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【論文摘要】Effect of Transcranial Direct Current Stimulation Combined With Neuromuscular Electrical Stimulation on Motor Recovery of Upper Extremity in Patients With Chronic Stroke: A Pilot Study

Background and Purpose: The feasibility and effect of bihemispheric-transcranial direct current stimulation (tDCS) combined with neuromuscular electrical stimulation (NMES) on upper extremity motor recovery in people with chronic stroke have not been investigated. The purpose of this preliminary study was to investigate the effect of the combination treatment strategy. Methods: We recruited ten chronic stroke patients from three outpatient clinics. Subjects were randomly allocated to the E1 group (bihemispheric tDCS + NMES, n = 3), E2 group (bihemispheric-tDCS + sham NMES, n = 3), and Control group (sham tDCS + sham NMES, n = 4). Subjects received a 30-minute intervention of tDCS applied concurrently with NMES at the wrist extensor muscle of paretic limb, 5 times per week, for 3 weeks. A constant direct current of 2 mA intensity was used for the tDCS, with the anodal and cathedral electrodes placed on the affected and nonaffected primary motor cortex, respectively. Upper-limb subscale of Fugl-Meyer assessment (UE-FMA), Action Research Arm Test (ARAT) and Modified Ashworth Scale (MAS) were assessed before and after the intervention. Results: Non-significant differences were found among groups for UE-FMA, ARAT and MAS. However, a trend was found that the motor recovery of upper extremity improved more in the E1 group than the other two groups (change in UE-FMA score: E1 group 38 ± 18 to 43 ± 17, E2 group 38 ± 25 to 40 ± 20, control group 37 ± 23 to 41 ± 22) after the 3-week intervention. Conclusion: Our preliminary findings suggest a combination stimulation strategy based on bihemispheric-tDCS and NMES had a positive effect on motor recovery of upper extremity for chronic stroke patients. Clinical Relevance: This preliminary finding may provide useful references for upper limbs motor recovery of stroke patients in physical therapy.

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【論文摘要】經顱直流電剌激合併神經肌肉電剌激對於中風病人大腦皮質興奮性的立即效應：經顱磁剌激初步研究

背景與目的：先前研究曾證實經顱直流電刺激與 神經肌肉電刺激對於中風患者上肢功能恢復的效益，但兩種刺激同時合併介入，對於大腦皮質興奮性的影響仍不清楚。本研究探討經顱直流電刺激合併神經肌肉電刺激對於大腦動作皮質興奮性的立即效應。方法：初步徵召4位慢性中風患者為受試者，每位給予經顱直流電刺激同時合併神經肌肉電刺激刺激介入30分鐘，經顱直流電刺激的電流強度設定為2 mA，採雙極刺激模式，陽極和陰極電極片分別置放於患側腦和健側腦的主要動作皮質區；神經肌肉電刺激強度約10 ~ 20 mA，頻率50 pps，波寬200 μs，電極片置於患側手橈側伸腕肌及伸指總肌。介入前和介入後，分別使用單次脈衝經顱磁刺激評估雙側大腦 於介入前後運動閾值(motor threshold)、動作誘發電位(motor evoked potential)和動作皮質活化區域(map size)大小變化之立即效應。結果：4位受試者患側腦平均運動閾值從58.0 ± 2.83%降低到53.3 ± 6.43%，動作誘發電位從0.10 ± 0.02增加到0.26 ± 0.09 mv，動作皮質活化區域從7.00 ± 0.00增加為12.50 ± 3.54點數；健側腦平均運動閾值從56.0 ± 4.24%降低到49.0 ± 5.66%，動作皮質活化區域從11.5 ± 2.12增加為19.5 ± 7.78點數。結論：初步結果顯示經顱直流電刺激與神經肌肉電刺激同時合併介入，可以誘發慢性期中風病人雙側大腦皮質區活化興奮之立即效應。臨床意義：這種合併刺激介入模式可以提供未來中風病患上肢臨床治療的參考。

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【論文摘要】互動式運動訓練對慢性中風病人平衡能力的影響

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【論文摘要】A Case Report of Hydrotherapy Intervention for Unilateral Multi- Fracture

Background and Purpose: A 23-year-old female choreographer had multiple fractures with operation due to a motorcycle accident on 11 April, 2017. The multiple fractures were at mid shaft of right femur, proximal ulna involving oclecranon, and lateral tibial plateau. After 2 days, she received the operation, internal fixation of right femur, right proximal ulna fixation, and right knee casting immobilization at our hospital. At first, she had received the electrical stimulation for pain relief and strengthening on land at a Keelung local Rehabilitation clinic. She preferred more functional training as early as possible, and went to our hydrotherapy section for further treatment. Her main complains were pain over right elbow and thing, right knee range of motion limitation and pain during ambulation. The aims of this case report was to show the effective of the hydrotherapy for this unilateral multi-fracture patient who needs high movement performance. Methods: The patient practiced the aquatic exercise and strengthening exercise for 50 minutes every treatment from the middle of June to the late of August. The intervention programs were: (1) Programs in pool: walking, weight shifting, heel cord stretch, iliopsoas stretch, leg circles, wall sit, side stepping laps, cross over stepping laps, pelvic curls and bicycle reps with water depth 110 cm, and jumping with water depth 130 cm. (2) Programs on land: selfstretch (bilateral triceps, elbow extensors, calf muscle, hip flexors and push-up for trunk self-mobilizations), muscle strengthening (right elbow flexor and extensor, leg circles), trunk stabilization exercises, deep friction massage (right side scars), body mapping and massage (elbow and knee). Outcome measures were taken before and after (2-week, 4-week, 6-week) the 2-month training, including percentage of load on the affect side, walking parameters (surface, contact time, maximum pressure, and average pressure), Visual Analog Scale (VAS) pain and range of motion. Results: The results showed a significant improvement over time in VAS pain, percentage of load on affect side, walking parameters (surface, contact time, maximum pressure, and average pressure). However, the range of motion of the right elbow didn’t improve much and the end-feel was hard. Conclusions: The results showed that the aquatic intervention is an effective and fast treatment to pain relief, and improves uneven weight bearing, walking parameters, and range of motion in the multi-fracture patient. Clinical Relevance: The early aquatic intervention appears to support the weight of the affect side and provide leg coordination training, thus improves the patient’s functional performance.

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【論文摘要】Association With Hip Internal Rotation Deficit and Sport Injury in Collegiate Baseball Pitchers: A Pilot Study

Background and Purpose: The throwing motion is a total body activity that requires coordination of the lower extremity, hip, trunk, and upper extremity for proper execution. Hip motion is important to develop necessary torque and velocity for overhead activity. Repetitive rotational stress in the hip may lead to sportspecific range of motion (ROM) adaptations. Which may increase the risk of injury in lower extremity. Therefore, the purpose of this study was to evaluate when hip rotation ROM adaptations and associated with a history of injury to hip or other joints in the lower extremity. Methods: Twenty-eight collegiate baseball pitchers participated in this study. All players underwent a comprehensive preparticipation physical health status examination. Hip ROM was assessed using a customized standard goniometer and hip side to side differences in rotational parameters were calculated. Hip internal rotation deficit (HIRD) as defined is a loss of internal rotation (IR) of the dominant hip of 10° or more as compared with the nondominant hip. Results: Ankle injuries or complaints, mostly at the dominant side, were reported in 42.86% of pitcher. Low back complaints, mostly minor, were reported in 25% of pitchers. Hamstrings strain were reported in 4 (14.29%) pitchers, and two of them involved the dominant side. Knee complaints, mostly meniscal tear or medial collateral ligament rupture, were reported in (3.5% of pitchers). Conclusions: These data suggest pitchers with HIRD may be associated with ankle sprain and nonspecific low back pain in baseball pitchers. Although the cause and effect relationship between HIRD and injuries are uncertain. Clinical Relevance: An understanding of hip ROM adaptations in baseball pitchers may help clinicians to examine inadequacies and provide various preventive interventions for baseball pitchers.

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【論文摘要】Glenohumeral Internal Rotation Deficit and Association With Sport Injury in Collegiate Baseball Pitchers: A Pilot Study

Background and Purpose: Baseball pitching generates large forces in the throwing shoulder. The repetitive pitching at high velocities over time leads to chronic adaptions to soft and osseous tissues in glenohumeral range of motion (ROM), which may increase the risk of injury to upper extremity joint. Therefore, the purpose of this study was to identify associations collegiate between pitchers with glenohumeral internal rotation deficit (GIRD) and upper extremity injury in collegiate baseball pitchers. Methods: A total of thirty baseball pitchers with GIRD underwent a comprehensive preparticipation physical health status examination. Passive ROM measurements were recorded using a customized standard gonimeter for shoulder external rotation (ER), internal rotation (IR), total rotation motion (IR + ER) on the dominant and nondominant arms, and associations with previous injuries were identified. GIRD as defined is a loss of IR of the throwing shoulder of 20° or more as compared with the nonthrowing shoulder. Results: There was a history of elbow injuries or complaints in 70% of pitchers; the most common diagnosis was ulnar collateral ligament tear (36.37% of pitcher). Two pitchers had been diagnosed tennis elbow (6%), Nine pitcher (30%) had suffered shoulder pain in the past. Five pitchers had been diagnosed with rotator cuff tear (16.67%). Three pitchers had been diagnosed as the subacrominal impingement (10%). Conclusions: We report pitchers with GIRD could potential risk factor for elbow and shoulder injury. GIRD may be associated with an ulnar collateral ligament tear in collegiate baseball pitchers. Clinical Relevance: Early detection, proper assessment techniques and various IR-flexibility program are important to prevent GIRD.

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【論文摘要】The Effect of Edema Control in Patients With Breast Cancer- Comparison of Manual Lymph Drainage, Self-Massage and Epidermis Fascia Taping With Ultrasonography

Background and Purpose: The effect of edema control by different methods is not clear. The objective of this study is to investigate the reliability of measuring severity of edema using ultrasound (USD) imaging, and to compare the effect of manual lymph drainage (MLD) technique, epidermis taping technique, and self-massage on edema control. Methods: Nineteen subjects with unilateral lymphedema were recruited. Subjects were randomized to three groups including MLD, epidermis taping and self-massage groups. Subjects' circumference (8 sites) and USD (6 sites) of the affected upper extremity were measured using tape-measurement and ultrasonography respectively. Results: USD showed good reliability (intraclass correlation coefficient [ICC] = 0.885) in measuring subcutaneous thickness. Significant difference in circumference before and after treatment was found in all three groups (p ＜ 0.05). One-way analysis of variance (one-way ANOVA) showed a significant group effect on mean differences of circumference [F(2,81.956) = 8.53, p ＜ 0.01]. Post-hoc comparisons using the Games-Howell test indicated that the mean difference for the taping group (mean [M] = 0.84, standard deviation [SD] = 0.96) and the MLD group (M = 0.66, SD = 0.47) were significantly higher (p ＜ 0.05) than the self-massage group (M = 0.27, SD = 0.53). However, no significant difference (p ＞ 0.05) was found between the taping group and the MLD group. Conclusion: Ultrasound is a reliable tool for measuring subcutaneous thickness. It is also found that all taping, MLD and self-massage could successfully decrease limb circumference, though taping and MLD were more effective than self-massage. Clinical Relevance: Taping could replace MLD treatment.

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【論文摘要】臺灣醫療人員執業相關肌肉骨骼疾患調查

背景與目的：根據調查，醫療人員肌肉骨骼疾患 發生率高，這是因為像護理人員、物理治療師、牙醫師、檢驗技術人員工作性質需長時間維持特定姿勢，或搬運患者，除了造成醫療支出增加，更降低工作效能和生活品質。儘管過去文獻調查結果顯示，醫療人員對於工作相關的骨骼肌肉疾患有高的盛行率，然而大多數採取問卷調查，結果不等同臨床上診斷，另外過去的研究，多侷限在其中幾項的職類，並未包含全體職類的分析，因此本研究目的在於利用臺灣健保資料庫，調查臺灣醫療人員執業相關骨骼肌肉疾患。方法：利用健保資料庫2005年百萬人抽樣檔進行橫斷性的研究，配合醫事人員類別碼篩選出西元2005 ~ 2008年醫療執業人員，排除樣本數小於100的職類，再以篩選出的醫療人員配對同年齡、性別之非醫療人員對照組，使用ICD-9-CM疾病分類代碼定義疾病範圍，包括ICD-9-CM: 719 ~ 729和ICD-9-CM: 840 ~ 847，排除腫瘤(ICD- 9-CM: 170, 171, 213)和風濕免疫疾患(ICD-9- CM: 725)。卡方檢定比較各醫療職類與非醫療人員發生肌肉骨骼相關疾患情形，顯著差異值定為 p ＜ 0.05。結果：合計10種醫療職類收案入本研究，其骨骼肌肉疾患顯著高於非醫療人員之疾病。中醫師：腕及手之扭傷及拉傷、膝及腿之扭傷及拉傷、背部之其他扭傷及拉傷、其他背部疾患、肩關節痛、髖關節痛；牙醫師：腕骨點病變；護理師：滑囊，肌腱及滑液囊之其他疾患、肌肉，韌帶及筋膜疾患、軟組織之其他疾患、肩骨點病變及有關徵候群、肘骨點病變、腕骨點病變、膝骨點病變、踝足骨點病變、其他背部疾患、頸椎椎間盤疾患、腰椎椎間盤疾患、頸椎關節病及有關疾患、腰椎關節病及有關疾患、腕隧道徵候群；醫檢師：軟組織之其他疾患；物理治療師：腕及手之扭傷及拉傷、膝及腿之扭傷及拉傷、踝之扭傷及拉傷、滑囊，肌腱及滑液囊之其他疾患、肌肉，韌帶及筋膜疾患、軟組織之其他疾患、骨周圍著骨點病變及有關徵候群、肩骨點病變及有關徵候群、肘骨點病變、踝足骨點病變、其他背部疾患、頸椎椎間盤疾患、腰椎椎間盤疾患、頸椎關節病及有關疾患、腰椎關節病及有關疾患；職能治療師：滑囊，肌腱及滑液囊之其他疾患、軟組織之其他疾患、腕骨點病變、腰椎椎間盤疾患；放射師：骨周圍著骨點病變及有關徵候群、踝足骨點病變；營養師：肌肉，韌帶及筋膜疾患。值得注意的是醫師與藥師無顯著高於非醫療人員疾患，多種疾患種類甚至比非醫療人員低(p ＜ 0.05)。結論：臺灣醫療人員因執業關係較一般人發生骨骼肌肉疾患機率高，依各職類屬性而有不同部位與疾病之損傷，其中以護理人員、物理治療師、職能治療師等職類項目最為多見。臨床意義：本研究調查結果，可以提供主管機關作為醫療職務調整與傷害預防的參考。

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【論文摘要】Effect of 6-Week Shoulder-Neck Exercise on Cervical Muscle Functions of Middle-Aged and Older Adults With Chronic Neck Pain

Background and Purpose: Although neck pain is a common musculoskeletal disorder, there is no consensus on suitable exercise methods for patients with chronic neck pain. Therefore, the aim of this study was to evaluate the effect of a 6-week shoulder-neck exercise on cervical muscle functions in middle-aged and older adults with chronic neck pain. Methods: A total of 72 subjects with chronic neck pain were randomly allocated to either the experimental group (n = 36; age = 57.3 ± 8.7 years) or the control group (n = 36; age = 58.2 ± 8.2 years). The control group received only traditional physiotherapy, whereas the experimental group received a 6-week shoulder– neck exercise program consisting of traditional physiotherapy and additional cranio-cervical flexion and progressive resistance exercises. The muscle functions of subjects in both groups were tested before (pretest) and after (posttest) the intervention program. The pretest and posttest measured the cranio-cervical flexion test (CCFT) and the superficial cervical muscle strength. Generalized estimating equation (GEE) was used to detect differences in measurements between groups. The significance level was set at p ＜ 0.05. Results: After the intervention, the experimental group showed a 56.48 point improvement in the performance index of the CCFT (p ＜ 0.001), a 1.71- kg improvement in superficial neck flexor strength (p ＜ 0.001), and a 2.52-kg improvement in superficial neck extensor strength (p ＜ 0.001), indicating that in 6-week intervention significantly influenced the improvement of cervical muscle functions. Conclusion: This study confirmed that the 6-week shoulder-neck exercise program can effectively improve cervical muscle function in middle-aged and older adults with chronic neck pain. Clinical Relevance: This study proves the potential benefit of shoulder-neck exercise on deep and superficial neck muscle strength in adults with chronic neck pain. Therefore, this study may serve as a reference for the clinical rehabilitation of adults with chronic neck pain.

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【論文摘要】Subjective and Objective Assessment of Physical Activity Level After Primary Total Knee Arthroplasty

Background and Purpose: In the worldwide, the number of persons undergoing primary total knee arthroplasty (TKA) for severe arthritis and knee pain has been dramatically increased and imposed a significant burden on health care system and society. Previous studies have demonstrated TKA can effectively reduce pain and increase quality of life. However, it is unknown whether the pain relief and functional improvement could lead to increasing physical activity (PA). Unfortunately, to date the profile of PA after TKA is still unknown. Therefore, the purpose of this study was to investigate the changes of PA in patients with TKA using both questionnaire and accelerometer-based measures. Methods: A total of 31 TKA patients participated in this study and completed the pre-operative evaluation. Eleven patients completed the post-operative 4-month evaluation. In addition, 14 healthy older adults were included as controls in this study. The level of physical activity was assessed objectively using a wearable accelerometer for at least one week. Patients were also required to complete the International Physical Activity Questionnaires (IPAQ) for subjectively assessing the PA level. In addition, Knee range of motion and strength were assessed using a universal goniometer and hand-held dynamometer. Self-reported functions and health-related quality of life were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form 36 (SF-36). Results: The strengths of knee extensors, WOMAC scores, and quality of life were significantly improved at postoperative 4-month evaluation. The PA level measured by the wearable accelerometer showed significant increases in the durations of high-, moderate-, and light-intensity activities. The walking steps increased from 2,700.69 to 4,933.19 steps per day. The self-reported PA also showed significant increases in the durations of moderate-and light-intensity activities. The estimated total energy expenditure was also increased significantly. However, there might be some discrepancies between the PA profiles recording from the accelerometer and from the IPAQ. Conclusion: The PA level after receiving TKA has improved. However, the increase in PA at post-operative 4 month may merely result from pain relief and temporary changes of knee functions after TKA. The changes of PA level in TKA patients still needs to be followed for longer duration or compared to the healthy adults to further examine how mobility or other factors affect the PA level. Clinical Relevance: Our results provide important information to understand the trajectories of functions and PA for patients with TKA, and thus help developing intervention program for prompting health in this population.