ABSTRACT: Although hyperbaric oxygen therapy has not been accepted as a standard therapy for traumatic brain injuries, it has been used, along with rehabilitative exercises, for traumatic brain injuries, and the standard protocol has a low risk of complications. We report a case of chronic traumatic brain injury that progressed to tension pneumocephalus after hyperbaric oxygen therapy. The patient was a 25-yr-old man who presented with left occipital bone fracture and subarachnoid and subdural hemorrhage after being hit by a car. He underwent craniectomy to remove the hematoma and cerebrospinal fluid diversion with a ventriculoperitoneal shunt for the treatment of hydrocephalus. Fifteen months after the trauma, the patient received hyperbaric oxygen therapy to promote functional recovery. Tension pneumocephalus developed after the first session of hyperbaric oxygen therapy, and immediate burr hole drainage followed by ligation of the ventriculoperitoneal shunt was performed. The patient's consciousness recovered gradually, and he was discharged home. We suggest that patients with unrepaired skull base fracture and cerebrospinal fluid diversion should be carefully evaluated before receiving hyperbaric oxygen therapy.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 02/2012; 91(6):528-32. · 1.56 Impact Factor
ABSTRACT: To investigate the immediate effects of bilateral upper-extremity sanding exercises on conduction and morphologic characteristics of the median and ulnar nerves at the wrist in hemiparetic subjects and control subjects.
Case control study using a pretest-post-test design.
Inpatient rehabilitation department affiliated with a teaching hospital. PATIENTS (OR PARTICIPANTS): Thirty hemiparetic subjects and 21 matched control subjects who met our inclusion criteria and had no history of diseases that may have predisposed them to peripheral neuropathies were recruited for this study.
Bilateral nerve conduction tests and ultrasonographic evaluations were performed on each subject before and immediately after a 30-minute bilateral sanding exercise with a frequency of 5 repetitions per minute.
The effects of exercises on bilateral median and ulnar wrist nerves were assessed with the use of sensory and motor nerve conduction velocity tests and by width/thickness ratios in ultrasonographic evaluations.
In the hemiparesis group, the pre-exercise amplitude of the motor component for the median and ulnar nerves were respectively lower than the corresponding values in the control group (P < .05), whereas the pre-exercise amplitude and velocity of the sensory component were lower than the corresponding values in the control group (P < .01). After the exercise, the assessments for the affected side showed reductions in the conduction velocity of the sensory component and an increase in the width/thickness ratio for the median nerve (P < .05).
The median and ulnar nerves at the wrist in hemiparetic subjects before sanding exercises showed different conduction characteristics compared with control subjects. Their affected side also demonstrated significant conduction and morphologic changes after the exercises. These subclinical findings may be attributed to different mechanisms such as overuse, spasticity, and demyelinating changes. Prevention of these subclinical changes is recommended to enhance exercise safety in hemiparetic patients.
Der Notarzt 10/2011; 3(10):933-9. · 0.28 Impact Factor
ABSTRACT: To evaluate the effectiveness of ultrasonographic guided botulinum toxin type A injections into the plantar fascia to reduce pain and improve gait in patients with unilateral plantar fasciitis.
A randomized double-blind control study.
Fifty patients with chronic unilateral plantar fasciitis were recruited, and divided into experimental and control groups.
Subjects in the experimental group were injected with 50 units botulinum toxin type A, reconstituted with normal saline, into the plantar fascia under ultrasonographic guidance. Follow-up evaluations were made 3 weeks and 3 months after injection. The control group subjects were injected with normal saline under ultrasonographic guidance. Outcome measures included comparing scores from the visual analogue pain scale, changes in thickness of the plantar fascia and fat pad, and gait assessment including the maximal centre of pressure velocity during first step loading response.
Visual analogue pain scale and plantar fascia thickness in the symptomatic foot decreased significantly, as noted at follow-up 3 weeks and 3 months after botulinum toxin type A injections (p < 0.001). However, the fat pad thickness remained unchanged. The centre of pressure velocity during loading response increased 3 months after injection (p < 0.05). Outcome measures of the control group remained unchanged.
Botulinum toxin type A is effective in the treatment of foot pain associated with plantar fasciitis and increases the centre of pressure velocity during loading response without inducing fat pad atrophy.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 02/2010; 42(2):136-40. · 1.88 Impact Factor
ABSTRACT: To investigate the electrophysiological prevalence and associated risk factors of upper extremity entrapment neuropathies in a cohort of Taiwanese patients with prior paralytic poliomyelitis.
Cross-sectional study involving a consecutive series of patients.
Ninety-seven polio survivors.
Demographic factors, medical and work history were recorded. Symptoms and functional deficits of the hand, mobility impairment level, physical activity level and manual muscle testing were assessed, and nerve conduction studies were performed.
The electrophysiological prevalence of nerve entrapment among the polio survivors was 80%. The most common electrodiagnostic dysfunction was median neuropathy at the wrist (62%), followed by ulnar neuropathy at the elbow (41%) and ulnar neuropathy at the wrist (38%). In multiple logistic regression, subjects who reported that their jobs involved repetitive hand movements, had a body mass index greater than 24 kg/m2, or used a cane/crutch were at increased risk of both median neuropathy at the wrist and ulnar neuropathy at the wrist. Subjects who used a wheelchair were also at increased risk of ulnar neuropathy at the wrist.
These results indicate a high occurrence of upper extremity entrapment neuropathies in polio survivors. The documentation of risk factors in this study provides support for screening of at-risk subjects.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 02/2009; 41(1):26-31. · 1.88 Impact Factor
ABSTRACT: Cervical manipulation has been considered an effective treatment for managing neck pain. However, clinical observation showed that cervical manipulation was not effective for every patient. Development of clinical prediction rules for identifying patients with neck pain who are likely to respond to cervical manipulation may improve clinical decision-making and the treatment success rate. The purpose of the study was to identify predictors for the immediate responders to cervical manipulation treatment in patients with neck pain. One hundred patients with neck pain (34 males and 66 females, mean age = 46 +/- 11 years) participated in the study. Patient's demographic data, symptom aggravating or easing factors, pain, and disability level were obtained through an initial assessment. A series of physical examinations were also administered. After receiving a single session of cervical manipulation, the patient was re-evaluated immediately to determine if a successful response to treatment was obtained. The successful response was determined by improvements seen in one of the three outcome variables that included reduction of pain intensity, significant perceived improvement, and high satisfaction level. From these judgment criteria, patients were classified into either responders or nonresponders to the cervical manipulation. Univariate analyses were used to assess if the treatment responders and nonresponders were different in their clinical presentations. The clinical factors that showed significant differences between two groups were then entered into a stepwise multiple logistic regression analysis to identify significant predictors and the prediction rule for treatment responders. Six predictors including "initial scores on Neck Disability Index < 11.50", "having bilateral involvement pattern", "not performing sedentary work > 5 h/day", "feeling better while moving the neck", "without feeling worse while extending the neck", and "the diagnosis of spondylosis without radiculopathy" were identified to significantly predict the immediate responders. The presence of four or more of these predictors increased the probability of success with manipulation to 89%. We concluded that using favourable predictors to identify treatment responders before administering cervical manipulations could significantly increase the probabilities of a successful treatment. This study finding may enhance the efficacy of clinical decision-making in using cervical manipulation intervention.
Manual Therapy 11/2006; 11(4):306-15. · 1.88 Impact Factor
ABSTRACT: To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke.
Randomized controlled trial.
Twenty-five subjects with stroke, who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis, randomly allocated to two groups, control (n = 12) and experimental (n = 13).
Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks. Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week.
Gait was measured using the Stride Analyzer. Gait parameters of interest were walking speed, cadence, stride length, gait cycle and symmetry index. Measures were made at baseline before commencement of training (pre-training) and at the end of the three-week training period (post-training).
After a three-week training period, subjects in experimental group showed more improvement than those in control group for walking speed (change score: 8.60 +/- 6.95 versus 3.65 +/- 2.92, p-value = 0.032), stride length (change score: 0.090 +/- 0.076 versus -0.0064 +/- 0.078, p-value = 0.006), and symmetry index (change score: 44.07 +/- 53.29 versus 5.30 +/- 13.91, p-value = 0.018).
This study demonstrated that asymmetric gait pattern in patients post stroke could be improved from receiving additional backward walking therapy.
Clinical Rehabilitation 06/2005; 19(3):264-73. · 2.12 Impact Factor