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Effects of Family-centered Intervention on Long-term Parenting Stress in Preterm Children in Taiwan

Background and Purpose: Parents of preterm children tend to show higher parenting stress than parents of term children. Some intervention programs have been shown to alleviate short-term maternal stress in preterm children; however, long-term concurrent maternal and paternal parenting stress has rarely been investigated. This study was therefore aimed to examine the effects of the family-centered intervention program on paternal and maternal stress in preterm children with very low birth weight (VLBW: birth weight ＜ 1,500 g) from term to 48 months of age compared to the usual care program (UCP). Methods: This multi-centered randomized controlled trial included 246 preterm children with VLBW that the intervention group received in-hospital and after-discharge interventions and the UCP group received standard care from hospitalization to 12 months of age. The intervention contained child-, parent-, and dyad-focused services, including environmental modification, feeding support, massage, developmental skills training, techniques to enhance parent-infant interaction, home activities, and parental support. Both maternal and paternal stress were assessed using the Parenting Stress Index-Long Form when children approached term, 6, 12, 24, and 48 months of age. All children were examined developmental outcomes and the executors of home activities in the intervention group were recorded during the experimental period. Results: Maternal stress was significantly higher than paternal stress in the parent domain, child domain, life stress, and total stress (all p ＜ 0.05). The fathers of intervention group showed a significantly greater reduction of parenting stress from term to 48 months of age than the UCP group fathers in the child domain (-13.1 vs. -5.1, p = 0.014) and total stress (-18.6 vs. -6.0, p = 0.033). However, the mothers of the intervention and UCP groups were comparable in the change of parenting stress across ages. Higher maternal stress was associated with poorer child behavior (all p ＜ 0.0001); whereas, a greater reduction of paternal stress had borderline relations with better child motor development (p = 0.051 and 0.06). There was no relation between the executors of home activities and parenting stress in the intervention group. Conclusion: Family-centered intervention was effective in reducing paternal parenting stress in preterm children with VLBW, especially toward 48 months of age. Furthermore, mothers of preterm children with VLBW perceived higher parenting stress than fathers throughout the term to 48 months of age. The results provide insightful information for the design and outcome assessment of early intervention for preterm children with VLBW in Taiwan.

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肩胛運動異常與相關肩膀疾患：介入與療效

本文目的為探討肩胛運動異常之運動與徒手介入方法與療效。肩胛運動異常的介入策略需要依據臨床評估的結果來決定，以軟組織延展度問題與肌肉表現問題為主要介入目標。肩胛區域軟組織緊縮的介入以胸小肌和肩關節後側軟組織的伸展運動和徒手治療最為常見。肌肉表現問題的介入主要分成3個階段：（1）在肩胛訓練早期，透過肩胛知覺控制提高個案對肩胛位置的本體感覺與恢復正常肩胛位置；（2）當個案能妥善控制肩胛骨位置後，下個階段會進展到日常生活動作能進行肩胛骨動態控制與肌肉活化。根據個案功能性需求教導開放鏈和閉鎖鏈肩胛運動；（3）最後階段會進展到針對過肩運動或功能特定動作進行肩胛肌力耐力訓練並整合動力鏈動作進入進階運動計畫。探討短期肩胛介入計畫對疼痛、肩膀功能、肩胛運動學與其它肩胛相關量測的文獻日趨增加。文獻結果顯示針對肩胛區域軟組織緊縮或肌肉表現問題或合併進行短期介入後會有疼痛減少與功能改善，但肩胛運動學的改變結果具有爭議。未來仍需要更多研究釐清肩膀疼痛與功能和肩胛動作改變之間的關係。

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新冠肺炎疫情期間物理治療師於醫學中心的臨床工作經驗

嚴重特殊傳染性肺炎於2020年蔓延全球，已造成嚴重的疫情。本文之目的在於提供新冠肺炎疫情期間，在醫學中心工作的物理治療師配合防疫政策的臨床工作經驗。在疫情期間為能安心維持治療工作的正常進行，必然相對應的各項嚴格的感染管制措施，包括環境設備的清潔消毒及治療人員的分艙分流等。此外，教學醫院肩負實習教學任務，考量學生學習的權益及環境的安全，在疫情期間亦指導實習學生認識如何面對重大傳染疫情與實踐物理治療師的責任與義務。同時討論在新冠肺炎疫情期間於臨床工作的困境，以及所作出的因應措施。

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病例報告：跨專業早期介入於先天性全身脂肪失養症個案之成效

此病例報告為一第二型先天性全身脂肪失養症的個案，旨在呈現此類型個案的早期介入成效，其介入內容包含早期物理治療介入、專業間早期介入及聯合評估後進入跨專業服務模式之早期療育門診給付改善方案，建立以家庭為中心的整合性照護模式。由個案1.5個月大時開始介入到目前2歲9個月大，此個案在整體動作能力、認知能力及語言能力皆有成效，生理生化檢查數據亦大多在正常範圍內。惟此類型個案於國內探討復健介入成效之文獻目前僅有一篇臨床實務經驗，未來仍需更多文獻研究進一步探討。

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【論文摘要】Effects of Blood Flow Restriction Training Combined With Abdominal Draw-in Maneuver on Transverse Abdominis Strengthening

Background and Purpose: The abdominal draw-in maneuver (ADIM), which is a main exercise usually used in clinics, is a core stability exercise in which TrA is selectively contracted earlier than other muscles on the surface such as the rectus abdominis, external oblique (EO), and internal oblique (IO) muscles. It is difficult to carry out ADIM precisely with sufficient activation of TrA. Blood flow restriction (BFR) is a training method performing light-load exercise with reduced blood flow to achieve an effective strengthening result similar with heavy-load training. However, there are few evidences for BFR training on core muscles, especially for TrA. The purpose of this study was to explore the effects of ADIM combined with BFR on TrA strengthening in healthy adults. Methods: Thirty healthy adults (age ranged 18-34 years) were recruited in the study and randomly divided into two groups including ADIM combined with BFR (n = 15) and ADIM alone (n = 15) groups. Participants received strengthening of ADIM combined with BFR or ADIM alone for 20 minutes per session, twice a week for 4 weeks. The thickness of IO, EO, and TrA measured by ultrasonography, core endurance, strength and stability measured by endurance test, dynamometer and double leg lowering test were evaluated before (week 1), after 8-session training (week 4) and final follow-up (week 5). Results: There were significantly increment on thickness and activation ratio of TrA and improvements on core endurance, strength and stability in the group trained with ADIM combined with BFR when compared to those with ADIM alone (p ＜ 0.05). Conclusion: ADIM combined with BFR might strengthen TrA effectively and precisely in young healthy subjects. Clinical Relevance: The findings provide a potential clinical rehabilitation tool for training of core deep muscle, especially for TrA strengthening.

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【論文摘要】The Influence of Glenohumeral Internal Rotation Deficit on Pitching Biomechanics in Elite High School Baseball Pitchers

Background and Purpose: Glenohumeral internal rotation deficit (GIRD) is believed to be a potential risk factor contributing to shoulder injury. Additionally, research has reported that it is associated with altered scapular kinematics. However, it is unclear whether these alterations and changes in muscle activities are related to fastball pitching in pitchers with and without symptom. The objectives of this study were to compare the scapular kinematics and associated muscular activities during fastball pitching in baseball pitchers with and without GIRD and GIRD baseball pitchers with and without symptom. Methods: Thirty-three high school baseball pitchers were recruited for 3 groups (11 pitchers per group), asymptomatic baseball pitchers without GIRD (AwG), asymptomatic baseball pitchers with GIRD (AG), and symptomatic baseball pitchers with GIRD (SG). During fast ball pitching, the scapular kinematics (upward/downward rotation, anterior/posterior tilt, external/internal rotation) and associated muscle activation (upper trapezius, lower trapezius, serratus anterior, anterior deltoid, biceps brachii, and triceps brachii) were recorded by three-dimensional electromagnetic motion analysis and electromyography. Results: GIRD baseball pitchers had increased scapular anterior tilt (AG = 6.8-18.4°, p ＜ 0.01 and SG = 14.5°, p = 0.009, respectively) compared to baseball pitchers without GIRD (AwG). Increased triceps brachii and serratus anterior muscular activity (9.9%, p = 0.015; 30.8%, p = 0.006, respectively) were also found in GIRD baseball pitchers (AG) compared to baseball pitchers without GIRD (AwG). Additionally, GIRD baseball pitchers with symptom (SG) had decreased triceps brachii and serratus anterior muscular activity (37.8%, p = 0.016; 4.8-30.2%, p ＜ 0.01, respectively) compared to GIRD baseball pitchers without symptom (AG). Conclusion: GIRD and symptom showed different effect on scapular kinematics and associated muscular activities during fastball pitching. Increased scapular anterior tilt and serratus anterior, triceps brachii muscle activity during pitching were characterized in GIRD pitchers while decreased serratus anterior, triceps brachii muscle activity during pitching were characterized in GIRD with symptom. Clinical Relevance: GIRD pitchers had specific characteristics during fastball pitching, like altered scapular anterior tilt and serratus anterior, triceps brachii muscle activity. These changes may be related to further symptomatic development. On the other hand, serratus anterior and triceps brachii muscle activity are important to consider in the rehabilitation of symptomatic GIRD pitchers.

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【論文摘要】Kinematics and Muscle Activity of Temporomandibular Joint in Patients With Non-specific Chronic Neck Pain

Background and Purpose: Non-specific chronic neck pain (NCNP) is highly prevalent, affecting 16.7-75.1% of population. Over one-fifth of patients with NCNP suffer from temporomandibular disorder (TMD), and those with neck pain has higher prevalence of TMD than those without neck pain. The comorbidity between NCNP and TMD could be explained by forward-head posture or neuronal convergence. Patients with TMD have showed changes in TMJ kinematics during movement, and altered muscle activation during resting and clenching. Although neck problems are highly associated with TMD, no study has investigated whether patients with NCNP demonstrate altered TMJ kinematics and muscle activation before they show any symptoms of TMD. Therefore, this study aimed to compare kinematics and muscle activity in patients with NCNP to those in healthy subjects. Methods: This is a cross-sectional exploratory study. We recruited 15 healthy subjects (8 males and 7 females, 20-30 years old) and 20 subjects, who had NCNP but no TMD symptom (10 males and 10 females, 20-34 years old). Zebris Jaw Motion Analyzer was used to measure TMJ kinematics data during mouth opening, closing, protrusion and lateral deviation. Surface electromyography was used to assess muscle activity of anterior temporalis, masseter, sternocleidomastoid and upper trapezius during clenching. Three-way ANOVA was used to compare condylar movements in different phases. Two-way ANOVA and independent t test were used to analyze other parameters. The significant level set at 0.05. Results: As compared to the healthy, NCNP group showed increased condylar path length during mouth opening (p = 0.019) and increased condylar translation during mouth opening and closing (p ＜ 0.003). No significant difference was found in muscle activity. Conclusion: Patients with NCNP demonstrate altered TMJ kinematics during movement. These changes might be early signs of the potential development of TMD. Clinical Relevance: In patients with mild NCNP, clinician may evaluate any increased condylar translation in their TMJs.

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【論文摘要】The Effects of Scapular Conscious Control Training and Strengthening Training on the Corticospinal System in Overhead Athletes With Shoulder Impingement Syndrome

Background and Purpose: Shoulder impingement syndrome (SIS) is the most common cause of shoulder pain. Previous studies have found that patients with SIS demonstrate abnormal scapular kinematics and muscle activation patterns. Recent studies also show that patients with SIS demonstrate changes in corticospinal system, including decreases in corticospinal excitability and increases in corticospinal inhibition of scapular muscles. To restore scapular kinematics and muscle activation patterns in patients with SIS, treatment protocols usually include scapular-focused exercises, such as scapular conscious control training (CCT) and strengthening training (ST). It is still not well understood whether these two types of exercise can reverse the changes in corticospinal system in patients with SIS. Therefore, the purpose of this study was to investigate the immediately effects of 30-minute CCT and ST on the corticospinal system and neuromuscular control in patients with SIS. Methods: This is a randomized control trial. Forty-one individuals with SIS were randomly assigned into either a CCT group or ST group. The outcomes included parameters testing the corticospinal system, scapular muscle activation, and scapular kinematics. The parameters of the corticospinal system included active motor threshold, motor evoked potential (MEP), cortical silent period, short interval intracortical inhibition and facilitation. These parameters were tested with transcranial magnetic stimulation, targeting lower trapezius (LT) muscle but collecting data of serratus anterior (SA) muscle simultaneously. Outcomes were measured before and after a 30-minute intervention protocol, which included three exercises to strengthen LT and SA muscles. When performing these exercises, subjects in the CCT group were trained to consciously control their scapula with electromyographic (EMG) biofeedback while subjects in the ST group did not have the feedback. The immediate training effects in two groups on the corticospinal excitability and inhibition were tested by two-way mixed repeated measures ANOVA. Those of the scapular muscle activation and kinematics was assessed by three-way mixed repeated measures ANOVA. Results: Following the CCT or ST, both groups demonstrated a significant increase in corticospinal excitability (MEP) of LT (p = 0.004) and SA muscles (p = 0.030) with no group difference. In addition, both groups also showed a significant increase in activation of LT (p ＜ 0.001) and SA muscles (p ＜ 0.001) during arm elevation with no group difference. There was no change in the scapular kinematics in both groups. Conclusion: Both CCT and ST can increase corticospinal excitability and scapular muscle activation. Future work may apply a short-term or long-term treatment protocol and study whether changes in corticospinal system are associated with pain and functional improvement. Clinical Relevance: With or without EMG biofeedback, a 30-minute scapula-focused exercise protocol can induce changes in central nervous system and neuromuscular control. Therefore, in clinical practice, as long as the exercise is correctly performed, EMG biofeedback may not be necessary during exercise training.

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【論文摘要】比較團體形式奧塔哥防跌運動與體感復健系統介入對於具跌倒風險長者之身體功能及步態表現改善效果

背景與目的：跌倒是影響長者身心健康與生命安全的重要議題，如何預防跌倒的發生是當務之急。本研究旨在探討並比較奧塔哥防跌運動（otago exercise program）與體感遊戲運動（exergame）介入，對於改善具跌倒風險長者之身體功能、跌倒風險與步態的效果。方法：本研究招募51名居住於社區或照護機構、且可獨立行走之長者（年齡≥65歲），符合以下任一點即具有具有跌倒風險：（1）過去一年具有跌倒史、（2）跌倒風險分數＞1分、（3）計時起走測試（time up and go, TUG）秒數＞13.5秒，採非隨機分配至奧塔哥運動組（16位）、體感遊戲組（15位）及對照組（20位），進行每周兩次、為期3個月的奧塔哥運動或體感遊戲介入。以澳洲跌倒風險生理評估系統（physiological profile assessment）及若干跌倒篩檢測試，如：TUG、5次坐到站測試（five times sit to stand, FTSS）、Tinetti氏之表現導向行動評量（Tinetti Performance Oriented Mobility Assessment）和配戴穿戴式步態感測器Physilog®5進行6公尺行走測試，作為介入前（基測T_0）、介入三個月後（後測T_1）及介入結束後3個月（追蹤後測T_2）之成效評估。使用Kruskal-Wallis測試進行3組基本特質比較，並以Mann-Whitney U測試進行事後分析；類別變項則使用卡方檢定。介入成效以各組從T_0、T_1到T_2之間的改變量予以界定，同樣使用Kruskal-Wallis測試進行組間比較，以Mann-Whitney U測試進行事後分析；組內效應則使用Wilcoxon sign rank測試進行比較。結果：長者平均年齡為79.8±7.24歲，女性比例佔54.9%。經過3個月運動介入後（T_1），在膝伸直肌力（p=0.002）、步頻（p=0.014）、足部平貼期（foot-flat）佔比（p=0.026）、步行速度（p＜0.001）、跨步長（p=0.004）和腳後跟抬離角度（lift-off angle）（p=0.018）達組間顯著差異，奧塔哥運動組和體感遊戲組皆優於對照組，然兩組運動介入組無明顯差異。在TUG（p=0.007）和FTSS（p=0.008）三組亦達組間顯著差異，僅體感遊戲組優於對照組。各組於介入結束後3個月之追蹤後測（T_2）大致維持在T_1水平，T1－T2期間僅體感遊戲組之FTSS相較於其他兩組有明顯退步（p=0.011）。若以追蹤後測值與基測值相比（T_0－T_2期間），奧塔哥運動組和體感遊戲組在TUG（p=0.001）和步行速度（p＜0.001）之改善幅度優於對照組，然而兩組運動介入組無明顯差異。就跌倒風險指數而言，體感遊戲組經過介入後跌倒風險降低（T_0－T_1）、於介入結束後3個月的追蹤後測仍能維持其改善效果（T_1－T_2），但奧塔哥運動組與對照組則呈現先下降（T_0－T_1）、後回升（T_1－T_2）的趨勢。結論：進行三個月的奧塔哥運動或體感遊戲介入，對於居住於社區或照護機構、且具跌倒風險的長者皆能帶來正面效果，可改善身體功能、降低跌倒風險及改善步態，並具有一定的維持效果。臨床意義：奧塔哥運動計畫和體感遊戲運動皆具有改善跌倒風險和步態表現的效果，可提供具跌倒風險長者因地制宜之臨床介入參考。

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【論文摘要】The Dual-task Effects on Postural Control in Patients With Early-stage Parkinson Disease Without Clinically Observed Postural Symptoms

Background and Purpose: Postural impairment is common in patients with Parkinson disease (PD). Because of no prominent postural symptoms, the issue of postural control ability in patients with early-stage PD has not been well investigated. On the other hand, ＂clinically observed postural symptoms＂ of early-stage PD was based on the performance of single postural tasks. However, dual-task paradigms are considered a more sensitive tool for postural control evaluation. Therefore, this study aimed to compare dual-task effects on postural control and its related brain activity between patients with early-stage PD who had no clinically observed postural symptoms and age-matched healthy adults. Methods: Sixteen patients with early-stage PD without clinically observed postural symptoms and sixteen age-matched healthy adults were recruited in this study. Participants were asked to (1) maintain balance in a tandem stance only (single-task condition), and (2) keep two interlocking rings apart and maintain balance in a tandem stance (dual-task condition). Postural sway, postural determinism (%DET), ring-touching time, and brain activity in theta band (4-8 Hz) recorded by electroencephalography were analyzed. Results: Under the single-task condition, there were no significant differences in postural sway and postural %DET between the patients with PD and the healthy subjects (postural sway: p = 0.070; postural %DET: p = 0.928). However, the patients with PD had higher theta power than the healthy subjects in Fz and FCz. When the ring-task was added, the PD patients showed greater values of postural sway and postural %DET compared to those in the healthy subjects (postural sway: p = 0.042; postural %DET: p = 0.007). In addition, the PD patients had greater theta power in bilateral frontal areas (F3/4, Fz, FC3/4, FCz) and left sensorimotor-parietal areas (C3, Cz, CP3, CPz, P3, Pz) relative to the healthy subjects under the dual-task condition. Conclusion: Patients with early-stage PD had to recruit more attentional resource for postural control (e.g. greater theta power). Besides, because much more attentional resource was devoted to the postural task, the automaticity for dual-task postural control was deteriorated (e.g., greater postural %DET) in patients with early-stage PD under the dual-task condition. Clinical Relevance: Our results provide important information that early intervention in postural balance, especially in dual-task postural control, is necessary for patients with early-stage PD, even the patients do not show clinically observed postural symptoms.