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Chao TC, Chiang SL, Lai CY, Huang CY, Lee MS, Lin CH, Chang CC, Lin CH. Association between Physical Activity Amount and Cardiorespiratory Fitness, Sleep Quality, and Health-related Quality of Life in Patients with Long COVID: A Cross-Sectional Study. Arch Phys Med Rehabil 2024:S0003-9993(24)00952-3. [PMID: 38697594 DOI: 10.1016/j.apmr.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To investigate the association between physical activity (PA) amount and gender differences on cardiorespiratory fitness (CRF), sleep quality, and health-related quality of life (HRQoL) in individuals with long COVID. DESIGN Cross-sectional study. SETTING An integrated outpatient clinic for post-COVID-19 at a medical center. PARTICIPANTS Convenience sample of patients (N=264) diagnosed with long COVID. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES PA amounts, sleep quality, and HRQoL were measured by the International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, and the World Health Organization Questionnaire on Quality of Life: Short Form, respectively. CRF was evaluated through graded exercise testing. RESULTS The participants had a mean age of 42.5±13.5 years and a mean duration of post-COVID-19 symptoms of 12.7±6.8 weeks. More than half (n=149, 56.5%) were female patients. Female participants had significantly lower CRF compared to male participants (P<.05). Older age and higher body mass index were associated with worse CRF and HRQoL (P<.05). Less sitting behavior and greater amounts of vigorous-intensity physical activity (VPA) or total PA were associated with better CRF (P<.05). In addition, greater total PA and moderate-intensity physical activity (MPA) were associated with better sleep quality and HRQoL (P<.05), respectively. CONCLUSIONS Gender differences were found in CRF among patients with long COVID. Greater self-reported VPA or total PA was associated with better CRF, while greater total PA and MPA were associated with better sleep quality and HRQoL, respectively, in patients with long COVID. Further research is needed to explore these associations in longitudinal studies.
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Affiliation(s)
- Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chueh-Ho Lin
- School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.
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Lu YY, Lin CM, Chiang SL. Adrenal insufficiency following cerebellar intracranial hemorrhage: a case report. Front Neurol 2024; 15:1332604. [PMID: 38533414 PMCID: PMC10963601 DOI: 10.3389/fneur.2024.1332604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
This report presents a case of a previously healthy 58 years-old man who had suffered from persistent weakness and dizziness after a cerebellar intracranial hemorrhage (ICH). Endocrine function tests revealed low levels of plasma cortisol (3.05 μg/dL; normal range: 5-25 μg/dL) and adrenocorticotropic hormone (ACTH) (6.0 pg/mL; normal range: 10-60 pg/mL). The subsequent ACTH stimulation test suggested partial or recent hypopituitarism, resulting in adrenal gland atrophy and a subnormal cortisol response. Ultimately, the dizziness was found to be caused by undiagnosed adrenal insufficiency, which was detected when a hypotensive fainting incident occurred during rehabilitation. The symptoms improved significantly with oral prednisone supplementation. Notably, the duration of impaired hypothalamic-pituitary-adrenal axis may last as long as a year. This case highlights that adrenal insufficiency can easily be overlooked since its symptoms are similar to those commonly seen with cerebellar stroke alone. Physicians must be aware of the symptoms of adrenal insufficiency in patients with brain insults and conduct the appropriate endocrine tests to clarify the underlying comorbidity.
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Affiliation(s)
- Yu-Yang Lu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Ming Lin
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Lin CH, Tzeng WC, Chiang LC, Lee MS, Chiang SL. Determinants of nurses' readiness for disaster response: A cross-sectional study. Heliyon 2023; 9:e20579. [PMID: 37810822 PMCID: PMC10550620 DOI: 10.1016/j.heliyon.2023.e20579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023] Open
Abstract
Reducing the impacts of disasters is imperative in these times when disasters continually threaten people's lives. Given that the readiness for disaster response of nurses are essential in mitigating damage, however, studies on the determinants of nurses' readiness for disaster response remain inconclusive and require further research, especially with various populations. This study therefore aimed to investigate factors associated with readiness for disaster response among Taiwanese hospital nurses. A cross-sectional study was conducted on 365 eligible and registered nurses at a medical centre in northern Taiwan. The Readiness for Disaster Responses Scale including four subscales: personal preparedness, self-protection, emergency response, and clinical management were used for assessment. Analyses were performed using multiple linear regression models. Our study results showed that the length of nursing work was positively associated with nurses' readiness for disaster responses (β = 0.28, p < .001). Nurses with a master's degree and working in intensive care units or emergency rooms had higher readiness for disaster responses (β = 0.13, p = .032; β = 0.14, p = .024) than those with a bachelor's degree and working in other units/specialties (i.e., outpatient department, operating rooms, etc.). Furthermore, nurses with previous disaster training were associated with greater readiness for disaster responses (β = 0.24, p < .001). This study findings indicate that the identified determinants of hospital nurses' readiness for disaster responses can be taken into consideration in the future recruiting of nurses for deployment to disaster response assistance and the designing of disaster training programmes specifically for nurses.
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Affiliation(s)
- Chia-Huei Lin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Li-Chi Chiang
- School of Nursing & Graduated Institute of Medical Science, National Defense Medical Center & China Medical University, Taipei, Taichung, Taiwan, ROC
| | - Meei-Shyuan Lee
- School of Public Health & Graduated Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, & School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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Chiang SL, Shen CL, Lee MS, Lin CH, Lin CH. Effectiveness of a 12-week tele-exercise training program on cardiorespiratory fitness and heart rate recovery in patients with cardiometabolic multimorbidity. Worldviews Evid Based Nurs 2023; 20:339-350. [PMID: 36193903 DOI: 10.1111/wvn.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exercise has positive impacts on cardiometabolic health. However, evidence regarding the effectiveness of tele-exercise training on cardiorespiratory fitness and heart rate recovery in patients with cardiometabolic multimorbidity remains limited. AIMS The aim of this study was to assess whether an assumed increase in physical activity (PA) after a 12-week tele-exercise training program improved cardiorespiratory fitness and heart rate recovery of patients with cardiometabolic multimorbidity. METHODS A parallel-group randomized controlled trial was conducted. Eligible patients with cardiometabolic multimorbidity (n = 83) were randomized 1:1 to either an experimental group (EG, received a 12-week tele-exercise training program with 3 sessions/week and 30 min/session and weekly remote monitoring for maintenance of exercise) or a control group (CG, usual care only). PA, cardiorespiratory fitness, and heart rate recovery were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group. RESULTS Sixty-eight participants (81.9%) completed the study, and 83 were included in the intention-to-treat analysis. The EG with higher vigorous-intensity PA (β = 714, p = .037), walking behavior (β = 750, p = .0007), and total amount of PA (β = 1748, p = .001) after the intervention had significantly elevated cardiorespiratory fitness, including VO2peak (β = 3.9, p = .042), workload (β = 17.9, p = .034), and anaerobic threshold (β = 2.1, p = .041), and increased one-min heart rate recovery (β = 5.3, p = .025), compared with the CG. LINKING EVIDENCE TO ACTION A 12-week tele-exercise training program was effective for increased PA, elevated cardiorespiratory fitness, and improved heart rate recovery for patients with cardiometabolic multimorbidity. These findings highlight the feasibility of better delivering lifestyle interventions for cardiometabolic health management.
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Affiliation(s)
- Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | - Meei-Shyuan Lee
- School of Public Health, Graduated Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Chueh-Ho Lin
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
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Chang JL, Chen HJ, Chen PY, Chou LW, Lai CH, Lu YH, Chiang SL, Lin CH, Wang XM, Lin CH. Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs. J Neuroeng Rehabil 2023; 20:32. [PMID: 36932449 PMCID: PMC10022551 DOI: 10.1186/s12984-023-01157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Coordinated control between the bilateral ankle joints plays an important role in performing daily life functions, such as walking and running. However, few studies have explored the impact of stroke on movement disorders that decrease the coordination control of the bilateral extremities and may decrease daily activities that require coordination control of the bilateral ankles. This study aimed to investigate the coordination control of the bilateral ankles using a novel bilateral ankle measurement system and evaluate the relationship of bilateral movement coordination control deficits with motor and functional performances of the lower extremities in patients with stroke. METHODS Twenty-one healthy adults (36.5 ± 13.2 y/o) and 19 patients with chronic stroke (58.7 ± 10.5 y/o) were enrolled. A novel measurement device with embedded rotary potentiometers was used to evaluate bilateral ankle coordination control. Participants were asked to move their dominant (non-paretic) foot from dorsiflexion to plantarflexion position and non-dominant (paretic) foot from dorsiflexion to plantarflexion position (condition 1) simultaneously, and vice versa (condition 2). Alternating time and angle for coordination control with movements of both ankles were calculated for each condition. Motor and functional performance measurements of the lower extremities included the lower-extremity portion of the Fugl-Meyer assessment (FMA-LE), Berg Balance Test (BBS), Timed Up and Go Test (TUG), and Barthel Index (BI). RESULTS Compared with the healthy group, alternating time was shorter in the stroke group by 8.3% (p = 0.015), and the alternating angles of conditions 1 and 2 were significantly higher than those of the healthy group by 1.4° (p = 0.001) and 2.5° (p = 0.013), respectively. The alternating angle in condition 2 showed moderate correlations with TUG (r = 0.512; p = 0.025), 10-m walk (r = 0.747; p < 0.001), gait speed (r = - 0.497 to - 0.491; p < 0.05), length (r = - 0.518 to - 0.551; p < 0.05), and BI (r = - 0.457; p = 0.049). CONCLUSION Stroke decreases alternating time, increases alternating angle, and shows bilateral ankle coordination control deficits temporally and spatially. A higher alternating angle is moderately to highly associated with motor function and lower limb function in patients with stroke.
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Affiliation(s)
- Jia-Lan Chang
- grid.412955.e0000 0004 0419 7197Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291, Jhongjheng Rd., Jhonghe, New Taipei, 23561 Taiwan
- grid.412896.00000 0000 9337 0481Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Hung-Ju Chen
- grid.59784.370000000406229172National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Rd., Zhunan Town, Miaoli County, 350 Taiwan (R.O.C.)
| | - Po-Yin Chen
- grid.412896.00000 0000 9337 0481Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Li-Wei Chou
- grid.260539.b0000 0001 2059 7017Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112 Taiwan (R.O.C.)
| | - Chien-Hung Lai
- grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
- grid.412897.10000 0004 0639 0994Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., New Taipei City, 235 Taiwan (R.O.C.)
- grid.412896.00000 0000 9337 0481Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Shang-Lin Chiang
- grid.278244.f0000 0004 0638 9360Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei, 114 Taiwan (R.O.C.)
| | - Chia-Huei Lin
- grid.278244.f0000 0004 0638 9360Department of Nursing, Tri-Service General Hospital; School of Nursing, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei, 114 Taiwan (R.O.C.)
| | - Xin-Miao Wang
- Faculty of Humanities, Zhejiang Dong Fang Polytechnic College, 47Th Floor, China Resources Building B 1366 Qianjiang Road, Hangzhou, China
| | - Chueh-Ho Lin
- grid.412896.00000 0000 9337 0481Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
- grid.416930.90000 0004 0639 4389Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Taipei, 116 Taiwan (R.O.C.)
- grid.412896.00000 0000 9337 0481International Ph.D. Program in Gerontology and Long-Term Care, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
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Kao CH, Chiang SL, Chou LW, Lin CH, Lu YH, Lu LH, Wang XM, Lin CH. Validation of Vibration Exercises on Enhancing Muscle Strength and Upper Limb Functionality among Pre-Frail Community-Dwelling Older Adults. Int J Environ Res Public Health 2022; 19:14509. [PMID: 36361390 PMCID: PMC9653631 DOI: 10.3390/ijerph192114509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
Pre-frail older adults require appropriate exercise to enhance muscle strength as well as upper limb functionality. We developed a handheld vibrator and evaluated its effectiveness in enhancing muscle strength compared to conventional exercises among pre-frail community-dwelling older adults. Thirty-one pre-frail older adults (aged 75.5 ± 5.1 years) were recruited and randomly allocated to a vibration group (VG) and control group (CG). The VG underwent 20 minutes of vibration (frequency: 30 Hz, amplitude: 5 mm, horizontal vibration) using a handheld vibrator as well as 40 minutes of conventional exercise. The CG received 60 minutes of conventional exercise only. The primary outcome was muscle strength assessment (kg), and the secondary outcome included activities of daily living and instrumental activities of daily living scores. The comparisons between the outcome measures revealed no significant differences at the baseline level. Muscle strength of the dominant (ß = 2.49, p = 0.002) and non-dominant (ß = 1.89, p = 0.02) wrist flexion, brachioradialis (ß = 3.8, p = 0.01), and biceps brachii (ß = 3.02, p = 0.02) in the dominant upper limbs was significantly increased among the VG. The vibration intervention can enhance muscle strength in the upper limbs among pre-frail older adults.
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Affiliation(s)
- Chia-Hui Kao
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Li-Wei Chou
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chia-Huei Lin
- Department of Nursing, Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei 114, Taiwan
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, Taipei 110, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Xin-Miao Wang
- Faculty of Humanities, Zhejiang Dong Fang Polytechnic College, Wenzhou 325011, China
| | - Chueh-Ho Lin
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
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Lin CH, Lin CH, Chen LC, Wei SH, Sung WH, Lu LH, Chang ST, Lin YH, Lee CY, Chiang SL. Chronic low back pain is associated with impaired bed turning ability: Evaluation by a mobility detection system. Clin Biomech (Bristol, Avon) 2022; 92:105572. [PMID: 35051838 DOI: 10.1016/j.clinbiomech.2022.105572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to assess and compare kinetics and kinematic variables of bed turning ability using a mobility detection system in patients with and without chronic low back pain and to observe the impacts of the disease on bed turning kinetics and kinematics. METHODS Thirty-five patients with chronic low back pain were enrolled and compared to healthy controls (n = 34). Pain scores and disability level were assessed by Numeric Pain Rating Scale and the function questionnaires including Oswestry Disability Index and Roland Morris Disability Questionnaire. Bed turning ability was tested using the Mobile Detection System. Univariate and multivariate regression analysis were applied to compare the differences between groups. FINDINGS Patients with chronic low back pain had significantly lower turning over and back force/weight ratio (p < 0.001) than those healthy controls. Turning over time was significantly longer in patients with Numeric Rating Scale score 3 than in those with Numeric Rating Scale score 2 (p = 0.015). Turning over and back force were significantly higher in male patients and patients with higher BMI after adjusting BMI and sex, respectively (all p < 0.001). When turning back, chronic low back pain patients with Numeric Rating Scale scores of 3 had lower turning back force/weight ratio than those with Numeric Rating Scale scores of 2 (p = 0.014). Male patients had higher turning back force/weight ratio after adjusting pain score (p = 0.001). INTERPRETATION The novel Mobility Detection System can provide more objective assessments of bed turning kinetics and kinematics in patients with chronic low back pain.
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Affiliation(s)
- Chia-Huei Lin
- School of Nursing, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Tsu Chang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yi-Hui Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Yi Lee
- Department of Physical Medicine and Rehabilitation, Kaohsiung Armed Forces General Hospital Gangshan Branch, Kaohsiung, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
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Liu WJ, Lin LF, Chiang SL, Lu LH, Chen CY, Lin CH. Impacts of Stroke on Muscle Perceptions and Relationships with the Motor and Functional Performance of the Lower Extremities. Sensors (Basel) 2021; 21:s21144740. [PMID: 34300480 PMCID: PMC8309499 DOI: 10.3390/s21144740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
Stroke results in paretic limb disabilities, but few studies have investigated the impacts of stroke on muscle perception deficits in multiaxis movements and related functional changes. Therefore, this study aimed to investigate stroke-related changes in muscle perceptions using a multiaxis ankle haptic interface and analyze their relationships with various functions. Sixteen stroke patients and 22 healthy participants performed active reproduction tests in multiaxis movements involving the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus, and flexor digitorum longus (FDL) of the ankle joint. The direction error (DE), absolute error (AE), and variable error (VE) were calculated. The lower extremity of Fugl-Meyer Assessment (FMA-LE), Barthel Index (BI), Postural Assessment Scale for Stroke Patients, Tinetti Performance-Oriented Mobility Assessment (POMA), and 10-m walk test (10MWT) were evaluated. VE of EDL for the paretic ankle was significantly lower than that for the nonparetic ankle (p = 0.009). AE of TA, EDL, and FDL and VE of EDL and FDL of muscle perceptions were significantly lower in healthy participants than in stroke patients (p < 0.05 for both). DE of TA for the paretic ankle was moderately correlated with FMA-LE (r = -0.509) and POMA (r = -0.619) scores. AE and VE of EDL for the paretic ankle were moderately correlated with the 10MWT score (r = 0.515 vs. 0.557). AE of FDL for the paretic ankle was also moderately correlated with BI (r = -0.562). This study indicated poorer accuracy and consistency in muscle perception for paretic ankles, which correlated with lower limb functions of stroke patients.
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Affiliation(s)
- Wan-Ju Liu
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan;
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan;
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan;
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 112, Taiwan;
| | - Chao-Ying Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan;
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Correspondence: ; Tel./Fax: +886-2-27361661 (ext. 6325)
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Cheng YY, Chen CM, Huang WC, Chiang SL, Hsieh PC, Lin KL, Chen YJ, Fu TC, Huang SC, Chen SY, Chen CH, Chen SM, Chen HS, Chou LW, Chou CL, Li MH, Tsai SW, Wang LY, Wang YL, Chou W. Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation. J Formos Med Assoc 2021; 120:83-92. [PMID: 32863084 PMCID: PMC7430281 DOI: 10.1016/j.jfma.2020.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 01/08/2023] Open
Abstract
The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice.
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Affiliation(s)
- Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No.1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan,School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Chin-Ming Chen
- Department of Intensive Care Medicine, Chi-Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan, Taiwan,Center for Quality Management, Chi-Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan, Taiwan,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Chun Huang
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan,Department of Critical Care Medicine and Cardiology Center, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, Taiwan,Department of Physical Therapy, Fooyin University, No. 151 Jinxue Rd., Daliao Dist., Kaohsiung, Taiwan,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Rd., Sanmin Dist., Kaohsiung, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei, Taiwan,School of Medicine, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, No. 138, Sheng Li Rd., Tainan, Taiwan,Institute of Clinical Medicine, National Cheng Kung University, No. 1, University Rd., Tainan, Taiwan
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, Taiwan
| | - Yi-Jen Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung, Taiwan,Department of Physical Medicine and Rehabilitation, School of Medicine, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Rd., Sanmin Dist., Kaohsiung, Taiwan,Department of Physical Medicine and Rehabilitation, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd, Siaogang Dist., Kaohsiung, Taiwan,Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung, Taiwan
| | - Tieh-Cheng Fu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist., Keelung, Taiwan,Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist., Keelung, Taiwan,School of Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, Taiwan
| | - Shu-Chun Huang
- School of Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, Taiwan,Department of Physical Medicine and Rehabilitation, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, Taiwan,Healthy Aging Research Center, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, Taiwan
| | - Ssu-Yuan Chen
- Division of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, No. 69, Guizi Rd., Taishan District, New Taipei City, Taiwan,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 1, Changde St., Zhongzheng Dist., Taipei, Taiwan
| | - Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung, Taiwan,Department of Physical Medicine and Rehabilitation, School of Medicine, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Rd., Sanmin Dist., Kaohsiung, Taiwan,Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung, Taiwan
| | - Shyh-Ming Chen
- School of Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, Taiwan,Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung, Taiwan
| | - Hsin-Shui Chen
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin, Taiwan,PHD Program of College of Medicine, China Medical University, No. 2, Yuh-Der Rd., Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, No. 91, Hsueh-Shih Rd., Taichung, Taiwan,Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, No. 91, Hsueh-Shih Rd., Taichung, Taiwan,Department of Rehabilitation, Asia University Hospital, No. 500, Lioufeng Rd., Wufeng, Taichung, Taiwan
| | - Chen-Liang Chou
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan,Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, Taiwan
| | - Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., Taichung, Taiwan,School of Medicine, Tzu Chi University, No. 701, Zhongyang Rd., Sec. 3, Hualien, Taiwan
| | - Lin-Yi Wang
- School of Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, Taiwan,Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung, Taiwan
| | - Yu-Lin Wang
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan, Taiwan,Center of General Education, Southern Taiwan University of Science and Technology, No. 1, Nan-Tai Street, Yongkang Dist., Tainan, Taiwan
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan, Taiwan; Center of General Education, Southern Taiwan University of Science and Technology, No. 1, Nan-Tai Street, Yongkang Dist., Tainan, Taiwan.
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10
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Lo YP, Chiang SL, Lin CH, Liu HC, Chiang LC. Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial. Int J Environ Res Public Health 2020; 18:ijerph18010101. [PMID: 33375668 PMCID: PMC7794827 DOI: 10.3390/ijerph18010101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/21/2022]
Abstract
The presence of multimorbidity in middle-aged and older adults, which reduces their physical activity and quality of life, is a global health challenge. Exercise is one of the most important health behaviors that individuals can engage in. Previous studies have revealed that aerobic exercise training is beneficial for healthy middle-aged and older adults and those with various chronic diseases, but few studies have designed individualized aerobic exercise training for individuals with multimorbidity. Although individuals with multimorbidity are considerably less adherent to physical activity interventions, telephone-based motivational interviewing may help in strengthening motivation and promoting behavioral change for increasing physical activity and health-related physical fitness. This study aimed to examine whether a 12-week individualized aerobic exercise training in a rehabilitation center combined with telephone-based motivational interviewing is effective in promoting physical activity and health-related physical fitness among middle-aged and older adults with multimorbidity. A randomized controlled trial was conducted. Forty-three participants (aged > 40) were recruited and randomly assigned to the intervention group, comparison group, or control group. The participants’ physical activity and health-related physical fitness were assessed at baseline and at 12 weeks. The results indicated that after individualized aerobic exercise training combined with telephone-based motivational interviewing, the participants reported increased total physical activity (Fin = 481.3, p = 0.011), vigorous-intensity physical activity (Fin= 298.9, p = 0.007), dominant and nondominant hand grip (kg) (Fin = 1.96, p = 0.019; Fin = 2.19, p = 0.027, respectively), FEV1/FVC (Fin = 0.045, p = 0.043), VO2 max (ml/kg/min) (Fin = 5.30, p = 0.001), VO2 max predicted (%) (Fin = 21.6, p = 0.001), work (watts) (Fin = 22.5, p = 0.001), and anaerobic threshold (L/min) (Fin = 0.165, p = 0.011). Twelve weeks of individualized aerobic exercise training in the rehabilitation center combined with telephone-based motivational interviewing can increase the total physical activity, vigorous physical activity, and cardiorespiratory fitness of middle-aged and older adults with multimorbidity.
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Affiliation(s)
- Yi-Pang Lo
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
- Department of Nursing, Tri-Service General Hospital SongShan Branch, Taipei 10581, Taiwan;
| | - Shang-Lin Chiang
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Chia-Huei Lin
- Department of Nursing, Tri-Service General Hospital SongShan Branch, Taipei 10581, Taiwan;
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
| | - Hung-Chang Liu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Li-Chi Chiang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
- School of Nursing, China Medical University, Taichung 40402, Taiwan
- Correspondence:
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11
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Lin RC, Chiang SL, Heitkemper MM, Weng SM, Lin CF, Yang FC, Lin CH. Effectiveness of Early Rehabilitation Combined With Virtual Reality Training on Muscle Strength, Mood State, and Functional Status in Patients With Acute Stroke: A Randomized Controlled Trial. Worldviews Evid Based Nurs 2020; 17:158-167. [PMID: 32212254 DOI: 10.1111/wvn.12429] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early rehabilitation has been shown to enhance functional outcomes. Whether the addition of virtual reality (VR) training could further improve muscle strength, mood state, and functional status for patients with acute stroke is unknown. AIMS To investigate the effectiveness of VR training on muscle strength, mood state (depression, anxiety), and functional status in patients following acute stroke. METHODS A randomized controlled trial was conducted. Patients with acute ischemic stroke (N = 152) were selected and randomly assigned with a 1:3 randomization ratio to either experimental group (EG) or comparison group (CG). Both groups received early rehabilitation. The EG received an extra 5 days of VR training (15 min of time, two times a day), started 24 hr to 3 days poststroke. Muscle strength, mood state, and functional status were collected at admission and at the day of discharge. Generalized estimating equations were applied to examine the intervention effects. RESULTS A total of 143 participants (94%) completed the study, and 145 were included in the intention-to-treat analysis. Participants in the EG reported increased muscle strength of upper and lower limbs in both affected and unaffected sides, decreased depression and anxiety, and increased functional status at discharge. When the group-time interaction was examined, the EG had greater increased upper limb muscle strength of the unaffected side (ß = 0.34, p < .001) and decreased depression and anxiety scores (ß = -2.31, p = .011; ß = -1.63, p = .047) at discharge compared with the CG. However, there was no difference in the functional status change scores from baseline between EG and CG. LINKING EVIDENCE TO ACTION A poststroke program that includes both early rehabilitation and VR training has greater benefit in relation to mood state and muscle strength at discharge than early rehabilitation alone. Therefore, an early physical rehabilitation program that includes VR training for acute stroke inpatients should be considered for implementation in clinical settings.
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Affiliation(s)
- Ruei-Ching Lin
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Margaret McLean Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA.,Division of Gastroenterology, University of Washington, Seattle, WA, USA.,Center for Research on Management of Sleep Disturbances, University of Washington, Seattle, WA, USA
| | - Shu-Min Weng
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Feng Lin
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Songshan Branch of Tri-Service General Hospital, Taipei, Taiwan
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12
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Hou YR, Chiu YL, Chiang SL, Chen HY, Sung WH. Development of a Smartphone-Based Balance Assessment System for Subjects with Stroke. Sensors (Basel) 2019; 20:s20010088. [PMID: 31877843 PMCID: PMC6982800 DOI: 10.3390/s20010088] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022]
Abstract
Stroke is a cerebral artery disease that negatively affects activities of daily living (ADLs) and quality of life (QoL). Smartphones have demonstrated strong potential in assessing balance performance. However, such smartphone-based tools have thus far not been applied to stroke survivors. The purpose of this study was to develop a smartphone-based balance assessment system for subjects who have experienced strokes and evaluate the system feasibility. The smartphone-based balance assessment application was developed with Android Studio, and reliability and validity tests were conducted. The smartphone was used to record data using a built-in accelerometer and gyroscope, and increased changes represented greater instability. Six postures were tested for 30 s each. Ten healthy adults were recruited in the reliability test, and the intraclass correlation coefficient (ICC) was used to analyze the within-day and between-day reliabilities. Eight subjects with chronic stroke and eight healthy adults were recruited for the validity test, in which balance performance was compared to represent the application validity. The ICC values of the reliability tests were at least 0.76 (p = 0.00). The acceleration data exhibited no difference between individuals who have experienced stroke and healthy subjects; however, all six postures were found to differ significantly between the two groups in the gyroscope data. The study demonstrates that the smartphone application provides a convenient, reliable, and valid tool for the balance assessments of subjects who have experienced chronic stroke.
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Affiliation(s)
- You-Ruei Hou
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 112, Taiwan; (Y.-R.H.); (Y.-L.C.)
| | - Ya-Lan Chiu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 112, Taiwan; (Y.-R.H.); (Y.-L.C.)
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan;
| | - Hui-Ya Chen
- Department of Physical Therapy, Chung Shan Medical University, Taichung 402, Taiwan;
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 112, Taiwan; (Y.-R.H.); (Y.-L.C.)
- Correspondence:
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13
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Chiang SL, Heitkemper MM, Hung YJ, Tzeng WC, Lee MS, Lin CH. Effects of a 12-week moderate-intensity exercise training on blood glucose response in patients with type 2 diabetes: A prospective longitudinal study. Medicine (Baltimore) 2019; 98:e16860. [PMID: 31490370 PMCID: PMC6739009 DOI: 10.1097/md.0000000000016860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The blood glucose response to moderate-intensity exercise remains unclear for patients with type 2 diabetes (T2DM). In addition, little is known about determinants of blood glucose response to a 12-week moderate-intensity exercise training. Therefore, this study aimed to explore trends in blood glucose in response to a 12-week moderate-intensity exercise training in patients with T2DM and to explore the predictors of post-exercise blood glucose (PEBG) and exercise-induced glucose response (EIGR). METHODS A prospective longitudinal study was conducted. Of the 66 participants with T2DM recruited from outpatient clinics of a medical center, 20 were eligible to enroll in a 12-week moderate-intensity exercise training. Participants were randomly assigned to 1 of 3 exercise times (morning, afternoon, or evening). Blood glucose were measured pre- and post-exercise. The EIGR was calculated by subtracting the PEBG from the before-exercise blood glucose (BEBG). Generalized estimating equations were used to examine the trends and predictors of PEBG and EIGR. RESULTS The BEBG declined progressively (β = -1.69, P < .001); while the PEBG (β = -0.18, P = .08) remained stable over time during the 12-week exercise training. Higher BEBG predicted higher (β = 0.53, P < .001) PEBG. Higher baseline maximum oxygen uptake (VO2max) contributed to a larger magnitude of EIGR; higher HgbA1c and BEBG predicted higher EIGR (β = 0.27, P = .02; β = 0.45, P < .001); afternoon or evening exercise predicted lower (β = -13.2, P = .04; β = -5.96, P = .005) EIGR than did morning exercise. CONCLUSIONS A 12-week moderate-intensity exercise training appears safe for patients with T2DM. Time of day for exercise, baseline VO2max, and baseline metabolic control may influence the impact of exercise for individuals with T2DM. These findings provide considerations for design of optimal exercise training for T2DM patients.
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Affiliation(s)
- Shang-Lin Chiang
- School of Medicine, National Defense Medical Center; Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Margaret McLean Heitkemper
- Department of Biobehavioral Nursing and Health Systems, Division of Gastroenterology, School of Medicine, University of Washington, USA
| | - Yi-Jen Hung
- Division of Endocrinology & Metabolism, School of Medicine, National Defense Medical Center; Tri-Service General Hospital, Songshan Branch
| | | | - Meei-Shyuan Lee
- School of Public Health & Graduated Institute of Medical Science, National Defense Medical Center
| | - Chia-Huei Lin
- School of Nursing & School of Medicine, National Defense Medical Center; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, ROC
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14
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Lai CH, Sung WH, Chiang SL, Lu LH, Lin CH, Tung YC, Lin CH. Bimanual coordination deficits in hands following stroke and their relationship with motor and functional performance. J Neuroeng Rehabil 2019; 16:101. [PMID: 31375122 PMCID: PMC6679439 DOI: 10.1186/s12984-019-0570-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Stroke can lead to movement disorders that affect interlimb coordination control of the bilateral upper extremities, especially the hands. However, few studies have investigated the influence of a stroke on bimanual force coordination control between the hands using a quantitative measurement tool, or the relationship of force coordination with paretic upper extremity motor and functional performance. We aimed to investigate these outcomes using a novel measurement device, and analyze the relationship of bimanual force coordination control deficits in both hands with motor and functional performances of the paretic upper extremity in stroke patients. Methods Sixteen healthy adults and 22 stroke patients were enrolled. A novel bilateral hand grip measurement device with two embedded dynamometers was used to evaluate the grip force during a bilateral hand grip-force coordination control task. The alternating time and force applied for coordination with the grip force of both hands were calculated to analyze control of bimanual grip force coordination. Motor and functional measurements included the upper-extremity portion of the Fugl-Meyer assessment (FMA-UE), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), and Barthel Index (BI). Results Compared with the healthy group, the alternating time from the non-paretic to the paretic hand was 27.6% shorter for stroke patients (p < 0.001). The grip force generated for coordination in the healthy group was significantly greater (30–59%) than that of the stroke group (p < 0.05), and the coefficients of variation of alternating time (p = 0.001) and force applied (p = 0.002) were significantly higher in the stroke group than the healthy group. The alternating time from the paretic to the non-paretic hand showed moderately significant correlations with the FMA-UE (r = − 0.533; p = 0.011), the WMFT (r = − 0.450; p = 0.036), and the BI (r = − 0.497; p = 0.019). Conclusions Stroke results in a decline in bimanual grip force generation and increases the alternating time for coordinating the two hands. A shorter alternating time is moderately to highly associated with enhanced motor and functional performances.
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Affiliation(s)
- Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, 252 Wu-Hsing Street, Taipei, 11031, Taiwan, Republic of China.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 250 Wu-Xing Street, Taipei, 11031, Taiwan, Republic of China
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang Ming University, 155 Linong Street, Sec. 2, Taipei, 112, Taiwan, Republic of China
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 325 Chenggong Road, Sec. 2, Neihu District, Taipei, 114, Taiwan, Republic of China
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang Ming University, 155 Linong Street, Sec. 2, Taipei, 112, Taiwan, Republic of China.,Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 325 Chenggong Road, Sec. 2, Neihu District, Taipei, 114, Taiwan, Republic of China
| | - Chia-Huei Lin
- School of Nursing & School of Medicine, National Defense Medical Center; Department of Nursing, Tri-Service General Hospital Songshan Branch, 325 Chenggong Road, Sec. 2, Neihu District, Taipei, 114, Taiwan, Republic of China
| | - Yi-Chun Tung
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 250 Wu-Xing Street, Taipei, 11031, Taiwan, Republic of China
| | - Chueh-Ho Lin
- Master Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan, Republic of China.
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15
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Ho TH, Yang FC, Lin RC, Chien WC, Chung CH, Chiang SL, Chou CH, Tsai CK, Tsai CL, Lin YK, Lee JT. Impact of virtual reality-based rehabilitation on functional outcomes in patients with acute stroke: a retrospective case-matched study. J Neurol 2019; 266:589-597. [PMID: 30610428 DOI: 10.1007/s00415-018-09171-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/22/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, the efficacy of the virtual reality (VR) application for acute stroke compared with conventional therapy (CT) remains unclear. This retrospective study aims to assess the impact of adjuvant VR technology on multidimensional therapy for patients with acute-stage stroke. METHODS 100 acute ischemic stroke patients with onset within 7 days who underwent combined adjuvant VR-based rehabilitation program and CT (intervention group-VR + CT) were compared to an equal number of cross-matched patients who received CT alone. While the intervention group received 40-min CT plus 20-min VR program (seven times for 1 week), the comparison group received time-matched CT alone. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), medical cost-effectiveness, and shortening of hospital stay were used as outcome measures. RESULTS Posttreatment, the VR + CT group revealed significantly improved NIHSS and mRS (P < 0.001), whereas only the mRS improvement was remarkable in the CT group. In between-group comparisons, the intervention group had better improvements of symptom severity (NIHSS percentage improvement from the baseline; 20.18% vs. 4.59%, P < 0.005), functional outcomes (mRS improvement from the baseline; - 0.58 vs. - 0.23, P < 0.001), and reduced medical cost (Taiwan dollar; 49474 vs. 66306, P < 0.005). Furthermore, the VR + CT group reached markedly higher proportion of functional independence in activities of daily living (mRS, 0-2) at discharge compared with the CT group (68% vs. 60%, P < 0.001). CONCLUSIONS This study suggests that the combination of VR-based rehabilitation and traditional therapy could be more effective for neurorehabilitation than CT alone in the early improvement of symptom severity, functional outcomes, and lower medical expenditure in acute stroke patients.
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Affiliation(s)
- Tsung-Han Ho
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Ruei-Ching Lin
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chung-Hsing Chou
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. .,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
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16
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Chiang SL, Lin CH, Hsu YD, Wei SH, Sung WH, Lu LH, Chang ST, Ho TY, Shen YP, Chen LC, Lin CH. Analysis of trunk rolling in Parkinson's disease patients using a mattress mobility detection system. Comput Methods Programs Biomed 2018; 162:157-163. [PMID: 29903482 DOI: 10.1016/j.cmpb.2018.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/30/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Parkinson's disease (PD) is a neurodegenerative condition characterized by motor dysfunction and various types of non-motor impairments. The reaction time and movement time are reported to become more severe delayed in worse PD patients. Most tools for evaluating motor impairment are limited by relying on subjective observations and being qualitative in design. The aim of this study was to investigate trunk rolling performance in PD patients by using a recently developed system to detect turning in bed. METHODS The study included 20 PD patients and 42 healthy controls. A mattress mobility detection system was employed for quantitative measurements. Each test session consisted of subjects starting by lying in a supine position on a bed and rolling 10 times onto their left side and 10 times onto their right side. Strain gauges mounted under the feet of the bed recorded changes in the center of pressure (CoP). RESULTS For turning back, the patients compared with the controls had significantly longer movement time (P = 0.017), longer time to peak counteraction (P = 0.001), larger ratio of peak counteraction to movement time (P = 0.006), shorter CoP displacement (P < 0.0001), slower turning speed (P = 0.000), weaker peak counteraction (P = 0.013), and smaller ratio of peak counteraction to weight (P = 0.032). Results for turning over were similar except there was no significant difference in the ratio of peak counteraction to weight. CONCLUSIONS The mattress mobility detection system was useful for objectively assessing trunk rolling performance of PD patients. Improved assessment of trunk function in PD patients could lead to better treatments and improved rehabilitation procedures.
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Affiliation(s)
- Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chueh-Ho Lin
- School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taiwan
| | - Yaw-Don Hsu
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang Ming University, Taipei, Taiwan
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang Ming University, Taipei, Taiwan
| | - Liang-Hsuan Lu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shin-Tsu Chang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsung-Yen Ho
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ping Shen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing & School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan.
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Hou YR, Chiu YL, Chiang SL, Chen HY, Sung WH. Feasibility of a smartphone-based balance assessment system for subjects with chronic stroke. Comput Methods Programs Biomed 2018; 161:191-195. [PMID: 29852961 DOI: 10.1016/j.cmpb.2018.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Stroke is a cerebral artery disease that may lead to long-term disabilities or death. Patients that survive a stroke usually suffer balance impairments, which affect their performance in activities of daily living (ADLs) and quality of life (QoL). In recent years, smartphones have become very popular and have many capabilities. Smartphone built-in sensors have shown their ability and potential in balance performance assessment. However, the feasibility of smartphones on subjects with chronic strokes remains to be proved. Therefore, the purpose of this study is to evaluate the feasibility of a smartphone-based balance assessment system for subjects with chronic stroke. METHODS Ten subjects with chronic stroke and thirteen healthy adults were recruited in the study. The smartphone HTC 10 (HTC Corporation, Taiwan) was used to perform the balance assessment, and its built-in accelerometer and gyroscope were used to record data from the subjects. Six postures were tested for thirty seconds each: shoulder-width stance (SWS) with eyes opened (E/O) and eyes closed (E/C), feet-together stance (FTS) with E/O and E/C, and semi-tandem stance (STS) with E/O and E/C. The smartphone was fixed to the back of subjects at the second sacral spine (S2) level. The changes registered in the accelerometer and gyroscope data were used to represent the balance performance, in which higher values indicate more instability. Data was analyzed using the independent t-test with the software SPSS 20, and the statistical significance level was set to α < 0.05. RESULTS AND DISCUSSION Significant difference in the acceleration data was found among subjects with chronic stroke and healthy adults under four assessment postures: SWS with E/C (p = 0.048), FTS with E/O (p = 0.027), FTS with E/C (p = 0.000), and STS with E/C (p = 0.048). Furthermore, according to the gyroscope data, there were significant differences in how the two groups performed the postures. The results demonstrate that a smartphone with a built-in accelerometer and gyroscope can be used to classify balance performances between healthy adults and subjects with chronic stroke. CONCLUSION This study shows that smartphones are feasible to assess balance for subjects with chronic stroke.
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Affiliation(s)
- You-Ruei Hou
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Lan Chiu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Lin Chiang
- Tri-Service Hospital, Taipei, Taiwan; National Defense Medical Center, Taipei, Taiwan
| | - Hui-Ya Chen
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
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Lin CH, Lu LH, Sung WH, Chiang SL, Chen PJ. Investigating The Effects Of Obesity On Fitness Among Community-dwelling Older Adults In Taiwan. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536431.73531.aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chen YL, Wu YT, Hsia CC, Chang ST, Chiang SL. Nontraumatic Acute Anterior Cord Syndrome Caused by Cervical Disc Herniation after Napping with Neck Extension. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nontraumatic acute anterior cord syndrome caused by disc herniation occurring in the cervical spine is rare. A 39-year-old man presented with a sharp burning pain in bilateral upper limbs and progressive paraplegia after a nap with neck extension. He had impaired sensation of pain and temperature with preservation of proprioception and light touch below the C6 level. The magnetic resonance imaging showed focal hyperintensity of the anterior cord at the C5-C7 level and central herniation of C5-6 and C6-7 discs. An anterior discectomy of C5-6 and C6-7 was conducted because of the poor response to a high dose of steroid. A postoperative intensive rehabilitation treatment was also performed. The patient showed significant improvement in motor and sensory function three months postoperatively. Long-term repetitive neck extension should be avoided because it may be a risk for degenerative spondylotic change and cord compression disorders. Surgical intervention should be considered in a patient with anterior cord syndrome associated with nontraumatic cervical disc herniation. (Hong Kong j.emerg.med. 2013;20:389-391)
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Affiliation(s)
| | | | - CC Hsia
- Tri-Service General Hospital, Department of Neurosurgery, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan
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Lu LH, Chiang SL, Wei SH, Lin CH, Sung WH. Development and clinical application of a computer-aided real-time feedback system for detecting in-bed physical activities. Comput Methods Programs Biomed 2017; 147:11-17. [PMID: 28734526 DOI: 10.1016/j.cmpb.2017.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 04/13/2017] [Accepted: 05/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Being bedridden long-term can cause deterioration in patients' physiological function and performance, limiting daily activities and increasing the incidence of falls and other accidental injuries. Little research has been carried out in designing effective detecting systems to monitor the posture and status of bedridden patients and to provide accurate real-time feedback on posture. The purposes of this research were to develop a computer-aided system for real-time detection of physical activities in bed and to validate the system's validity and test-retest reliability in determining eight postures: motion leftward/rightward, turning over leftward/rightward, getting up leftward/rightward, and getting off the bed leftward/rightward. METHODS The in-bed physical activity detecting system consists mainly of a clinical sickbed, signal amplifier, a data acquisition (DAQ) system, and operating software for computing and determining postural changes associated with four load cell sensing components. Thirty healthy subjects (15 males and 15 females, mean age = 27.8 ± 5.3 years) participated in the study. All subjects were asked to execute eight in-bed activities in a random order and to participate in an evaluation of the test-retest reliability of the results 14 days later. Spearman's rank correlation coefficient was used to compare the system's determinations of postural states with researchers' recordings of postural changes. The test-retest reliability of the system's ability to determine postures was analyzed using the interclass correlation coefficient ICC(3,1). RESULTS The system was found to exhibit high validity and accuracy (r = 0.928, p < 0.001; accuracy rate: 87.9%) in determining in-bed displacement, turning over, sitting up, and getting off the bed. The system was particularly accurate in detecting motion rightward (90%), turning over leftward (83%), sitting up leftward or rightward (87-93%), and getting off the bed (100%). The test-retest reliability ICC(3,1) value was 0.968 (p < 0.001). CONCLUSIONS The system developed in this study exhibits satisfactory validity and reliability in detecting changes in-bed body postures and can be beneficial in assisting caregivers and clinical nursing staff in detecting the in-bed physical activities of bedridden patients and in developing fall prevention warning systems.
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Affiliation(s)
- Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, and Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chueh-Ho Lin
- School of Gerontology Health Management and Master Program in Long-Term Care, Taipei Medical University, Taipei, Taiwan, ROC.
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC.
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Hou YR, Chiou YL, Chiang SL, Tsai YJ, Sung WH. Development of Smartphone-Based Balance Assessment System for Subjects with Chronic Stroke. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517721.38278.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lin CH, Lu LH, Chiang SL, Lai CH. Exploring Bilateral Handgrip Forces Control During Inter-limb Coordination Task After Hemiparetic Stroke. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519834.24954.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chiou CP, Chiang SL, Lin CH, Ho CW, Chen LC, Chang CC, Wang YW. Effects of a 12-week exercise training on insulin sensitivity, quality of life, and depression status in patients with type 2 diabetes. J Med Sci 2017. [DOI: 10.4103/jmedsci.jmedsci_68_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lin CH, Chiang SL, Lu LH, Wei SH, Sung WH. Validity of an ankle joint motion and position sense measurement system and its application in healthy subjects and patients with ankle sprain. Comput Methods Programs Biomed 2016; 131:89-96. [PMID: 27265051 DOI: 10.1016/j.cmpb.2016.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Ankle motion and proprioception in multiple axis movements are crucial for daily activities. However, few studies have developed and used a multiple axis system for measuring ankle motion and proprioception. This study was designed to validate a novel ankle haptic interface system that measures the ankle range of motion (ROM) and joint position sense in multiple plane movements, investigating the proprioception deficits during joint position sense tasks for patients with ankle instability. METHODS Eleven healthy adults (mean ± standard deviation; age, 24.7 ± 1.9 years) and thirteen patients with ankle instability were recruited in this study. All subjects were asked to perform tests to evaluate the validity of the ankle ROM measurements and underwent tests for validating the joint position sense measurements conducted during multiple axis movements of the ankle joint. Pearson correlation was used for validating the angular position measurements obtained using the developed system; the independent t test was used to investigate the differences in joint position sense task performance for people with or without ankle instability. RESULTS The ROM measurements of the device were linearly correlated with the criterion standards (r = 0.99). The ankle instability and healthy groups were significantly different in direction, absolute, and variable errors of plantar flexion, dorsiflexion, inversion, and eversion (p < 0.05). CONCLUSIONS The results demonstrate that the novel ankle joint motion and position sense measurement system is valid and can be used for measuring the ankle ROM and joint position sense in multiple planes and indicate proprioception deficits for people with ankle instability.
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Affiliation(s)
- Chueh-Ho Lin
- School of Gerontology Health Management and Master Program in Long-Term Care, Taipei Medical University, Taipei, Taiwan
| | | | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
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Lu LH, Female, Chiang SL, Lin CH, Sung WH. Development And Clinical Application Of The Body Movement Detection System. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487391.29700.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Li TY, Chang CY, Chou YC, Chen LC, Chu HY, Chiang SL, Chang ST, Wu YT. Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial. Medicine (Baltimore) 2016; 95:e3544. [PMID: 27149465 PMCID: PMC4863782 DOI: 10.1097/md.0000000000003544] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Recently, studies have reported that extracorporeal shock wave therapy (ESWT) is a safe, noninvasive, alternative treatment for spasticity. However, the effect of ESWT on spasticity cannot be determined, because most studies to date have enrolled small patient numbers and have lacked placebo-controlled groups and/or long-term follow-up. In addition, whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of radial ESWT (rESWT) in patients with poststroke spasticity and surveyed the outcome of functional activity.Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.
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Affiliation(s)
- Tsung-Ying Li
- From the Department of Physical Medicine and Rehabilitation (T-YL, C-YC, L-CC, H-YC, S-LC, S-TC, Y-TW), Tri-Service General Hospital, School of Medicine; School of Public Health, National Defense Medical Center (Y-CC), Neihu District, Taipei; Department of Physical Medicine and Rehabilitation (L-CC), Hualien Armed Forces General Hospital, Hualien County; and Department of Rehabilitation (S-TC), Taichung Veterans General Hospital, Taiwan Boulevard, Taichung, Taiwan, Republic of China
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Lin CH, Chiang SL, Heitkemper MM, Hung YJ, Lee MS, Tzeng WC, Chiang LC. Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial. Int J Nurs Stud 2016; 60:12-23. [PMID: 27297365 DOI: 10.1016/j.ijnurstu.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 02/23/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Lifestyle modification is often difficult for middle-aged and older women living in the community who are at high risk of physical inactivity and metabolic syndrome. OBJECTIVES To examine the effects of telephone-based motivational interviewing in a 12-week lifestyle modification program on physical activity, MetS, metabolic risks (fasting plasma glucose, blood pressure, triglyceride, high-density lipoprotein, and central obesity), and the number of metabolic risks in community-living middle-aged and older women diagnosed with metabolic syndrome. RESEARCH DESIGN AND METHOD A randomized controlled trial was conducted. Recruited were 328 middle-aged and older women from a community health center in Taiwan. Eligible women medically diagnosed with metabolic syndrome (n=115) were randomly assigned to one of three groups: The experimental group received an individualized telephone delivered lifestyle modification program that included motivational interviewing delivered by an experienced nurse. The brief group received a single brief lifestyle modification counseling session with a brochure. The usual care group received standard care. Physical activity was assessed with the International Physical Activity Questionnaire and metabolic risks were determined by serum markers and anthropometric measures at pre- and post-intervention. One hundred women completed the study and an intention-to-treat analysis was performed. Generalized estimating equations were used to examine the intervention effects. RESULTS Women in the experimental group increased physical activity from 1609 to 1892 MET-min/week (β=846, p=.01), reduced the percentage of diagnosed with metabolic syndrome to 81.6% (β=-0.17, p=.003), and decreased the number of metabolic risks from 4.0 to 3.6 (β=-0.50, p<.001), compared to the usual care group (4.4-4.6). There was not a reduction in the percentage of diagnosed with metabolic syndrome in the brief group, but they had fewer metabolic risks after 12 weeks (mean=4.0 vs. 4.6, β=-0.2, p=.02) compared to the usual care group. CONCLUSIONS Motivational interviewing as a component of an individualized physical activity and lifestyle modification program has positive benefit in reducing metabolic risks in middle-aged and older women.
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Affiliation(s)
- Chia-Huei Lin
- Department of Nursing at Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Margaret McLean Heitkemper
- Department of Biobehavioral Nursing and Health Systems, Division of Gastroenterology, School of Medicine, University of Washington, USA
| | - Yi-Jen Hung
- Division of Endocrinology & Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Meei-Shyuan Lee
- School of Public Health & Graduated Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Li-Chi Chiang
- School of Nursing & Graduated Institute of Medical Sciences, National Defense Medical Center & China Medical University, Taipei & Taichung, Taiwan, ROC.
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Lin CH, Chiang SL, Tzeng WC, Chiang LC. Systematic review of impact of lifestyle-modification programs on metabolic risks and patient-reported outcomes in adults with metabolic syndrome. Worldviews Evid Based Nurs 2015; 11:361-8. [PMID: 25488565 DOI: 10.1111/wvn.12069] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiable risk factor. Researchers have been exploring various strategies, including lifestyle-modification programs (LMPs), to prevent the progression of MetS. However, the effectiveness of LMPs on metabolic risks and patient-reported outcomes (PROs) among adults with MetS remains inconclusive. AIM To evaluate the effectiveness of LMPs on the metabolic risks and PROs among adults with MetS. METHODS A systematic review of randomized controlled trials published from January 1985 to June 2014 was conducted. The review extracted LMP interventions that included outcomes on the metabolic risks and PROs (quality of life and any other psychological health indicators). The quality of the included studies was assessed using the Cochrane Collaboration criteria. RESULTS Among the five trials included, the most commonly applied intervention components were diet plans, supervised exercise, health education, individual counseling, behavioral modification, and motivational interviewing. Three fifths of the studies were nurse-led, and only one of the selected trials was theory-guided. LMPs can effectively reduce triglyceride levels, waist circumference, and systolic blood pressure. However, few trials consistently confirmed the benefits of metabolic risks, and none revealed a significant effect on high-density lipoprotein, fasting blood glucose, or any PRO, except quality of life. The duration of LMPs in the included trials ranged from 4 to 24 weeks, and durations of at least 12 weeks significantly improved quality of life. LINKING EVIDENCE TO ACTION LMPs had positive effects on some metabolic risks and on quality of life, whereas longer-duration LMPs may have highly beneficial effects on quality of life. The essential elements of LMPs need to be evaluated more thoroughly to determine their effectiveness. Larger and more rigorous randomized controlled trials are required to assess the effectiveness of LMPs on metabolic risks and PROs among adults with MetS.
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Affiliation(s)
- Chia-Huei Lin
- Doctoral candidate, Graduate Institute of Medical Sciences, National Defense Medical Center; Lecturer of School of Nursing, National Defense Medical Center and Supervisor of Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
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Lin CH, Chou LW, Luo HJ, Tsai PY, Lieu FK, Chiang SL, Sung WH. Effects of Computer-Aided Interlimb Force Coupling Training on Paretic Hand and Arm Motor Control following Chronic Stroke: A Randomized Controlled Trial. PLoS One 2015; 10:e0131048. [PMID: 26193492 PMCID: PMC4507879 DOI: 10.1371/journal.pone.0131048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 05/27/2015] [Indexed: 11/26/2022] Open
Abstract
Objective We investigated the training effects of interlimb force coupling training on paretic upper extremity outcomes in patients with chronic stroke and analyzed the relationship between motor recovery of the paretic hand, arm and functional performances on paretic upper limb. Design A randomized controlled trial with outcome assessment at baseline and after 4 weeks of intervention. Setting Taipei Veterans General Hospital, National Yang-Ming University. Participants Thirty-three subjects with chronic stroke were recruited and randomly assigned to training (n = 16) and control groups (n = 17). Interventions The computer-aided interlimb force coupling training task with visual feedback included different grip force generation methods on both hands. Main Outcome Measures The Barthel Index (BI), the upper extremity motor control Fugl-Meyer Assessment (FMA-UE), the Motor Assessment Score (MAS), and the Wolf Motor Function Test (WMFT). All assessments were executed by a blinded evaluator, and data management and statistical analysis were also conducted by a blinded researcher. Results The training group demonstrated greater improvement on the FMA-UE (p<.001), WMFT (p<.001), MAS (p = .004) and BI (p = .037) than the control group after 4 weeks of intervention. In addition, a moderate correlation was found between the improvement of scores for hand scales of the FMA and other portions of the FMA UE (r = .528, p = .018) or MAS (r = .596, p = .015) in the training group. Conclusion Computer-aided interlimb force coupling training improves the motor recovery of a paretic hand, and facilitates motor control and enhances functional performance in the paretic upper extremity of people with chronic stroke. Trial Registration ClinicalTrials.gov NCT02247674.
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Affiliation(s)
- Chueh-Ho Lin
- School of Gerontology Health Management & Master Program in Long-Term Care, Taipei Medical University, Taipei, Taiwan (R.O.C.)
| | - Li-Wei Chou
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Hong-Ji Luo
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Po-Yi Tsai
- Physical Medicine and Rehabilitation Department, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | | | - Shang-Lin Chiang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei, Taiwan (R.O.C.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
- * E-mail:
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Lin CH, Chiang SL, Yates P, Lee MS, Hung YJ, Tzeng WC, Chiang LC. Moderate physical activity level as a protective factor against metabolic syndrome in middle-aged and older women. J Clin Nurs 2014; 24:1234-45. [PMID: 25257388 DOI: 10.1111/jocn.12683] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2014] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To investigate whether physical activity is a protective factor against metabolic syndrome in middle-aged and older women. BACKGROUND Socio-demographic and lifestyle behaviour factors contribute to metabolic syndrome. To minimise the risk of metabolic syndrome, several global guidelines recommend increasing physical activity level. However, only limited research has investigated the relationship between physical activity levels and metabolic syndrome in middle-aged and older women after adjusting for socio-demographic and lifestyle behaviour factors. DESIGN Cross-sectional design. METHODS A convenience sample of 326 middle-aged and older women was recruited. Metabolic syndrome was confirmed according to the National Cholesterol Education Program, Adult Treatment Panel III guidelines, and physical activity levels were measured by the International Physical Activity Questionnaire. RESULTS The sample had a mean age of 60·9 years, and the prevalence of metabolic syndrome was 43·3%. Postmenopausal women and women with low socioeconomic status (low-education background, without personal income and currently unemployed) had a significantly higher risk of developing metabolic syndrome. After adjusting for significant socio-demographic and lifestyle behaviour factors, the women with moderate or high physical activity levels had a significantly lower (OR = 0·10; OR = 0·11, p < 0·001) risk of metabolic syndrome and a lower risk for each specific component of metabolic syndrome, including elevated fasting plasma glucose (OR = 0·29; OR = 0·26, p = 0·009), elevated blood pressure (OR = 0·18; OR = 0·32, p = 0·029), elevated triglycerides (OR = 0·41; OR = 0·15, p = 0·001), reduced high-density lipoprotein (OR = 0·28; OR = 0·27, p = 0·004) and central obesity (OR = 0·31; OR = 0·22, p = 0·027). CONCLUSIONS After adjusting for socio-demographic and lifestyle behaviour factors, physical activity level was a significant protective factor against metabolic syndrome in middle-aged and older women. Higher physical activity levels (moderate or high physical activity level) reduced the risk of metabolic syndrome in middle-aged and older women. RELEVANCE TO CLINICAL PRACTICE Appropriate strategies should be developed to encourage middle-aged and older women across different socio-demographic backgrounds to engage in moderate or high levels of physical activity to reduce the risk of metabolic syndrome.
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Affiliation(s)
- Chia-Huei Lin
- Graduate Institute of Medical Sciences, School of Nursing, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
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Lin CH, Wei SH, Chou LW, Chiang SL, Sung WH. The Effects of Bilateral Task Training on Improving Upper Extremity Function in Chronic Stroke. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000494090.51450.7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lu LH, Sung WH, Chiang SL, Lin CH. Evaluation Of Trunk Mobility Performances In Patients With Stroke. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000496227.43605.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lin CH, Chou LW, Wei SH, Lieu FK, Chiang SL, Sung WH. Validity and reliability of a novel device for bilateral upper extremity functional measurements. Comput Methods Programs Biomed 2014; 114:315-323. [PMID: 24690377 DOI: 10.1016/j.cmpb.2014.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 02/07/2014] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE This study was designed to establish the validity and reliability of a new device that measures bilateral shoulder and elbow range of motion (ROM) and grip force performance in vivo. A further aim was to investigate the control of inter-limb grip force coordination during isometric force-maintenance tasks. Validity of the ROM and grip force measurements was examined using a validated clinical goniometer and standard weights. SUBJECTS Twenty-one healthy adults (six female, 15 male; mean±standard deviation age=23.05±3.51) were recruited for this study. DESIGN All subjects were asked to perform tests to evaluate the validity and reliability of ROM, grip force maximum voluntary contraction (MVC) and coordination control measurements. RESULTS The ROM and grip force measurements were linearly correlated with criterion standards. For reliability testing, all of the intraclass correlation coefficient values were >0.99. The inter-limb grip force coordination control task showed that the force modulation timing during dominant-to-non-dominant hand transition was longer than the non-dominant-to-dominant hand transition (p<0.05). CONCLUSIONS These results demonstrate that this device is valid and reliable when used to measure shoulder and elbow ROM and grip force of both hands. Isometric force-maintenance tasks also indicated changes in inter-limb grip force control.
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Affiliation(s)
- Chueh-Ho Lin
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Hung-Kung University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Wen-Hsu Sung
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
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Chen LC, Chiang SL, Lin CH, Tsai SH, Chang ST, Lin SP, Ni SM, Wei SH, Wu YT, Lin FH. Cigarette smoking dose as a predictor of need for surgical intervention in patients with lumbar disk herniation. J Med Sci 2014. [DOI: 10.4103/1011-4564.129387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lin CH, Tzeng WC, Li SY, Liao RW, Chiang SL, Chiang LC. [Spontaneous fracture: a potential clinical concern]. Hu Li Za Zhi 2013; 60:93-8. [PMID: 23922095 DOI: 10.6224/jn.60.3.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has received only limited attention in nursing research. Gaps in understanding related to spontaneous fractures may increase medical-legal risks faced by frontline care nurses, exacerbate nursing pressures, and serve as a disincentive to remain in the already understaffed nursing profession. This article reviews previous research on spontaneous fractures to determine the epidemiological causes of clinical spontaneous fracture and identify effective prevention strategies. We hope this paper may increase clinical practitioner and expert awareness of spontaneous fractures; help establish a screening mechanism to identify high risk spontaneous fracture patients; and help nurses develop and implement proactive prevention / treatment strategies to strengthen awareness of this topic among patients and their families.
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Affiliation(s)
- Chia-Huei Lin
- School of Nursing, National Defense Medical Center, Taiwan, ROC.
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Lin CH, Tzeng WC, Chiang SL, Chiang LC. [Clinical outcomes: the impact of patient-centered care]. Hu Li Za Zhi 2012; 59:104-110. [PMID: 23212262 DOI: 10.6224/jn.59.6.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
An extensive body of literature advocating a "patient-centered" approach to medical care has emerged over the past three decades. This approach is now a mainstream trend in healthcare. Despite its popularity, there remains little consensus regarding the content or definition of patient-centered care. Various quantitative and qualitative research studies have extracted core meanings from "doctor-patient relationship" perspectives and investigated the relationships of these meanings with patient satisfaction, compliance with health promoting behavior, and health status. Mead and Bower's review of the conceptual and empirical literature represented the first attempt to develop a model of the doctor-patient relationship that considered the multiple aspects embraced by the "patient-centered" approach. However, any interpretation of the "patient-centered" concept that fails to consider the perspective of nursing is likely incomplete, as patient-centered care is the essence of nursing. This paper reviewed the concept of "patient-centered care", conducted a systematic review of randomized control trials to explore the effectiveness of patient-centered care, and integrated nursing-related studies that focused on patient-centered care. Our search covered articles published through the end of February 2011 in the Cochrane Controlled Trials Register, JBI, MEDLINE, CINAHL, Pubmed, ProQuest, PsycInfo, and CEPS, with 13 relevant articles identified. The majority of trials addressed by these studies demonstrated a positive "patient-centered care" effect on self-care knowledge and skills but a limited/insignificant effect on disease improvement. The reviewed studies used traditional definitions of "patient-centered care" that were inconsistent with the concepts defined by Mead and Bower. Heterogeneities exist between reviewed studies and the lack of related research in Taiwan. We thus integrated outcome indicators related to "patient-centered care". This study may be referenced by nursing research and clinical care professionals responsible to improve and integrate medical care quality.
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Affiliation(s)
- Chia-Huei Lin
- Department of Nursing, Tri-Service General Hospital, Graduate Institue of Medical Science, National Defense Medical Center, Taiwan, ROC
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Wu YT, Li TY, Lu SC, Chen LC, Chu HY, Chiang SL, Chang ST. Hyperglycemia as a Predictor of Poor Outcome at Discharge in Patients with Acute Spontaneous Cerebellar Hemorrhage. Cerebellum 2011; 11:543-8. [DOI: 10.1007/s12311-011-0317-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wu YT, Li TY, Chu HY, Chen LC, Chiang SL, Chang ST. Relationship between the interval before high-dose methylprednisolone administration and chronic pain in traumatic spinal cord injury. Neurosciences (Riyadh) 2011; 16:324-328. [PMID: 21983374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine the relationship between the interval before the administration of high-dose methylprednisolone (MP) and pain in traumatic spinal cord injury (SCI) patients. METHODS We retrospectively studied the medical records of admitted patients with traumatic SCI at the Department of Physical Medicine and Rehabilitation, Tri- Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan from January 2005 to January 2010. We examined the relationship between the interval before the administration of highdose MP, and the severity of pain and the presence of neuropathic pain (NeP). Patients treated with highdose MP <8 hours after their injuries were defined as the classical-MP group (n=22), and patients who received high-dose MP >/-8 hours after their injuries were defined as the delayed-MP group (n=10). The patients were mailed questionnaires including the Short-Form McGill Pain Questionnaire (SF-MPQ), and the Douleur Neuropathique 4 Questions questionnaire (DN4Q). RESULTS The SF-MPQ score in the classical-MP group (9.54 +/- 10.4) was almost 2-fold more than in the delayed-MP group (5.9 +/- 3.5). The interval before the administration of high-dose MP was positively correlated with the DN4Q and SF-MPQ scores, although these differences, and associations were not statistically significant. The increased interval in the administration of MP resulted in slightly greater pain and an increased prevalence of NeP. CONCLUSION Although the delayed administration of high-dose MP did not significantly increase the severity of pain or prevalence of NeP, it should still be avoided due to the increased risk of serious side effects.
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Affiliation(s)
- Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chang CC, Chu HY, Chiang SL, Li TY, Chang ST. Impairment of static upright posture in subjects with undifferentiated arthritis in sacroiliac joint in conjunction with elevation of streptococcal serology. J Back Musculoskelet Rehabil 2010; 22:33-41. [PMID: 20023362 DOI: 10.3233/bmr-2009-0217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Our latest work has demonstrated a strong correlation between the anti-streptolysin O (ASO) titer and the sacroiliac (SI) joint scintigraphy in subjects with undifferentiated arthritis [Journal of Rheumatology 34 (2007), 1746-1752]. Of a significant percentage in those subjects with sacroiliac disorder reported suffering from postural abnormality. The purpose of this study was to determine whether there was an abnormality of upright postural sway in those subjects. METHODS All subjects who have been examined for ASO titer levels and SI joint scintigraphy were divided into two groups according to the reference level of ASO titer in our central laboratory, and were subjected to ten sway tests to assess static postural sway when they were standing upright. The comparisons of the sway parameters were analyzed by using two sample t-test for continuous variables and repeated-measures analysis of variance (ANOVA) for the degree effect and interaction effect (sloped degree x group) in varying stressful conditions (eyes open vs closed, plantar flexion or dorsiflexion of feet). RESULTS In a total of 84 subjects, mean age was 23 years (range 18.0-36.4). Compared with the low ASO (ASO titer <or=116 IU/mL) group, the two sample t-test showed that high ASO (ASO titer >116 IU/mL) group had 2.76-, 4.46- and 4.59-fold in sway area, 1.32-, 1.50- and 1.61-fold in sway velocity, and 2.02-, 1.97- and 1.70-fold in sway intensity, over the study period at 0 degrees, 10 degrees, and 20 degrees in conditions of eyes open and plantar flexion. The values of sway velocity/intensity obtained with eyes open and plantarflexion/dorsiflexion had lower intensity values when compared with those obtained in closed eyes and plantar flexion/dorsiflexion in high ASO group, but not the same as in low ASO group. Repeated-measures ANOVA showed that the sloped degree only affected the sway area in condition of eyes closed and dorsiflexion (P = 0.016), and affected the velocity/intensity in all conditions tested (all P < 0.0001). In consideration of interaction effect, the sloped degree showed significant difference in sway area in conditions of eyes open and plantar flexion/dorsiflexion (P = 0.03 and P = 0.0113), in sway velocity in most conditions tested (P < 0.05), and in sway intensity in condition of eyes open and dorsiflexion only (P = 0.0004). CONCLUSION Subjects with high level of streptococcal serology demonstrated increased sway on all postural control measures as compared to those with low serology. Proprioceptive deficits in the SI joint might contribute to the postural impairment measured in this study.
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Affiliation(s)
- Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Chang CC, Chang ST, Ku CH, Chiang SL, Chang HY, Lai MH, Tsai KC, Chen LC. First-ever Ischemic Stroke after a Flight in a Patient with Prior Poliomyelitis. Clin Med Pathol 2008; 1:1-5. [PMID: 21876645 PMCID: PMC3160001 DOI: 10.4137/cpath.s476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Survivors of poliomyelitis sometimes travel by air with mobility assistance. However, prolonged seating during long-haul flights may also possibly produce stroke events on polio-inflicted patients. A 48-year-old polio-inflicted male suffered a stroke after an extended flight. A two-dimensional echocardiography was normal without detected patent foramen ovale or dyskinetic segment. The venodynamic variables were all within normal limits. MR Imaging studies revealed acute cerebral infarction in the distribution of the right middle cerebral artery and posterior watershed area. Hematological examination revealed positive anti-cardiolipin IgG antibody which might contribute to the risk of thrombosis as an underlying condition in addition to immobilization. This is the first presentation of ischemic stroke after a flight in a patient with prior poliomyelitis. In addition to decompression sickness, economy class stroke syndrome and postpoliomyelitis syndrome, the physician should also take other coagulation disorders into consideration during the investigation.
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Affiliation(s)
- Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Abstract
BACKGROUND Intractable hiccups are occasionally encountered in the presence of stroke but are usually difficult to manage. METHODS We describe two stroke patients with intractable hiccups that were refractory to pharmacological treatment but were well resolved by application to relevant acupoints with the modality linear polarized near-infrared ray equipment on PC 6 (Nei Guan), ST 36 (Zu San Li), and DU 9 (Chih Yang), which are the empirical acupoints aimed at regulating gastrointestinal mobility and function of the thoracic organ. RESULTS The first patient who received the treatment for only one time came out with a dramatic termination of intractable hiccups 3 hours later and with no recurrence thereafter. We applied the same treatment on the second patient once a day for 8 consecutive days, which led to progressive amelioration of intractable hiccups. CONCLUSIONS This is the first report about the complete resolution of intractable hiccups due to stroke using near-infrared irradiation to acupoints, rather than using conventional pharmacologic therapy, traditional acupuncture, or moxibustion. Consequently, these findings suggest that linear polarized near-infrared ray irradiation, with its noninvasive properties, might be an alternative treatment for intractable hiccups after stroke.
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Affiliation(s)
- Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China..
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Kao-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Jiann-Chyun Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Ho CW, Chen LC, Hsu HH, Chiang SL, Li MH, Jiang SH, Tsai KC. Isokinetic muscle strength of the trunk and bilateral knees in young subjects with lumbar disc herniation. Spine (Phila Pa 1976) 2005; 30:E528-33. [PMID: 16166880 DOI: 10.1097/01.brs.0000179307.34310.7d] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study comparing normal subjects and patients with lumbar disc herniation. OBJECTIVE To evaluate trunk and knee muscle strength in patients with L4-L5 and/or L5-S1 disc herniation. SUMMARY OF BACKGROUND DATA Numerous studies have shown that patients with low back pain have weaker trunk muscles. The strength of trunk and knee muscles has not been investigated simultaneously in patients with lumbar disc herniation. METHODS Forty-one controls and 2 patients were included. Isokinetic strength of the trunk and bilateral knees was tested on a calibrated isokinetic testing machine (Biodex System 3 Pro) regardless of the laterality of the radiculopathy. The testing was carrying out at two different velocities: 60 degrees and 120 degrees per second. RESULTS Total trunk strength and knee strength were significantly lower in these patients (4.34 +/- 1.06 and 4.06 +/- 1.16 vs. 6.21 +/- 1.05 and 5.83 +/- 1.09 Nm/kg at 60 degrees and 120 degrees per second, respectively, P < 0.001). In patients with unilateral sciatica, there was no significant difference (P > 0.05) in unilateral knee strength between sciatica-involved and -uninvolved limbs (1.89 +/- 0.5, 1.08 +/- 0.45, 1.48 +/- 0.58, 0.93 +/- 0.41 vs. 1.68 +/- 0.45, 0.91 +/- 0.38, 1.41 +/- 0.48, 0.79 +/- 0.39 Nm/kg in sciatica-uninvolved vs. sciatica-involved limbs during extension and flexion at 60 degrees and 120 degrees per second, respectively). Total trunk strength was significantly correlated with total knee strength in both groups. CONCLUSIONS In the patients with lumbar disc herniation, muscle strength of the trunk and knees was decreased to a similar extent. Weaker knee strength was found on either side of the lower extremity in the patients with unilateral sciatica, regardless of its location.
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Affiliation(s)
- Cheng-Wen Ho
- Institute of Aerospace Medicine, Taiwan, Republic of China.
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Abstract
Recent efforts to develop a vaccine against the diarrheal disease cholera have focused on the use of live attenuated strains of the causative organism, Vibrio cholerae. The Ogawa lipopolysaccharide phenotype is expressed by many epidemic strains, and motility defects reduce the risk of reactive diarrhea in vaccine recipients. We therefore converted a motile Inaba(+) vaccine candidate, Peru-2, to a nonmotile Ogawa(+) phenotype using a mariner-based transposon carrying rfbT, the gene required for expression of the Ogawa phenotype. Analysis of 22 nonmotile Peru-2 mutants showed that two were Ogawa(+), and both of these strains had insertions in the flgE gene. It was possible to convert these strains to antibiotic sensitivity by introducing a recombinase that acts on sites flanking the antibiotic marker on the transposon. The resulting strains are competent for colonization in infant mice and may therefore be suitable as vaccine candidates for use either independently or in a combination with strains of different biotypes and serotypes.
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Affiliation(s)
- S L Chiang
- Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
In vitro assays contribute greatly to our understanding of bacterial pathogenesis, but they frequently cannot replicate the complex environment encountered by pathogens during infection. The information gained from such studies is therefore limited. In vivo models, on the other hand, can be difficult to use, and this has to some extent diminished the incentive to perform studies in living animals. However, several recently developed techniques permit in vivo examination of many genes simultaneously. Most of these methods fall into two broad classes: in vivo expression technology and signature-tagged mutagenesis. In vivo expression technology is a promoter-trap strategy designed to identify genes whose expression is induced in a specific environment, typically that encountered in a host. Signature-tagged mutagenesis uses comparative hybridization to isolate mutants unable to survive specified environmental conditions and has been used to identify genes critical for survival in the host. Both approaches have so far been used exclusively for investigating pathogen-host interactions, but they should be easily adaptable to the study of other processes.
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Affiliation(s)
- S L Chiang
- Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Chiang SL, Mekalanos JJ. rfb mutations in Vibrio cholerae do not affect surface production of toxin-coregulated pili but still inhibit intestinal colonization. Infect Immun 1999; 67:976-80. [PMID: 9916119 PMCID: PMC96415 DOI: 10.1128/iai.67.2.976-980.1999] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The toxin-coregulated pilus (TCP) of Vibrio cholerae is essential for colonization. It was recently reported that rfb mutations in V. cholerae 569B cause the translocation arrest of the structural subunit of TCP, raising the possibility that the colonization defects of lipopolysaccharide mutants are due to effects on TCP biogenesis. However, an rfbB gene disruption in either V. cholerae O395 or 569B has no apparent effect on surface TCP production as assessed by immunoelectron microscopy and CTX phage transduction, and an rfbD::Tn5lac mutant of O395 also shows no defect in TCP expression. We conclude that the colonization defect associated with rfb mutations is unrelated to defects in TCP assembly.
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Affiliation(s)
- S L Chiang
- Department of Microbiology and Molecular Genetics and Shipley Institute of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
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Steitz SA, Hasegawa K, Chiang SL, Cobb RR, Castro MA, Lobl TJ, Yamada M, Lazarides E, Cardarelli PM. Mapping of MCP-1 functional domains by peptide analysis and site-directed mutagenesis. FEBS Lett 1998; 430:158-64. [PMID: 9688530 DOI: 10.1016/s0014-5793(98)00637-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Monocyte chemoattractant protein-1 (MCP-1) is a member of the beta chemokine family which acts through specific seven transmembrane receptors to recruit monocytes, basophils, and T lymphocytes to sites of inflammation. To identify regions of the human MCP-1 protein which are important for its biological activity, we have synthesized domain-specific peptides and tested their ability to antagonize MCP-1 binding and chemotaxis in THP-1 cells. We have found that an intercysteine first loop peptide encompassing amino acids 13-35 inhibits MCP-1 binding and chemotactic activity, while peptides representing the amino-terminus (amino acids 1-10), second loop (amino acids 37-51), and carboxy-terminus (amino acids 56-71) of MCP-1 have no effect. In addition, we have found that cyclization of the first loop peptide by disulfide linkage and blocking the C-terminus of the peptide by amidation increases the activity of this peptide to block MCP-1 binding and chemotaxis. In order to specifically identify amino acid residues within the first loop that are crucial for MCP-1 functional activity, we have substituted alanine for tyrosine (Y13A) or arginine (R18A) in MCP-1 recombinant proteins. While baculovirus produced wild type and R18A MCP-1 proteins are indistinguishable in their ability to induce THP-1 chemotaxis and show modest effects in binding activity compared to commercially available recombinant MCP-1 protein, the Y13A point mutation causes a dramatic loss in function. The identification of functional domains of MCP-1 will assist in the design of MCP-1 receptor antagonists which may be clinically beneficial in a number of inflammatory diseases.
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Affiliation(s)
- S A Steitz
- Tanabe Research Laboratories USA, Inc., San Diego, CA 92121, USA
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Abstract
The pathogenesis of cholera begins with colonization of the host intestine by Vibrio cholerae. The toxin co-regulated pilus (TCP), a fimbrial structure produced by V. cholerae, is absolutely required for colonization (i.e. the persistence, survival and growth of V. cholerae in the upper intestinal milieu), but many other aspects of the colonization process are not well understood. In this study, we use signature-tagged transposon mutagenesis (STM) to conduct a screen for random insertion mutations that affect colonization in the suckling mouse model for cholera. Of approximately 1100 mutants screened, five mutants (approximately 0.5%) with transposon insertions in TCP biogenesis genes were isolated, validating the use of STM to identify attenuated mutants. Insertions in lipopolysaccharide, biotin and purine biosynthetic genes were also found to cause colonization defects. Similar results were observed for mutations in homologues of pta and ptfA, two genes involved in phosphate transfer. Finally, our screen identified several novel genes, disruption of which also caused colonization defects in the mouse model. These results demonstrate that STM is a powerful method for isolating colonization-defective mutants of V. cholerae.
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Affiliation(s)
- S L Chiang
- Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, MA 02115, USA
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Chiang SL, Taylor RK, Koomey M, Mekalanos JJ. Single amino acid substitutions in the N-terminus of Vibrio cholerae TcpA affect colonization, autoagglutination, and serum resistance. Mol Microbiol 1995; 17:1133-42. [PMID: 8594332 DOI: 10.1111/j.1365-2958.1995.mmi_17061133.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The toxin-coregulated pilus (TCP) of Vibrio cholerae O1 is required for successful infection of the host. TcpA, the structural subunit of TCP, belongs to the type IV family of pilins, which includes the PilE pilin of Neisseria gonorrhoeae. Recently, single amino acid changes in the N-terminus of PilE were found to abolish autoagglutination in gonococci. As type IV pilins demonstrate some similarities in function and amino acid sequence, site-directed mutagenesis and allelic exchanges were used to create corresponding mutations in TcpA. All four mutant strains demonstrated autoagglutination defects, and all were highly defective for colonization in the infant mouse model. These results support the previously proposed correlation between autoagglutination and colonization. Finally, all four mutants are serum sensitive, indicating that TcpA plays a role in serum resistance, a phenotype previously attributed to TcpC. As the mutations have similar effects in N. gonorrhoeae and V. cholerae, our results support the idea that type IV pilins have similar functions in a variety of pathogenic bacteria.
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Affiliation(s)
- S L Chiang
- Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA
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Cardarelli PM, Cobb RR, Nowlin DM, Scholz W, Gorcsan F, Moscinski M, Yasuhara M, Chiang SL, Lobl TJ. Cyclic RGD peptide inhibits alpha 4 beta 1 interaction with connecting segment 1 and vascular cell adhesion molecule. J Biol Chem 1994; 269:18668-73. [PMID: 7518441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The integrin supergene family includes receptors for a variety of extracellular matrix as well as cell surface proteins. Integrin alpha 4 has been shown to play an important role in leukocyte adhesion and extravasation during immune and inflammatory reactions. One recognition sequence known to interact with alpha 4 is the Leu-Asp-Val (LDV) site contained in the connecting segment 1 region of fibronectin. Here we present evidence that shows that a conformationally restricted RGD-containing peptide is a potent inhibitor of cell adhesion mediated by alpha 4 beta 1, a receptor not convincingly documented to interact with RGD peptides. This peptide, 1-adamantaneacetyl-Cys-Gly-Arg-Gly-Asp-Ser-Pro-Cys (disulfide bridge between residues 1-8), blocks Jurkat cell adhesion to connecting segment 1-containing peptides as well as cell adhesion to cytokine-activated endothelial cells. Adhesion of Jurkat cells to either vascular cell adhesion molecule-expressing cells or recombinant vascular cell adhesion molecule-coated plates was likewise inhibited by this peptide. Furthermore, alpha 4 beta 1 can bind directly to a cyclic RGD peptide immobilized to Sepharose. Integrins, alpha 5 beta 1, alpha v beta 3, alpha IIb/beta IIIa, alpha 2 beta 1, alpha v beta 1, alpha v beta 5, alpha v beta 6, and alpha 3 beta 1, have been shown to recognize the Arg-Gly-Asp (RGD) sequence present in a variety of extracellular matrix proteins, and our data support the addition of alpha 4 beta 1 to this group. Further studies using molecular modeling of such cyclic RGD peptides could help in the design of more potent peptides or nonpeptide mimetics that could effectively block alpha 4-mediated activity and have potential application in a number of inflammatory diseases.
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Affiliation(s)
- P M Cardarelli
- Tanabe Research Laboratories, San Diego, California 92121
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Nowlin DM, Gorcsan F, Moscinski M, Chiang SL, Lobl TJ, Cardarelli PM. A novel cyclic pentapeptide inhibits alpha 4 beta 1 and alpha 5 beta 1 integrin-mediated cell adhesion. J Biol Chem 1993; 268:20352-9. [PMID: 7690755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Lymphocytes and monocytes initiate and modulate inflammatory and immune responses for host defense. This process is dependent upon extravasation of leukocytes from the circulation to sites of antigenic challenge and is controlled, in part, by various integrins, including alpha 4 beta 1 and alpha 5 beta 1. A small cyclic pentapeptide that inhibits, in vitro, both alpha 4 beta 1 and alpha 5 beta 1 activity is described. This peptide, Arg-Cys-Asp-Thioproline-Cys (RC*D[ThioP]C*), is cyclized by a disulfide bond through the cysteine residues (the asterisks denote cyclizing residues). RC*D(ThioP)C* inhibits alpha 5 beta 1-mediated leukocyte adhesion to the 120-kDa Arg-Gly-Asp (RGD)-containing binding site of fibronectin. Two different adhesion activities of alpha 4 beta 1 are also inhibited: alpha 4 beta 1-mediated cell adhesion to the alternatively spliced CS-1 site of fibronectin and the alpha 4 beta 1-dependent binding of leukocytes to cytokine-activated endothelial cells. Both alpha 4 beta 1 and alpha 5 beta 1 can be purified by affinity chromatography using the immobilized pentapeptide. The peptide does not inhibit adhesion to other extracellular matrix proteins including laminin and vitronectin. The specificity of the RC*D(ThioP)C* peptide for alpha 4 beta 1 and alpha 5 beta 1 suggests potential therapeutic utility for inhibiting inflammatory disease.
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Affiliation(s)
- D M Nowlin
- Tanabe Research Laboratories, San Diego, California 92121
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