Wasuwat Kitisomprayoonkul’s research while affiliated with Chulalongkorn University and other places

Objective The aim of this systematic review and meta‐analysis is to assess the efficacy of mirror neuron system‐based therapy for managing pain and improving motor and upper limb function in patients with upper limb orthopedic conditions. Literature Survey Systematic bibliographical searches of the PubMed, SCOPUS, and CENTRAL registries and databases up to September 2023 were conducted to find randomized controlled trials (RCTs) assessing the efficacy of mirror neuron system‐based therapy for rehabilitation of upper limb orthopedic conditions. Methodology Two reviewers assessed the RCTs using a Cochrane risk‐of‐bias tool and extracted data from studies with similar outcome measures in the domains of pain, motor function, or functional score, which were pooled into meta‐analyses. Synthesis The review included 13 studies to compare the efficacy of mirror neuron system‐based therapy with that of conventional rehabilitation programs. The therapy reduced pain intensity (mean difference [MD] 2.04, 95% confidence interval [CI] 1.46–2.63) and kinesiophobia (MD 8.43, 95% CI 6.98 to 9.88), and increased grip strength (MD 1.86, 95% CI 0.28–3.45). The therapy also improved upper limb functional outcomes as assessed by the 30‐item Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score (MD 13.52, 95% CI 10.63–16.41). However, the outcomes as assessed by the 11‐item Quick DASH questionnaire and the Shoulder Pain and Disability Index (SPADI) were not superior to conventional rehabilitation. Conclusions Mirror neuron system‐based therapy for rehabilitation of upper limb orthopedic conditions may reduce pain intensity and kinesophobia, and improve grip strength and DASH scores compared with conventional rehabilitation programs. However, this interpretation is limited by the heterogeneity and various quality of the RCTs included in our meta‐analysis.

Objectives: The Thai Osteoporosis Foundation (TOPF) is an academic organization that consists of a multidisciplinary group of healthcare professionals managing osteoporosis. The first clinical practice guideline for diagnosing and managing osteoporosis in Thailand was published by the TOPF in 2010, then updated in 2016 and 2021. This paper presents important updates of the guideline for the diagnosis and management of osteoporosis in Thailand. Methods: A panel of experts in the field of osteoporosis was recruited by the TOPF to review and update the TOPF position statement from 2016. Evidence was searched using the MEDLINE database through PubMed. Primary writers submitted their first drafts, which were reviewed, discussed, and integrated into the final document. Recommendations are based on reviews of the clinical evidence and experts' opinions. The recommendations are classified using the Grading of Recommendations, Assessment, Development, and Evaluation classification system. Results: The updated guideline comprises 90 recommendations divided into 12 main topics. This paper summarizes the recommendations focused on 4 main topics: the diagnosis and evaluation of osteoporosis, fracture risk assessment and indications for bone mineral density measurement, fracture risk categorization, management according to fracture risk, and pharmacological management of osteoporosis. Conclusions: This updated clinical practice guideline is a practical tool to assist healthcare professionals in diagnosing, evaluating, and managing osteoporosis in Thailand.

Purpose: Stroke patients have difficulty performing tasks using their paretic hands. There are limited data on the effects of using a soft robotic glove to assist with hand function. The objective of this study was to investigate the effectiveness of a soft robotic glove in assisting hand function in stroke patients. Methods: This study was a cross-sectional pilot study. Twenty stroke patients with partial or complete hand weakness were recruited from a rehabilitation centre. The Box and Block Test (BBT) and the Action Research Arm Test (ARAT) were performed under two conditions: with and without use of the soft robotic glove. The order of the conditions was randomly assigned by a computer-generated program. Results: BBT scores increased 6.4 blocks when using the soft robotic glove (p < 0.001). ARAT grasp, grip, pinch, and overall scores increased by 27.08% (p < 0.01), 28.75% (p < 0.001), 15.89% (p < 0.01), and 21.15% (p < 0.001), respectively, using the glove versus not using the glove. Conclusions: The findings of this study suggest that using a soft robotic glove can assist a poststroke paretic hand in executing grasp, grip, and pinch.

Objective To study the short-term effect of bilateral transcutaneous tibial nerve stimulation (TTNS) on urodynamic study (UDM) parameters in spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO). Design Single-blinded sham-controlled study. Setting Rehabilitation center. Participants Seventeen SCI patients with NDO were recruited. Fifteen patients (mean age 40±18 years) completed the study. Most of them were chronic incomplete SCI. Interventions UDM was performed three times. The first UDM was performed after taking anticholinergics for one hour to assess the effects of medication. After stopping anticholinergics for a 5 half-lives, the second UDM was performed immediately after a 20-min sham TTNS (switch on for 30 sec at the beginning, switch off for 20 min, and switch on for 30 sec before stopping). The third UDM was performed immediately after a 20-min bilateral TTNS. Main Outcome Measures Reflex volume (ml); cystometric capacity (ml); maximum pressure detrusor (mmH2O); and bladder compliance (ml/mmH2O). Results UDM tracings were interpreted by 2 blinded assessors. This study used per-protocol analysis and repeated measures ANOVA with Bonferroni post-hoc analysis. When compared with sham stimulation, bilateral TTNS and anticholinergics produced greater increases in reflex volume (136.1±99.88, 212.2±112.82, 226.3±111.52 ml, P<.001), cystometric capacity (218.3±137.66, 319.1±143.74, 350.7±163.43 ml, P<.001) and compliance (5.8±6.81, 7.9±6.74, 9.7±8.12 ml/cmH2O, P=.02). No significant differences in reflex volume, cystometric capacity or compliance were found between bilateral TTNS and anticholinergics (P>.05). The maximum pressure detrusor was not significantly different between groups (P>.05). Conclusion Bilateral TTNS may be an effective short-term intervention to improve UDM parameters in SCI with NDO. Further study is necessary to determine the long-term effects and benefits of combined bilateral TTNS with anticholinergics.

Background: Dysphagia is a common problem in acute stroke patient. Aspiration pneumonia increases in this group. Swallowing therapy is immediately conducted in a stable stroke patient. An effectiveness of our program has not been determined. Objective: To determine an effectiveness of conventional swallowing therapy in acute stroke patients with dysphagia. Methods: We retrospectively reviewed data from medical records of acute stroke patients with dysphagia who participated a swallowing therapy from January 2017 to June 2017. Fifty-seven acute stroke patients with dysphagia (26 males and 31 females) were participating in a conventional swallowing therapy (50 minutes a day for 3 days per week). A functional oral intake scale (FOIS) and swallow function scoring system (SFSS) were used to determine an effectiveness of the swallowing therapy. FOIS and SFSS scores before the first therapy session and after the last therapy session were compared using a paired t-test. Results: The mean age of the patient was 69.5 ± 15.35 years. The period from stroke onset to the first swallowing therapy session was 7.5 ± 6.69 days. The number of therapy was 5.6 ± 2.83 sessions. Participants showed a significant improvement of the FOIS (mean score increased from 1.74 to 3.30 points, P = 0.001) and SFSS (mean score increased from 2.51 to 3.68 points, P = 0.001). Forty-two percent of patients with tube dependent change to total oral intake. Conclusion: Conventional swallowing therapy is an effective treatment in acute stroke with dysphagia.

Background: Based on the histological confirmation of the presence of nerve structure in the fascia, hence, myofascial pain was treated by the mechanism referred to as interfascial block. To date, the studies of physiological saline for treating patients with myofascial pain has been limited. Ultrasound (US) guided with physiological saline injection (PSI) technique has been routinely practiced among patients with myofascial pain in outpatient service at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. The main objective of this present study is to find the overview data including the percentage of patients responding, acceptable pain period, and adverse events. Materials and methods: Electronic medical reports among 142 patients receiving US-guided PSI from August 1, 2016, to November 20, 2017, at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, were retrospectively reviewed by the first author. Procedures were performed by the last author. The analysis was independently performed by the first author. Results: One hundred and forty-two patients with complete medical records were compatible with analysis. The average age of patients was 55 years. Most of the patients were female (68.3%). Most of the patients (76.8%) had chronic suffering from myofascial pain. Approximately half of the patients (56.4%) are currently received pain-relieving medications. Upper trapezius muscle (19.5%) was the most common muscle receiving the procedure, followed by multifidus (10.0%) and quadratus lumborum (9.5%). Most of the patients (86.8%) received the procedure one muscle. Approximately 30% of the patients were able to stop pain-relieving medications after the procedure. The median of acceptable pain period was 63 days. The percentage of patients having an acceptable pain period >3 months was 43.9%. No major adverse events were demonstrated. Conclusion: US-guided PSI technique demonstrated pain reduction in 72.8% of the analyzed patients, with an acceptable pain period of 63 days. No major adverse events were demonstrated among all the patients. This technique should be considered as another invasive procedure for eradication myofascial trigger point.

We developed a robot, CUREs (Chulalongkorn University Rehabilitation robotic Exoskeleton system), for upper extremity rehabilitation. Five subacute stroke patients participated in this pilot study. All patients had severe upper extremity weakness (Brunnstrom stage I and II, Fugl–Meyer Assessment Upper Extremity score, motor function, are from 4 to 10). They participated in 30 min of conventional upper extremity training and 30 min of robotic training, 5 days per week for 2 consecutive weeks. The Fugl–Meyer Assessment Upper Extremity Scale was improved after 2 weeks training in all participants. However, the Motor Assessment Scale was not changed. In the future, we plan to conduct a 4 week randomized–controlled trial study to compare the rehabilitation outcome between CUREs robot with conventional therapy in stroke patient.

Introduction Treadmill walking is a cheap and attainable form of exercise, which carries a low injury risk and confers other health benefit. The aim of this study is to investigate the effects of 3-month treadmill walking on biochemical bone markers in Thai postmenopausal women. Material and methods Thai postmenopausal women participated in a 3-month supervised treadmill walking program. The program consisted of treadmill walking, the intensity of which was 55–70% of maximal heart rate, with duration of 30 min per day, at a frequency of 3 days a week. Crosslinked C–terminal telopeptides of type I collagen (CTX–I) and N–terminal propeptides of type I procollagen (PINP) level were measured at baseline and at 1 week after 3-month training. Results Eighteen women completed the training program. The average age of patients was 59.39 ± 4.18 years. The average period after menopause was 9.28 ± 6.52 years. CTX–I and PINP levels at baseline were 0.43 ± 0.14 and 52.15 ± 13.43 ng/ml. CTX–I and PINP levels after 3-month training were 0.80 ± 0.26 and 66.77 ± 22.82 ng/ml. Bone resorption and formation markers were significantly increased after treadmill walking (p < 0.01). Conclusion Bone turnover increases after 3-month supervised treadmill walking in Thai postmenopausal women.

Background: It has been pointed that cueing techniques may have influence upon gait training in Parkinson's disease (PD). Objective: Study the effects of music cue on treadmill training in PD patients. Subject and methods: A randomized single-blind controlled trial was conducted. Thirty male PD patients, aged 60 to 80 years with Hoehn and Yahr stage 2-3 were allocated into three groups (each 10 patients). Group A: treadmill with music three days and home walking three days/week, Group B: treadmill three days and home walking three days/week, and Group C: home walking six days/week. Each group received four weeks training followed by self-practice for other four weeks. Gait performances at pre-program, fourth, and eighth week were compared. Results: The results showed that A, B, and C, stride length gained 12%, 5.2%, and 6.7% (p=0.042), walking-speed gained 8.6%, 6.5%, and -2.4%, six-minute walk distance gained 10.2%, 5.4%, and 2.9%, and Timed Up and Go (TUG) gained 14.2%, 12.5%, and 7.6%. Conclusion: Music cue enhanced gait training in mild to moderate PD patients.