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ABSTRACT: Patients with osteoporotic vertebral compression fracture (OVCF) have postural changes and increased risk of falling. The aim of this study is to compare balance characteristics between patients with OVCF and healthy control subjects.
Patients with severe OVCF and control subjects underwent computerised dynamic posturography (CDP) in this case-control study.
Forty-seven OVCF patients and 45 controls were recruited. Compared with the control group, the OVCF group had significantly decreased average stability; maximal stability under the `eye open with swayed support surface' (CDP subtest 4) and 'eye closed with swayed support surface' conditions (subtest 5); and decreased ankle strategy during subtests 4 and 5 and under the `swayed vision with swayed support surface' condition (subtest 6). The OVCF group fell more frequently during subtests 5 and 6 and had longer overall reaction time and longer reaction time when moving backward during the directional control test.
OVCF patients had poorer static and dynamic balance performance compared with normal control. They had decreased postural stability and ankle strategy with increased fall frequency on a swayed surface; they also had longer reaction times overall and in the backward direction. Therefore, we suggest balance rehabilitation for patients with OVCF to prevent fall.
Journal of Back and Musculoskeletal Rehabilitation 01/2013; 26(2):199-205. · 0.59 Impact Factor
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ABSTRACT: To investigate the correlation between hemiplegic shoulder pain factors during the acute and chronic stages of stroke recovery.
A prospective longitudinal study.
Seventy-six stroke patients with hemiplegic shoulders.
Hemiplegic shoulder pain and clinical, physical, and sonography results were recorded at admission and during both acute (before discharge) and chronic stages (6 months after discharge).
During the acute stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level and range of motion limitations. During the chronic stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level, range of motion limitations, spasticity and abnormal sonographic findings. Higher incidence (p=0.014) of hemiplegic shoulder pain and pain scores (p<0.01) were noted and abnormal sonographic findings of the biceps tendon long head (p=0.01) and subscapularis tendon (p=0.01) were higher during the chronic stage. Effusion, tenosynovitis or tendinopathy of the biceps tendon long head, and supraspinatus tendinopathy were notable during both stages.
Hemiplegic shoulder pain was correlated with lower motor function level and shoulder range of motion limitation in both stages. Shoulder spasticity and abnormal sonographic findings were correlated with hemiplegic shoulder pain during the chronic stage.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 06/2012; 44(7):553-7. · 1.88 Impact Factor
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ABSTRACT: This study aims to compare donor-site morbidity between the traditional fibula osteocutaneous and chimeric fibula flaps for mandibular reconstruction. Twenty-three patients with head and neck cancer were recruited. Fifteen patients underwent the traditional fibula osteocutaneous flap. Eight patients received a chimeric fibula osteocutaneous flap with a sheet of soleus muscle. Subjective donor-site morbidities were evaluated by questionnaire. Objective isokinetic testing and 6-minute walking test (6MWT) were used to evaluate ankle strength and walking ability. The results revealed no significant difference was found in total average score of the questionnaire between the traditional (2.57) and the chimeric (2.75) groups (P > 0.05). There were no significant differences in peak torque/total work of ankle motions and in walking ability at 6MWT between the traditional and chimeric groups (P > 0.05). In conclusion, compared with the traditional fibula osteocutaneous flap, the chimeric fibula flap does not increase donor-site morbidity for reconstructive surgery.
Microsurgery 11/2011; 32(1):20-5. · 1.61 Impact Factor
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ABSTRACT: Zac1 acts as a transcription factor and a transcriptional cofactor cooperated with histone acetyltransferases and/or histone deacetylases. The molecular mechanisms underlying the subcellular localization and specificity of Zac1 transcriptional regulation are unclear. Here, we show that Zac1 might have physical and functional interactions with death-associated protein (Daxx) and promyelocytic leukemia protein (PML). However, unlike Daxx, nuclear Zac1 was not relocalized into PML nuclear bodies (PML-NBs). The enhancement of the transactivation activity of Zac1 by PML and Daxx might occur outside PML-NBs. Other components of PML-NBs, such as CREB-binding protein (CBP), ubiquitin-conjugating enzyme 9, and p53, were also regulatory targets for Zac1, for whom the locations to mediate its regulatory functions were distinct from PML-NBs. Our findings further suggest that Zac1 might play differential roles over the functions of CBP depending on the status of post-translational modification on CBP. Hence, our results link PML-NB components to the transactivation and coactivation functions of Zac1 at non-PML-NB sites.
The international journal of biochemistry & cell biology 06/2010; 42(6):902-10. · 4.89 Impact Factor
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ABSTRACT: To validate the hypothesis that the reconstruction of the missing segment of the fibula using a redundant split fibular graft after a vascularized fibular flap transfer may have a better effect on ankle function.
Of the 24 head and neck cancer patients who received a free fibula flap for mandible reconstruction, 14 patients underwent the conventional method of donor site closure, in which the redundant fibular bone was discarded (Group I). Ten patients underwent longitudinal osteotomy of the redundant non-vascularized fibular portion to bridge the donor site defect (Group II). Postoperative subjective satisfaction level was evaluated with a self-constructed questionnaire in 10 parameters (ambulation with assistance, ankle instability, ankle stiffness, muscle weakness, leg edema, foot numbness, ankle pain, other sites of pain besides the ankle, and restriction to run) and the 4 voluntary motions (dorsiflexion, plantar flexion, eversion, and inversion) of both ankles were measured using a CYBEX II dynamometer.
The muscle peak torque of the donor leg was significantly lower at ankle plantar flexion (P = 0.002), eversion (P = 0.002), and inversion (P = 0.0002) in Group I as well as at dorsiflexion (P = 0.031), plantar flexion (P = 0.016), and inversion (P = 0.002) in Group II against the contralateral non-operated leg. The muscle power was significantly greater when performing ankle eversion (P = 0.049) in those who underwent split fibular bone reconstruction. There was no difference in the subjective satisfaction score between these two groups.
The reconstruction of the donor site with a split fibular bone graft led only a slight improvement in ankle eversion.
Archives of Orthopaedic and Trauma Surgery 06/2010; 130(6):781-6. · 1.37 Impact Factor
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ABSTRACT: Physical and sonographic evaluation of hemiplegic shoulder in patients after acute stroke and correlation between the physical/sonographic findings and early-onset hemiplegic shoulder pain.
Cross-sectional study.
Fifty-seven patients after stroke with hemiplegic shoulder.
Subjects were assigned to poor motor function and good motor function groups according to the Brunnström motor recovery stages of hemiplegic shoulder. Physical findings and sonography of hemiplegic shoulder at admission and before discharge were compared, and the relationship between the physical/sonographic findings of hemiplegic shoulder and hemiplegic shoulder pain was analysed.
The 2 groups differed significantly in proprioception, spasticity, subluxation, and shoulder rotation (p<0.05) than in the good motor function group. Brunnström motor recovery stages, shoulder motion, subluxation, and abnormal sonographic findings of hemiplegic shoulder were moderately correlated with visual analogue scale scores of hemiplegic shoulder pain (gamma=0.34-0.65; p<0.01). Conclusion: The frequency of shoulder soft tissue injuries (85%) and hemiplegic shoulder pain (67%) was higher in patients with hemiplegic shoulder with impaired sensation, spasticity, subluxation, and restricted rotation. Brunnström motor recovery stages, limited rotation, subluxation, and abnormal sonographic findings of hemiplegic shoulder were associated with hemiplegic shoulder pain severity in patients after acute stroke.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 01/2010; 42(1):21-6. · 1.88 Impact Factor
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Progress in Neuro-Psychopharmacology and Biological Psychiatry 08/2009; 33(7):1284-5. · 3.25 Impact Factor
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ABSTRACT: To examine the hemiplegic shoulders for soft-tissue injury by musculoskeletal sonography and to determine the relationship between the motor functions of the upper extremity and these injuries, which play an important role in hemiplegic shoulder pain and may impede rehabilitation.
The following characteristics of 34 acute stroke patients were recorded: age, gender, height, body weight, side of hemiplegia, type and duration of stroke, Brunnstrom stage, subluxation, and degree of spasticity of the upper extremity. On the basis of the Brunnstrom stage, the patients were divided into 2 groups. Patients with stages I, II, or III were categorized under the lower Brunnstrom stage (LBS) group (n = 21), and those with stages IV, V, or VI were allocated to the higher Brunnstrom stage (HBS) group (n = 13). Both shoulders of each patient were examined by musculoskeletal sonography with a 5-10-MHz linear transducer on 2 separate occasions (i.e., at admission and 2 weeks after rehabilitation).
With the exception of age, there were no significant differences in the demographic and clinical characteristics of the patients in the 2 groups. Shoulder musculoskeletal sonography revealed soft-tissue injury in 7 patients (33%) and 15 patients (71%) in the LBS group at admission and 2 weeks after rehabilitation, respectively (p < 0.05), and in 4 patients (31%) in the HBS group both at admission and 2 weeks after rehabilitation.
Acute stroke patients with poor upper limb motor functions are more prone to soft-tissue injury of the shoulder during rehabilitation.
Journal of Clinical Ultrasound 05/2009; 37(4):199-205. · 0.81 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the relationship between flexible flatfoot and plantar fasciitis.
Twenty-three subjects with flexible flatfoot and 23 subjects with normal arched feet were enrolled. Footprint analysis was used to evaluate the foot conditions in both groups to calculate the individual arch index. We compared the sonographic images of plantar fascia in the flexible flatfoot group with the normal arch group using high-frequency ultrasound.
The analysis results indicated that the thickening of the plantar fascia in the flexible flatfoot group was significantly different from the normal arch group. In the flexible flatfoot group, 10 of 23 patients (43.4%) had plantar fasciitis, but only two subjects (8.7%) in the normal arch group had plantar fasciitis.
There was a higher incidence of plantar fasciitis in the flexible flatfoot group than the normal arch control group in this study.
Chang Gung medical journal 07/2004; 27(6):443-8.
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ABSTRACT: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata.
Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite ALT flap combined with vascularized fascia lata. The size of the skin islands ranged from 20 to 32 cm in length and 10 to 22 cm in width, and the vascularized fascia lata sheath measured 14 to 28 cm and 8 to 18 cm, respectively. Functional outcome of the abdominal wall strength and donor thigh morbidity were investigated by using a Cybex kinetic dynamometer.
All flaps survived. No postoperative ventral hernia occurred except for one mild inguinal incision hernia. Subjectively there were no significant donor site problems. Objective assessment was performed in 4 patients 2 years postoperatively. In the reconstructed abdomen, isokinetic concentric and eccentric measurements of extension/flexion ratios of the abdominal wall strength showed no apparent decrease compared with other references. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed an averaged deficit of 30% as compared with the contralateral legs. However, no difficulties in daily ambulating were reported by the patients.
The free composite ALT myocutaneous flap with vascularized fascia lata provides an alternative option for a stable repair in complex abdominal wall defects.
Annals of Surgery 04/2004; 239(3):352-8. · 7.49 Impact Factor
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ABSTRACT: This retrospective study reported on the treatment of extension contracture of the knee after surgical treatment of patellar fractures.
Twenty-eight patients who sustained extension contractures of the knee after surgical treatment of patellar fractures 8-14 months previously (mean, 12 months) were treated. A midline longitudinal approach was made. After implants were removed, adhesions between the vastus intermedius and the femur, and in the patellofemoral joint were released completely. The knee was flexed up to 110 degrees. Postoperatively, a continuous passive motion (CPM) machine was used to assist knee flexion. Physical therapy was continued at local clinics. No aids were necessary for ambulation.
Twenty-four patients were followed-up for at least 2 years (range, 2.1-7.6 years; mean, 4.6 years). The mean arc of motion of the knee improved from 72 degrees preoperatively to 123 degrees (p < 0.001). Knee function improved from an unsatisfactory grade in all 24 patients preoperatively to a satisfactory grade in 21 patients (p < 0.001). There were no significant surgical complications.
This surgical technique has a high success rate with few complications. Above all, the surgical procedure is relatively simple. Therefore, it can be considered for indicated cases.
Chang Gung medical journal 30(3):263-9.
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ABSTRACT: Analysis of electromyographic (EMG) activities in the back during dynamic exercise is needed because more complex loading on the spine is created in comparison with that during static exercise. The purpose of this study is to investigate the difference in bilateral midback and low-back paraspinal muscle (PSM) activities during performance of different resistance isokinetic exercises in healthy subjects and those with scoliosis.
Forty-one healthy subjects and thirty-three subjects with adolescent idiopathic scoliosis (AIS) were enrolled. An isokinetic back system in combination with quantitative surface EMG was used to evaluate the dominant and nondominant PSM activities by analyzing the root mean square (RMS) during isokinetic extension and flexion exercise at velocities of 30 degree/s and 90 degree/s.
Significantly higher RMS of EMG were found in the dominant medial and lateral PSM of the lumbar region than the non-dominant muscles in the healthy control group and in those with AIS with smaller curves (<20 degrees) during isokinetic flexion and extension exercises. In AIS patients with larger curves (20 to 50 degrees), shifting of muscle activities from the dominant to the non-dominant side occurred during isokinetic exercises, and the EMG activities of the thoracic muscle were significantly higher on the non-dominant (concave) side than on the dominant (convex) side.
The bilateral PSM do not act symmetrically during isokinetic back exercises. The dominant lumbar PSM supply the major action in healthy subjects and patients with small curve scoliosis. For larger curve scoliosis, compensated muscle activity is needed in the midback when doing resistance exercises. More midback protection may be needed by scoliotic subjects with large curves during resistance exercise.
Chang Gung medical journal 33(5):540-50.
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ABSTRACT: Background: After harvesting the fibula flap, pain, sensory disturbance, weakness of donor leg, reduced walking endurance, ankle instability, and lower walking speed had been reported. The aim of this study was to quantitatively assess functional outcome of regular home-based exercise on donor ankle strength, endurance, and walking ability after free fibula flap for mandibular reconstruction. Methods: Fourteen patients were recruited. Objective isokinetic testing and a 6-min walk test (6MWT) were used to evaluate ankle strength/endurance and walking ability, respectively. Results: There was a significant increase in the peak torque of ankle dorsiflexion/foot inversion of the healthy leg and ankle dorsiflexion/foot eversion of the donor leg after exercise (p < 0.05). After home-based exercise, there was reduced asymmetry in the peak torques of ankle dorsiflexion and foot eversion and the total work of foot eversion between the donor and healthy legs. In 6MWT, no significant difference was found between the walking distances before and after exercise. Conclusion: Regular home-based exercise could improve the strength of ankle dorsiflexion and foot eversion of the donor leg, and get more symmetric ankle motor function between the donor and healthy legs.
Biomedical journal. 36(2):90-5.
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ABSTRACT: High-resolution ultrasonography (HRUS) has been used to diagnose carpal tunnel syndrome (CTS) in recent years. However, the best diagnostic criterion and optimal cut-off value for HRUS remain controversial.
This study enrolled 37 patients with idiopathic CTS (61 CTS hands) and 20 healthy subjects (40 normal hands). The subjects underwent nerve conduction studies along with HRUS. Several ultrasonographic measurements with good reliability were compared, including the median nerve cross-sectional areas (CSA) at the pisiform and hook of hamate levels; the flattening ratios (FR) at the pisiform, hook of hamate, and distal radioulnar joint levels; retinacular bowing (RB); and the longitudinal compression sign (LCS). Receiver operating characteristic (ROC) curves were plotted for the optimal cut-off values as well as the sensitivity and specificity.
There was a significant increase in the median nerve CSA at the pisiform and hook of hamate levels, RB, and LCS, but the FR was decreased at the hook of hamate level. The ROC curves demonstrated that the median nerve CSA at the pisiform level was most predictive of CTS; the optimal cut-off value was > or = 9.875 mm2, yielding 82% sensitivity and 87.5% specificity.
CTS can be diagnosed by HRUS. The most useful diagnostic criterion is a median nerve CSA of > or = 9.875 mm2 at the pisiform level.
Chang Gung medical journal 31(5):469-76.
