (standard deviation (SD) 4.18) in the control group and 2.52 (SD 5.48) in the experimental group. Although FMA in the experimental group improved significantly after training, the improvement in FMA did not differ significantly between groups. Among the secondary outcomes, the Motricity Index (MI) improved significantly after training in the experimental group, and the change in MI between groups was statistically significant.

Conclusion: Electromechanically-assisted rehabilitation using Camillo® was not more effective than conventional occupation therapy for upper arm function.
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http://dx.doi.org/10.2340/20030711-1000074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628063PMC
November 2021

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

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

Intermittent pneumatic compression for prolonged standing workers with leg edema and pain.

Medicine (Baltimore) 2021 Jul;100(28):e26639

Department of Physical Medicine and Rehabilitation, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.

Abstract: Even healthy individuals often encounter leg venous symptoms such as heaviness, pain, and swelling especially after prolonged standing work. Intermittent pneumatic compression (IPC) is a widely used simple therapy for preventing deep vein thrombosis and for treating lymphedema and chronic venous insufficiency. However, IPC has not been evaluated for its effect in relieving venous symptoms of healthy people.This was single center, cross-over study to investigate the effect of IPC for 20 healthy volunteers who usually stand on duty and complain of leg pain and swelling. The primary outcome was pain (measured using a visual analogue scale) and secondary outcomes were leg circumference and volume. Three different interventions included natural rest, sequential mode of IPC, and circular mode of IPC. Outcomes were measured before work and immediately after work (T1), after 30 minutes of intervention (T2), and 30 minutes of rest after intervention (T3).Pain and leg circumferences were significantly improved at T2 and T3 compared with those at T1. Sequential and circular IPC led to significantly greater improvement in pain and leg circumferences than just natural rest, but there was no difference in its effect according to the 2 modes of IPC. Leg volume was reduced significantly at T2 and T3 as compared with T1 in all 3 interventions, but effects did not differ among 3 intervention groups.IPC is effective for reducing leg pain and circumferences more than natural rest in healthy adults with prolonged standing work, without causing adverse events.
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http://dx.doi.org/10.1097/MD.0000000000026639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284752PMC
July 2021

The Effect of Convergence Gamification Training in Community-Dwelling Older People: A Multicenter, Randomized Controlled Trial.

J Am Med Dir Assoc 2022 03 30;23(3):373-378.e3. Epub 2021 Jun 30.

Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea.

Objectives: It is necessary to improve the health of older adults through exercise, but there is no concrete way to implement it or an environment in which they can exercise continuously. Our objective was to confirm the safety and efficacy of information technology (IT) convergence gamification exercise equipment for older adults. We tried to demonstrate equivalence to conventional exercise by comparing the functional improvement.

Design: Randomized controlled trial, with 8-week-long IT convergence exercises 3 times a week vs conventional exercise.

Setting And Participants: 40 community-dwelling participants aged 60-85 years.

Method: Participants were randomly divided into a conventional exercise group (group 1) and an IT convergence exercise group (group 2). Both groups were trained for 8 weeks, and functional assessment was performed before training (pre-evaluation), after training, and after 4 weeks of rest.

Results: There were functional improvements in both groups. A comparison of the differences in the functional assessment between pre-evaluation and after 8 weeks of training yielded the following results. In group 1, the mean Five Times Sit to Stand Test-30 seconds was scored as 3.60 ± 2.56 (P < .015); Five Times Sit to Stand Test-5 times, -1.75 ± 2.04 s (P < .015); Berg Balance Scale, 1.05 ± 1.39 (P < .015); Timed Up-and-Go test, -0.64 ± 0.64 s (P < .015); and 10-m Walking Test, -0.35 ± 0.47 s (P < .015). And in group 2, the mean Five Times Sit to Stand Test-30 seconds (s) was scored as 3.70 ± 2.62 (P < .015), Five Times Sit to Stand Test-5 times, -1.65 ± 1.59 s (P < .015); Berg Balance Scale, 1.05 ± 1.00 (P < .015); Timed Up-and-Go test, -0.93 ± 0.68 s (P < .015); 10-m Walking Test, -0.41 ± 0.489 s (P < .015); Chair Sit and Reach test, 2.23 ± 3.19 cm (P < .015); and Korean version of the Falls Efficacy Scale-International, -1.05 ± 1.43 (P < .015).

Conclusion And Implications: The results of this study suggest that the IT convergence gamification exercise equipment such as balpro110 has exercise effects similar to conventional exercise and also has advantages as an alternative to exercise for older adults in the next generation.
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http://dx.doi.org/10.1016/j.jamda.2021.05.041DOI Listing
March 2022

Cerebrolysin Combined with Rehabilitation Enhances Motor Recovery and Prevents Neural Network Degeneration in Ischemic Stroke Patients with Severe Motor Deficits.

J Pers Med 2021 Jun 11;11(6). Epub 2021 Jun 11.

Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

The objective of this study was to evaluate whether Cerebrolysin combined with rehabilitation therapy supports additional motor recovery in stroke patients with severe motor impairment. This study analyzed the combined data from the two phase IV prospective, multicenter, randomized, double-blind, placebo-controlled trials. Stroke patients were included within seven days after stroke onset and were randomized to receive a 21-day treatment course of either Cerebrolysin or placebo with standardized rehabilitation therapy. Assessments were performed at baseline, immediately after the treatment course, and 90 days after stroke onset. The plasticity of the motor system was assessed by diffusion tensor imaging and resting state fMRI. In total, 110 stroke patients were included for the full analysis set (Cerebrolysin = 59, placebo = 51). Both groups showed significant motor recovery over time. Repeated-measures analysis of varianceshowed a significant interaction between time and type of intervention as measured by the Fugl-Meyer Assessment ( < 0.05). The Cerebrolysin group demonstrated less degenerative changes in the major motor-related white matter tracts over time than the placebo group. In conclusion, Cerebrolysin treatment as an add-on to a rehabilitation program is a promising pharmacologic approach that is worth considering in order to enhance motor recovery in ischemic stroke patients with severe motor impairment.
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http://dx.doi.org/10.3390/jpm11060545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231166PMC
June 2021

Effects of ICT-Based Multicomponent Program on Body Composition and Cognitive Function in Older Adults: A Randomized Controlled Clinical Study.

Clin Interv Aging 2021 21;16:1161-1171. Epub 2021 Jun 21.

Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Purpose: Information and communication technology (ICT)-based training devices for older adults' care related to dementia are being developed to enhance older adults' cognitive functions. Older adults who require bicycle training devices can improve muscle strength and balance of lower limbs by continuously contracting and relaxing lower-limb muscles and improving cognitive function to prevent dementia. This study was conducted to investigate the effects of an ICT-based multicomponent program on body composition and cognitive function in older adults.

Patients And Methods: In a randomized controlled intervention test on 20 people over the age of 60 (exercise group: n = 10; control: n = 10), the multicomponent program was applied to the exercise group twice per week, once per day for 12 weeks, at 30 min per session, whereas the control group was advised to maintain their usual daily activities.

Results: Comparing body composition changes and cognitive function changes before and after intervention exhibited statistically significant differences in skeletal muscle mass (=0.01) and modified Alzheimer's disease assessment scale-cognitive score (=0.01) between the two groups.

Conclusion: It can be difficult to be engaged in a simple repetitive exercise program. Therefore, to meet older adults' interests and expectations, a customized ICT-based multicomponent program, which can improve body composition and cognitive function in older adults and is believed to help prevent dementia, is recommended.

Trial Registration: UMIN000042129 (https://www.umin.ac.jp/english/).
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http://dx.doi.org/10.2147/CIA.S306894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232840PMC
July 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

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

Therapeutic efficacy of repetitive transcranial magnetic stimulation in an animal model of Alzheimer's disease.

Sci Rep 2021 01 11;11(1):437. Epub 2021 Jan 11.

Rehabilitation and Regeneration Research Center, CHA University, Seongnam, Republic of Korea.

Previous studies on repetitive transcranial magnetic stimulation (rTMS) suggested potential neurorestorative properties in Alzheimer's disease (AD). This study aimed to investigate therapeutic effects of rTMS on an AD mouse model at high and low frequencies. The subject mice were allocated into the AD model group (AD induced by intracerebroventricular amyloid beta 42 oligomer [Aβ42] injection) and the saline-injected control group. Each group was subdivided according to rTMS treatment: high frequency (20 Hz), low frequency (1 Hz), and not rTMS-treated. Behavioural assessments with Y-maze test and novel object recognition task were performed; the results indicated cognition recovery by both the frequencies of rTMS after treatment in the AD model (Ps < 0.01). Tendency of further effects by high frequency compared to low frequency rTMS was also shown in Y-maze test. Neurotransmitter assay showed increment in dopamine concentration and upregulation of dopamine-receptor 4 (DR4) by rTMS in AD mice with higher response by high frequency stimulation (Ps < 0.05). Only high-frequency rTMS induced an elevation of brain-derived neurotrophic factor (BDNF) levels and enhanced the expression of Nestin and NeuN in the brain tissue (Ps < 0.05). Under in vitro conditions, Aβ42 incubated mouse hippocampal cell showed an increase in dopamine levels and BDNF by application of high-frequency rTMS treatment. In conclusion, rTMS might have a potential therapeutic effect on AD, and it seems to be related with dopaminergic activation. High frequency of stimulation seems to induce higher efficacy than that induced by low frequency, with elevated expressions of DR4 gene and neurogenic proteins.
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http://dx.doi.org/10.1038/s41598-020-80147-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801521PMC
January 2021

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

Minimal weight loss related to a short fasting period causes superior mesenteric artery syndrome in a patient with amyotrophic lateral sclerosis: A case report.

Medicine (Baltimore) 2020 Jul;99(27):e20571

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

Introduction: Superior mesenteric artery syndrome (SMAS) is rare cause of small bowel obstruction and is characterized by an extrinsic vascular compression of the duodenum. The most common cause of SMAS is known as rapid and significant weight loss.

Patient Concerns: A 61-year-old man who was diagnosed with amyotrophic lateral sclerosis and maintained a stable diet before admission. When the patient re-started feeding by gastrostomy tube after 5 days of therapeutic fasting due to gastric ulcer caused by gastrostomy tube irritation, he presented postprandial vomiting, abdominal distention, and tachycardia. Since fasting, his weight has been reduced by about 3 kg.

Diagnosis: Based on clinical symptoms and radiological findings, diagnose of SMAS was finally made. Abdomen computed tomography confirmed decreased aortomesenteric distance and tubography confirmed gastric and proximal duodenum distension above the compressed part.

Interventions: We performed jejunal tube insertion and the amount of feeding through the jejunal tube was gradually increased while maintaining parenteral nutrition.

Outcomes: The presenting symptoms of the patient gradually improved. Follow-up abdomen computed tomography and tubography showed improvement in duodenal narrowing and stomach distension.

Conclusion: SMAS should be considered when there is an abrupt observation of symptom of gastrointestinal obstruction in patients with predisposing condition such as a low body weight, even if the weight loss is relatively small.
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http://dx.doi.org/10.1097/MD.0000000000020571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337452PMC
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

Effects of trunk stabilization training robot on postural control and gait in patients with chronic stroke: a randomized controlled trial.

Int J Rehabil Res 2020 Jun;43(2):159-166

Department of Rehabilitation Medicine.

Our study aimed to confirm the therapeutic effects of using a trunk stabilization training robot (3DBT-33) in patients with chronic stroke. A total of 38 patients with chronic stroke were randomly assigned to either an experimental or a control group. The robot group (n = 19) received 30 min of trunk stability robot training in addition to conventional physical therapy, while the control group (n = 19) received a similar conventional physical therapy as the robot group. All participants were assessed using the following: the Functional Ambulation Categories (FAC), timed up and go (TUG) test, Berg Balance Scale (BBS), Korean Modified Barthel Index (K-MBI), and Fugl-Meyer Assessment of Lower Extremity (FMA-LE). There were statistically significant improvements in all parameters at follow-up assessment after 4 weeks of intervention (P < 0.05). There were statistically significant differences in the FMA-LE, K-MBI, and BBS between the robot and control groups (P < 0.05). There was no significant difference in FAC (P = 0.935) and TUG (P = 0.442). Minimal detectable change was more significantly observed in the FMA-LE and BBS than in FAC, TUG, and K-MBI. The findings in the present study showed that trunk stabilization rehabilitation training using a rehabilitation robot in patients with chronic stroke was effective in improving the balance and functions in the lower extremities.
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http://dx.doi.org/10.1097/MRR.0000000000000399DOI Listing
June 2020

Comparison of a novel algorithm quantitatively estimating epifascial fibrosis in three-dimensional computed tomography images to other clinical lymphedema grading methods.

PLoS One 2019 10;14(12):e0224457. Epub 2019 Dec 10.

Department of Biomedical Engineering, School of Electrical Engineering, University of Ulsan, Ulsan, Republic of Korea.

No method has yet been approved for detecting lymphedema fibrosis before its progression. This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mean, minimum) of computed tomography reticulation indexes were digitally calculated from trans-axial images using absorptive values, and the computed tomography reticulation indexes compared with clinical scales and measurements. Of 326 patients evaluated by at least one of lymphoscintigraphy, bio-electrical impedance, and computed tomography, 24 were evaluated by all three. The mean number of computed tomography scans in these patients was 109. Sixteen patients had breast cancer, seven had gynecologic cancers, and one had primary lymphedema. Mean computed tomography reticulation index (r = 0.52, p < 0.01) and maximal computed tomography reticulation index (r = 0.45, p < 0.05) were significantly associated with time from initial limb swelling to computed tomography. Mean computed tomography reticulation index (r = 0.86, p < 0.01), minimal computed tomography reticulation index (r = 0.79, p < 0.01), and maximal computed tomography reticulation index (r = 0.68, p < 0.01) were significantly associated with International Society of Lymphedema substage. Minimal computed tomography reticulation index correlated with 1-kHz-based bio-electrical impedance ratio (r = -0.46, p < 0.05) and with standardized proximal limb circumference difference ratio (r = 0.45, p < 0.05) of both limbs. Maximal computed tomography reticulation index had a sensitivity of 0.78, specificity of 0.60, and areas under the curve of 0.66 in detecting lymphoscintigraphic stage IV. The algorithm utilizing three-dimensional computed tomography images of epifascial fibrosis may be used as a marker for lymphedema duration, limb swelling, International Society of Lymphedema substage, and interstitial lymphatic fluids of lymphedema. The current approach shows promise in providing an additional method to assist in characterizing and monitoring lymphedema patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224457PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903723PMC
March 2020

Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study.

J Neuroeng Rehabil 2019 10 24;16(1):122. Epub 2019 Oct 24.

Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea.

Background: Virtual reality (VR)-based rehabilitation is considered a beneficial therapeutic option for stroke rehabilitation. This pilot study assessed the clinical feasibility of a newly developed VR-based planar motion exercise apparatus (Rapael Smart Board™ [SB]; Neofect Inc., Yong-in, Korea) for the upper extremities as an intervention and assessment tool.

Methods: This single-blinded, randomized, controlled trial included 26 stroke survivors. Patients were randomized to the intervention group (SB group) or control (CON) group. During one session, patients in the SB group completed 30 min of intervention using the SB and an additional 30 min of standard occupational therapy; however, those in the CON group completed the same amount of conventional occupational therapy. The primary outcome was the change in the Fugl-Meyer assessment (FMA) score, and the secondary outcomes were changes in the Wolf motor function test (WMFT) score, active range of motion (AROM) of the proximal upper extremities, modified Barthel index (MBI), and Stroke Impact Scale (SIS) score. A within-group analysis was performed using the Wilcoxon signed-rank test, and a between-group analysis was performed using a repeated measures analysis of covariance. Additionally, correlations between SB assessment data and clinical scale scores were analyzed by repeated measures correlation. Assessments were performed three times (baseline, immediately after intervention, and 1 month after intervention).

Results: All functional outcome measures (FMA, WMFT, and MBI) showed significant improvements (p < 0.05) in the SB and CON groups. AROM showed greater improvements in the SB group, especially regarding shoulder abduction and internal rotation. There was a significant effect of time × group interactions for the SIS overall score (p = 0.038). Some parameters of the SB assessment, such as the explored area ratio, mean reaching distance, and smoothness, were significantly associated with clinical upper limb functional measurements with moderate correlation coefficients.

Conclusions: The SB was available for improving upper limb function and health-related quality of life and useful for assessing upper limb ability in stroke survivors.

Trial Registration: The study was registered with the clinical research information service (CRIS) ( KCT0003783 , registered 15 April 2019; retrospectively registered).
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http://dx.doi.org/10.1186/s12984-019-0595-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813964PMC
October 2019

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
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