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Lee K, Kim JH, Hong H, Jeong Y, Ryu H, Kim H, Lee SU. Deep learning model for classifying shoulder pain rehabilitation exercises using IMU sensor. J Neuroeng Rehabil 2024; 21:42. [PMID: 38539223 PMCID: PMC10967210 DOI: 10.1186/s12984-024-01343-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Artificial intelligence is being used for rehabilitation, including monitoring exercise compliance through sensor technology. AI classification of shoulder exercise wearing an IMU sensor has only been reported in normal (i.e. painless) subjects. To prove the feasibility of monitoring exercise compliance, we aimed to classify 11 types of shoulder rehabilitation exercises using an AI (artificial intelligence) algorithm in patients with shoulder pain. We had the patients wear an IMU-based sensor, collected data during exercise, and determined the accuracy of exercise classification. METHODS Data were collected from 58 patients (27 males, 31 females, age range 37-82 years) diagnosed with shoulder diseases such as adhesive capsulitis and rotator cuff disease. 11 types of shoulder pain rehabilitation exercise programs were developed and repeated each exercise ten times per session while wearing an IMU sensor. The study applied the Rectified Linear Unit (ReLU) and the SoftMax as the activation function for hidden layers, the output layer. RESULTS The acquired data was used to train a DNN model using the multilayer perceptron algorithm. The trained model was used to classify 11 types of shoulder pain rehabilitation exercises. The training accuracy was 0.975 and the test accuracy was 0.925. CONCLUSION The study demonstrates that IMU sensor data can effectively classify shoulder pain rehabilitation exercises, providing more appropriate feedback for patients. The model can be utilized to establish a system for remotely monitoring patients' exercise performance. The use of deep learning in patient monitoring and rehabilitation has significant potential to bring innovative changes to healthcare service delivery.
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Affiliation(s)
- Kyuwon Lee
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Jeong-Hyun Kim
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Hyeon Hong
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Yeji Jeong
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Hokyoung Ryu
- Dept. of Graduate School of Technology and Innovation Management, Hanyang University, Seoul, South Korea
| | - Hyundo Kim
- Dept. of Intelligence Computing, Hanyang University, Seoul, South Korea
| | - Shi-Uk Lee
- Dept. of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
- Dept. of Physical Medicine & Rehabilitation, College of Medicine, Seoul National University, Seoul, South Korea.
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Yoon DH, Kim JH, Lee K, Cho JS, Jang SH, Lee SU. Inertial measurement unit sensor-based gait analysis in adults and older adults: A cross-sectional study. Gait Posture 2024; 107:212-217. [PMID: 37863672 DOI: 10.1016/j.gaitpost.2023.10.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Gait assessment has been used in a wide range of clinical applications, and gait velocity is also a leading predictor of disease and physical functional aspects in older adults. RESEARCH QUESTION The study aim to examine the changes in IMU-based gait parameters according to age in healthy adults aged 50 and older, to analyze differences between aging patients. METHODS A total of 296 healthy adults (65.32 ± 6.74 yrs; 83.10 % female) were recruited. Gait assessment was performed using an IMU sensor-based gait analysis system, and 3D motion information of hip and knee joints was obtained using magnetic sensors. The basic characteristics of the study sample were stratified by age category, and the baseline characteristics between the groups were compared using analysis of variance (ANOVA). Pearson's correlation analysis was used to analyze the relationship between age as the dependent variable and several measures of gait parameters and joint angles as independent variables. RESULTS The results of this study found that there were significant differences in gait velocity and both terminal double support in the three groups according to age, and statistically significant differences in the three groups in hip joint angle and knee joints angle. In addition, it was found that the gait velocity and knee/hip joint angle changed with age, and the gait velocity and knee/hip joint angle were also different in the elderly and adult groups. CONCLUSIONS We found changes in gait parameters and joint angles according to age in healthy adults and older adults and confirmed the difference in gait velocity and joint angles between adults and older adults.
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Affiliation(s)
- Dong Hyun Yoon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea; Institute on Aging, Seoul National University, Seoul, South Korea
| | - Jeong-Hyun Kim
- Department of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Kyuwon Lee
- Department of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Jae-Sung Cho
- Korea Orthopedics & Rehabilitation Engineering Center, Incheon, South Korea
| | - Seong-Ho Jang
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Gyeonggi-do, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
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Ye DH, Chun MH, Park YG, Paik NJ, Lee SU, Yoo SD, Kim DY. A Randomized, Double-Blind, Active Control, Multicenter, Phase 3 Study to Evaluate the Efficacy and Safety of Liztox ® versus Botox ® in Post-Stroke Upper Limb Spasticity. Toxins (Basel) 2023; 15:697. [PMID: 38133201 PMCID: PMC10748261 DOI: 10.3390/toxins15120697] [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: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Botulinum toxin type A (BTX-A) injection is a commonly used therapeutic intervention for upper limb spasticity in stroke patients. This study was designed as a randomized, active-drug-controlled, double-blind, multicenter, phase 3 clinical trial to evaluate the safety and efficacy of Liztox® in comparison to onabotulinum toxin A (Botox®) for individuals with post-stroke upper limb spasticity. The primary outcome was the alteration in wrist flexor muscle tone from the initial assessment to the fourth week, evaluated using the modified Ashworth scale (MAS). Secondary outcomes included MAS score changes for the wrist at weeks 8 and 12 from baseline; MAS score changes for finger and elbow flexors; and changes in the Disability Assessment Scale (DAS), Subject's Global Assessment (SGA), the Investigator's Global Assessment (IGA), and Caregiver Burden Scale (CBS) at weeks 4, 8, and 12 from baseline. The MAS score for wrist flexor spasticity decreased by -1.14 ± 0.59 in the Liztox® group and -1.22 ± 0.59 in the Botox® group from baseline to week 4. The difference [97.5% confidence interval (CI)] between the test and control groups was 0.08 [-∞, 0.26], confirming the non-inferiority of the test group compared to the control group. Furthermore, there were consistent improvements in the IGA, SGA, and CBS scores across all assessment intervals, with no statistically significant variances detected between the two groups. No safety-related concerns were reported during the study. In conclusion, Liztox® injection proved to be a secure and efficacious intervention for managing upper extremity spasticity in post-stroke patients.
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Affiliation(s)
- Dong Hyun Ye
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea;
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea;
- Department of Medicine (AgeTech-Service Convergence Major), Kyung Hee University, Seoul 05278, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
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Lee J, Chun MH, Ko YJ, Lee SU, Kim DY, Paik NJ. Safety and efficacy of MT10107 in post-stroke upper limb spasticity treatment: A phase I randomized controlled trial. Medicine (Baltimore) 2022; 101:e31367. [PMID: 36343044 PMCID: PMC9646656 DOI: 10.1097/md.0000000000031367] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Botulinum toxin type A injection is widely used treatment option for the treatment of upper limb spasticity in stroke patients. The purpose of this study was to explore the safety and efficacy of MT10107, a new botulinum toxin type A, in patients with post-stroke upper limb spasticity. METHODS A prospective, randomized, double-blind, active drug-controlled, multi-center, phase I clinical trial. Thirty patients with post-stroke upper limb spasticity were received either MT10107 or onabotulinumtoxinA. Primary endpoint was change of modified Ashworth scale (MAS) score for wrist flexor from baseline to week 4. The secondary endpoints were changes of MAS scores for elbow and finger flexors, response rate, Disability Assessment Scale (DAS), and global assessment of treatment. The safety endpoints such as adverse events, vital signs, physical examination, and laboratory test were evaluated. The outcome measures were evaluated from baseline to week 4. RESULTS The primary endpoints were -1.07 ± 0.70 and -1.23 ± 0.56 for the MT10107 and onabotulinumtoxinA groups, respectively. The intergroup difference of change between the 2 groups was 0.17 (95% confidence interval -0.31 to 0.64, P = .5769). In secondary endpoints, both groups showed a significant improvement in both MAS and DAS. There was no significant between-group difference in all secondary endpoints and safety measures. CONCLUSION The safety and efficacy of MT10107 showed no significant difference compared to onabotulinumtoxinA in post-stroke upper limb spasticity treatment.
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Affiliation(s)
- Junekyung Lee
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jin Ko
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Abstract
BACKGROUND This study was performed to update the current evidence and evaluate the effects of robot-assisted rehabilitation (RAR) in comparison with conventional rehabilitation (CR) in patients following total knee (TKR) or hip replacements (THR). METHODS PubMed Central, OVID Medline, Cochrane Collaboration Library, and EMBASE for a comprehensive search for all relevant studies, from database inception to July 2022. The following inclusion criteria were used to determine eligibility for studies: randomized and matched controlled trials recruiting men and women who underwent TKR and THR; and studies examining the effect of RAR on outcome measures of physical function and pain. RESULTS A total of 9 studies (230 patients) were included in this review and 4 were included in the meta-analysis. The meta-analysis of 2 studies showed that Hybrid Assistive Limb (HAL) training for 5 days, significantly improved pain measured on a visual analogue scale, compared to CR in patients following TKR (SMD = 1.05, 95% confidence interval [Cl] 0.39-1.71). Heterogeneity for I2 value was lower than moderate (tau^2 = 0.0121; I2 = 5%; P = .30). There were 2 studies that assessed self-selected walking speed. The meta-analysis of these studies showed that HAL training was significantly superior to CR in patients following TKR (SMD = 48.70, 95% Cl -50.53 to 147.94) at 2 months. A high heterogeneity was detected (P < .01; I2 = 97%). CONCLUSION The result of this systematic review and meta-analysis suggest that RAR may be an effective treatment in TKR and THR patients. However, high-quality studies are needed to verify the long-term effect on their recovery.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
- *Correspondence: Chang Han Lee, Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju 52727, Korea (e-mail: )
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Lee CW, Kim IS, Kim JG, Hwang H, Jung IY, Lee SU, Seo KS. Effects of Hydrodilatation With Corticosteroid Injection and Biomechanical Properties in Patients With Adhesive Capsulitis After Breast Cancer Surgery. Ann Rehabil Med 2022; 46:192-201. [PMID: 36071001 PMCID: PMC9452287 DOI: 10.5535/arm.22059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the biomechanical properties of the glenohumeral joint capsule between adhesive capsulitis (AC) after breast cancer surgery and idiopathic AC and demonstrate the effects of hydrodilatation (HD) with corticosteroid injection for AC after breast cancer surgery. Methods Twenty-three prospective patients with AC after breast cancer surgery (BC group) and 44 retrospective patients with idiopathic AC without breast cancer (CON group) underwent HD with corticosteroid injection and home exercise training. We compared their biomechanical characteristics (capsular capacity, maximal pressure, and capsular stiffness). In the BC group, the passive range of motion (ROM) of the affected shoulder and a questionnaire (Shoulder Pain and Disability Index [SPADI]) were evaluated at baseline and 2 and 4 weeks after treatment. Results The BC group showed higher biomechanical characteristics (maximal pressure and capsular stiffness) than did the CON group. The mean maximal pressure and capsular stiffness were 519.67±120.90 mmHg and 19.69±10.58 mmHg/mL in the BC group and 424.78±104.42 mmHg and 11.55±7.77 mmHg/mL in the CON group (p=0.002 and p=0.001, respectively). And, the BC group showed significant improvements in all ROMs (abduction, flexion, and external rotation) and the SPADI pain and disability sub-scores following the treatment. Conclusion The glenohumeral joint capsular stiffness was greater in the patients with AC after breast cancer surgery than in those with idiopathic AC. HD with corticosteroid injection was effective in treating AC after breast cancer surgery.
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Hwang W, Kang SM, Lee SY, Seo HG, Park YG, Kwon BS, Lee KJ, Kim DY, Kim HS, Lee SU. Efficacy and Safety of Botulinum Toxin Type A (NABOTA) for Post-stroke Upper Extremity Spasticity: A Multicenter Phase IV Trial. Ann Rehabil Med 2022; 46:163-171. [PMID: 36070998 PMCID: PMC9452292 DOI: 10.5535/arm.22061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate the efficacy and safety of Daewoong botulinum toxin type A (NABOTA) after its launch in South Korea. Methods This prospective, multicenter, open-label phase IV clinical trial included 222 patients with stroke. All patients visited the clinic at baseline and at weeks 4, 8, and 12 after injection of upto 360 units of NABOTA into the wrist, elbow, and finger flexor muscles at the first visit. The primary outcome was the change in Modified Ashworth Scale (MAS) score for the wrist flexor muscles between baseline and week 4. The secondary outcomes were the changes in MAS, Disability Assessment Scale (DAS), and Caregiver Burden Scale (CBS) scores between baseline and each visit, and the Global Assessment Scale (GAS) score at week 12. Results There was a statistically significant decrease in the MAS score for the wrist flexors between baseline and week 4 (−0.97±0.66, p<0.001). Compared with baseline, the MAS, DAS and CBS scores improved significantly during the study period. The GAS was rated as very good or good by 86.8% of physicians and by 60.0% of patients (or caregivers). The incidence of adverse events was 14.4%, which is smaller than that in a previous trial. Conclusion NABOTA showed considerable efficacy and safety in the management of upper limb spasticity in stroke patients.
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Kim JY, Kim E, Shim HS, Lee JH, Lee GJ, Kim K, Lim JY, Beom J, Lee SY, Lee SU, Chung SG, Oh BM. Reference Standards for Nerve Conduction Studies of Individual Nerves of Lower Extremity With Expanded Uncertainty in Healthy Korean Adults. Ann Rehabil Med 2022; 46:9-23. [PMID: 35272436 PMCID: PMC8913270 DOI: 10.5535/arm.21170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2001] [Accepted: 01/12/2022] [Indexed: 01/03/2023] Open
Abstract
Objective To develop a set of reference standards for tibial motor, common peroneal motor, sural sensory, and superficial peroneal sensory nerve conduction studies (NCSs) with expanded uncertainty in a healthy Korean population.Methods Standardized procedures were conducted for individual lower extremity NCSs of 199 healthy participants in their 20s (n=100) and 50s (n=99). Mean values and expanded uncertainties for parameters were analyzed with thorough consideration of multiple uncertainty factors under the International Guide to the Expression of Uncertainty in Measurement. In addition, side-to-side differences in onset latency, amplitude, and nerve conduction velocity (NCV) were analyzed.Results Mean (reference range) for distal onset latency, baseline to negative peak amplitude, NCV of tibial motor nerve in males in their 20s were 4.3 ms (3.1–5.4 ms), 7.1 mV (3.4–10.9 mV), and 50.7 m/s (42.2–59.3 m/s), respectively; sural sensory nerve baseline to negative peak amplitude in males in their 20s was 21.7 μV (8.3–35.2 μV). Including the aforementioned data, we present a vast dataset of normative mean values and expanded uncertainties for NCSs of the leg in a healthy Korean population. Furthermore, upper limits for normal side-to-side differences for onset latency, amplitude, and NCV of each nerve are suggested.Conclusion To our knowledge, this is the first study to present the reference standards of leg NCSs with consideration for multifactorial uncertainties in an Asian population. We expect these results to help practitioners make reliable and reproducible clinical decisions.
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Cho WS, Chung SG, Kim W, Jo CH, Lee SU, Lee SY. Correction: Mesenchymal Stem Cells Use in the Treatment of Tendon Disorders: A Systematic Review and Meta-Analysis of Prospective Clinical Studies. Ann Rehabil Med 2021; 45:410. [PMID: 34743484 PMCID: PMC8572994 DOI: 10.5535/arm.21078.e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Woo Sup Cho
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Chris H Jo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
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Lee CH, Lee SU. Usefulness of Extracorporeal Shockwave Therapy on Myofascial Pain Syndrome. Ann Rehabil Med 2021; 45:261-263. [PMID: 34496468 PMCID: PMC8435462 DOI: 10.5535/arm.21128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
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Cho WS, Chung SG, Kim W, Jo CH, Lee SU, Lee SY. Mesenchymal Stem Cells Use in the Treatment of Tendon Disorders: A Systematic Review and Meta-Analysis of Prospective Clinical Studies. Ann Rehabil Med 2021; 45:274-283. [PMID: 34496470 PMCID: PMC8435464 DOI: 10.5535/arm.21078] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the efficacy and safety of mesenchymal stem cells (MSCs) therapy in patients with tendon disorders enrolled in prospective clinical studies. Methods We systematically searched prospective clinical studies that investigated the effects of MSC administration on human tendon disorders with at least a 6-month follow-up period in the PubMed-MEDLINE, EMBASE, and Cochrane Library databases. The primary outcome of interest was the change in pain on motion related to tendon disorders. Meta-regression analyses were performed to assess the relationship between MSC dose and pooled effect sizes in each cell dose. Results Four prospective clinical trials that investigated the effect of MSCs on tendon disorders were retrieved. MSCs showed a significant pooled effect size (overall Hedges’ g pooled standardized mean difference=1.868; 95% confidence interval, 1.274–2.462; p<0.001). The treatment with MSCs improved all the aspects analyzed, namely pain, functional scores, radiological parameters (magnetic resonance image or ultrasonography), and arthroscopic findings. In the meta-regression analysis, a significant cell dose-dependent response in pain relief (Q=9.06, p=0.029) was observed. Conclusion Our meta-analysis revealed that MSC therapy may improve pain, function, radiological, and arthroscopic parameters in patients with tendon disorders. A strong need for large-scale randomized controlled trials has emerged to confirm the long-term functional improvement and adverse effects of MSC therapies in tendon disorders.
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Affiliation(s)
- Woo Sup Cho
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Chris H Jo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
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Kang MG, Yun SJ, Lee SY, Oh BM, Lee HH, Lee SU, Seo HG. Effects of Upper-Extremity Rehabilitation Using Smart Glove in Patients With Subacute Stroke: Results of a Prematurely Terminated Multicenter Randomized Controlled Trial. Front Neurol 2020; 11:580393. [PMID: 33240205 PMCID: PMC7680863 DOI: 10.3389/fneur.2020.580393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/06/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Although there have been many trials and interventions for reducing upper-extremity impairment in stroke survivors, it remains a challenge. A novel intervention is needed to provide high-repetition task-specific training early after stroke. Objective: This study aimed to investigate the effect of smart glove training (SGT) for upper-extremity rehabilitation in patients with subacute stroke. Methods: A prospective, multicenter, randomized, controlled study was conducted in patients with upper-extremity hemiparesis with Brunnstrom stage for arm 2–5 in the subacute phase after stroke. Eligible participants were randomly allocated to the SGT group or the control group. The SGT group underwent 30 min of standard occupational therapy plus 30 min of upper-extremity training with smart glove. The control group underwent standard occupational therapy for 30 min plus upper-extremity self-training (homework tasks at bedside) for 30 min. All participants underwent each intervention 5 days/week for 2 consecutive weeks. They were evaluated before, immediately after, and 4 weeks after the intervention. The primary outcome measure was the change in the score of the Fugl-Meyer assessment of the upper extremity (FMA-UE). Results: Twenty-three patients were enrolled. Repeated-measures analysis of covariance after controlling for age and disease duration showed significant time × group interaction effects in the FMA-UE, FMA-distal, and FMA-coordination/speed (p = 0.018, p = 0.002, p = 0.006). Repeated-measures analysis of variance showed significant time × group interaction effects in the FMA-UE, FMA-distal, and Box and Block Test (p = 0.034, p = 0.010, p = 0.046). Mann-Whitney U-test showed a statistically higher increase in the FMA-UE and FMA-distal in the SGT group than in the control group (p = 0.023, p = 0.032). Conclusion: Upper-extremity rehabilitation with a smart glove may reduce upper-extremity impairment in patients with subacute stroke. Clinical Trial Registration: ClinicalTrials.gov (NCT02592759).
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Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Lee J, Chun MH, Ko YJ, Lee SU, Kim DY, Paik NJ, Kwon BS, Park YG. Efficacy and Safety of MT10107 (Coretox) in Poststroke Upper Limb Spasticity Treatment: A Randomized, Double-Blind, Active Drug-Controlled, Multicenter, Phase III Clinical Trial. Arch Phys Med Rehabil 2020; 101:1485-1496. [PMID: 32497599 DOI: 10.1016/j.apmr.2020.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/26/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of MT10107 (Coretox) with those of onabotulinum toxin A (Botox) in patients with poststroke upper limb spasticity DESIGN: Prospective, randomized, double-blind, active drug-controlled, multicenter, phase III clinical trial. SETTING Seven university hospitals in the Republic of Korea. PARTICIPANTS Patients (N=220) with poststroke upper limb spasticity. INTERVENTIONS All participants received a single injection of either MT10107 (Coretox group) or onabotulinum toxin A (Botox group). MAIN OUTCOME MEASURES The primary outcome was change in wrist flexor spasticity from baseline to week 4, which was assessed using the modified Ashworth scale (MAS). The secondary outcomes were MAS scores for wrist, elbow, and finger flexors; percentage of treatment responders (response rate); Disability Assessment Scale (DAS) score, and global assessment of treatment. Safety was evaluated based on adverse events, vital signs, physical examination findings, and laboratory test results. The efficacy and safety were evaluated at 4, 8, and 12 weeks postintervention. RESULTS The primary outcome was found to be -1.32±0.69 and -1.40±0.69 for the Coretox and Botox groups, respectively. MT10107 showed a non-inferior efficacy compared with onabotulinum toxin A, as the 95% confidence interval for between-group differences was -0.10 to 0.27 and the upper limit was less than the non-inferiority margin of 0.45. Regarding the secondary outcomes, MAS scores for all muscles and DAS scores showed a significant improvement at all time points in both groups, with no significant between-group difference. No significant between-group differences were observed regarding response rate, global assessment of treatment, and safety measures. CONCLUSIONS MT10107 showed no significant difference in efficacy and safety compared with onabotulinum toxin A in poststroke upper limb spasticity treatment.
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Affiliation(s)
- Junekyung Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
| | - Young Jin Ko
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea
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Yoo JI, Oh MK, Chun SW, Lee SU, Lee CH. The effect of focused extracorporeal shock wave therapy on myofascial pain syndrome of trapezius: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19085. [PMID: 32049811 PMCID: PMC7035035 DOI: 10.1097/md.0000000000019085] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 12/29/2022] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) is commonly seen in clinical settings and negatively influences a patient's daily life. Recently, the application of extracorporeal shock wave therapy (ESWT) has been utilized as one of the treatment methods for MPS. The aim of this systematic review and meta-analysis was to summarize the current evidence for the short-term effect of ESWT on MPS of trapezius. METHODS PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were searched from the database inception to March 2019. Two reviewers independently screened articles, evaluated methodological quality, and extracted data. The primary outcome was post-interventional pain intensity. RESULTS Randomized controlled trials (RCTs) were conducted to determine whether ESWT was used as the main treatment on MPS. The 5 studies reviewed in this meta-analysis were evaluated for changes in pain intensity. Compared with other treatments, focused ESWT in MPS was more effective in reducing the scores of visual analog scale (VAS) (standardized mean difference [SMD] = -0.48, 95% CI -0.74 to -0.22). CONCLUSIONS There is very low level evidence that focused ESWT is effective for short-term relief of neck pain in MPS. The limited sample size and poor quality of these studies highlight and support the need for large scale, good quality placebo controlled trials in this area.
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Affiliation(s)
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongjaro, Seongsan-gu, Changwon, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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Lee SJ, Jung SH, Lee SU, Lim JY, Yoon KS, Lee SY. Postoperative delirium after hip surgery is a potential risk factor for incident dementia: A systematic review and meta-analysis of prospective studies. Arch Gerontol Geriatr 2019; 87:103977. [PMID: 31751902 DOI: 10.1016/j.archger.2019.103977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 09/08/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although a few trials have explored the relationship between postoperative delirium (POD) and incident dementia in patients with hip surgery, the numbers of participants in each study are relatively small. Thus, we performed a meta-analysis to examine whether POD after hip surgery is a risk factor for incident dementia. METHODS Six prospective cohort studies investigating the development of incident dementia in patients with POD after hip surgery were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- and random- effect models. RESULTS POD significantly increased the risk of incident dementia and cognitive decline (overall odds ratio [ORs] = 8.957; 95 % confidence interval [CI], 5.444-14.737; P < 0.001 in fixed-effects model; overall ORs = 8.962; 95 % CI, 5.344-15.029; P < 0.001 in random-effects model). A publication bias was not evident in this study. CONCLUSIONS Our meta-analysis revealed that POD after hip surgery is a risk factor for incident dementia. Early identification of cognitive function should be needed after surgery and appropriate prevention and treatment for dementia will be required, especially in cases with POD.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kang-Sup Yoon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
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Choi JS, Seo HG, Oh BM, Choi H, Cheon GJ, Lee SU, Lee SH. 18 F-FDG uptake in denervated muscles of patients with peripheral nerve injury. Ann Clin Transl Neurol 2019; 6:2175-2185. [PMID: 31588693 PMCID: PMC6856607 DOI: 10.1002/acn3.50899] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We aimed to investigate the clinical significance of increased uptake in 18 F-fluorodeoxyglucose positron emission tomography in patients with peripheral nerve lesions. METHODS We selected patients with unilateral peripheral nerve lesions confirmed with electromyography who had undergone 18 F-fluorodeoxyglucose positron emission tomography covering the lesions. In the denervated muscles and their contralateral corresponding pairs, a mean (SUVmean) and maximum standardized uptake value (SUVmax) were obtained from 18 F-fluorodeoxyglucose positron emission tomography images. We analyzed the difference in these values between the denervated and normal muscles. The lesion-to-normal ratio of the SUVmean (LNRmean) between each muscle pair was also obtained. Subgroup analysis was performed to find whether these three parameters were related to severity, abundance of abnormal spontaneous activity, and etiology. RESULTS Twenty-three patients with 38 denervated muscles were included. Compared to their normal counterparts, the denervated muscles showed significantly higher SUVmax (1.33 ± 0.49 vs. 1.10 ± 0.37, n = 38, P < 0.001) and SUVmean (0.91 ± 0.31 vs. 0.77 ± 0.28, n = 38, P < 0.001). The muscles with severe neuropathy showed significantly higher LNRmean than those with mild neuropathy (1.30 ± 0.36, n = 19 vs. 1.11 ± 0.24, n = 19; P = 0.046), and the muscles with traumatic neuropathy showed significantly higher LNRmean than those with nontraumatic neuropathy (1.32 ± 0.28, n = 13 vs. 1.14 ± 0.33, n = 23; P = 0.015). INTERPRETATION Denervated muscles with peripheral nerve injury showed higher uptake than normal muscles in 18 F-fluorodeoxyglucose positron emission tomography, and this was associated with severity and etiology.
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Affiliation(s)
- Ji Soo Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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Kim JC, Lee SU, Jung SH, Lim JY, Kim DH, Lee SY. Natural aging course of paraspinal muscle and back extensor strength in community-dwelling older adults (sarcopenia of spine, SarcoSpine): a prospective cohort study protocol. BMJ Open 2019; 9:e032443. [PMID: 31492798 PMCID: PMC6731812 DOI: 10.1136/bmjopen-2019-032443] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Sarcopenia in the lumbar paraspinal muscles is receiving renewed attention as a cause of spinal degeneration. However, there are few studies on the precise concept and diagnostic criteria for spinal sarcopenia. Here, we develop the concept of spinal sarcopenia in community-dwelling older adults. In addition, we aim to observe the natural ageing process of paraspinal and back muscle strength and investigate the association between conventional sarcopenic indices and spinal sarcopenia. METHODS AND ANALYSIS This is a prospective observational cohort study with 120 healthy community-dwelling older adults over 4 years. All subjects will be recruited in no sarcopenia, possible sarcopenia or sarcopenia groups. The primary outcomes of this study are isokinetic back muscle strength and lumbar paraspinal muscle quantity and quality evaluated using lumbar spine MRI. Conventional sarcopenic indices and spine specific outcomes such as spinal sagittal balance, back performance scale and Sorenson test will also be assessed. ETHICS AND DISSEMINATION Before screening, all participants will be provided with oral and written information. Ethical approval has already been obtained from all participating hospitals. The study results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03962530.
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Affiliation(s)
- Ju Chan Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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Abstract
BACKGROUND Although several trials have reported the use of extracorporeal shock wave therapy (ESWT) for mild to moderate carpal tunnel syndrome (CTS), little is known about the efficacy of ESWT. Thus, we performed a meta-analysis to evaluate whether ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in CTS. METHODS Six randomized controlled trials investigating the effect of ESWT on CTS were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- or random-effects models. RESULTS ESWT showed significant overall effect size compared to the control (overall Hedge g pooled standardized mean difference (SMD) = 1.447; 95% confidence interval [CI], 0.439-2.456; P = .005). Symptoms, functional outcomes, and electrophysiologic parameters all improved with ESWT treatment. However, there was no obvious difference between the efficacy of ESWT and local corticosteroid injection (pooled SMD = 0.418; 95% CI, -0.131 to 0.968; P = .135). A publication bias was not evident in this study. CONCLUSION Our meta-analysis revealed that ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in patients with CTS. Further research is needed to confirm the long-term effects and the optimal ESWT protocol for CTS.
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Affiliation(s)
- Ju Chan Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Cha S, Kim I, Lee SU, Seo KS. Correction: Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy. Ann Rehabil Med 2019; 43:239. [PMID: 31072092 PMCID: PMC6509582 DOI: 10.5535/arm.2019.43.2.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Kim
- Division of Hematology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Kwan Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Park MW, Lee SU, Kwon S, Seo KS. Comparison Between the Effectiveness of Complex Decongestive Therapy and Stellate Ganglion Block in Patients with Breast Cancer-Related Lymphedema: A Randomized Controlled Study. Pain Physician 2019; 22:255-263. [PMID: 31151333] [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: 06/09/2023]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) of the upper extremities often follows breast cancer treatment. Although complex decongestive therapy (CDT) is currently the standard treatment for BCRL, stellate ganglion block (SGB) has also been reported to be effective. OBJECTIVES This study aimed to determine the effectiveness of SGB in the treatment of BCRL, and to assess the impact of the treatment on the quality of life (QoL) compared to CDT. STUDY DESIGN A randomized controlled trial. SETTING A single academic hospital, outpatient setting. METHODS A total of 38 patients with BCRL were recruited. Patients were randomly divided into 2 groups. Patients enrolled in the CDT group underwent 10 sessions of CDT for 2 weeks, whereas patients in the SGB group received 3 consecutive SGBs every 2 weeks. Changes in circumference, volume, and bioimpedance in the upper extremity were measured at baseline and 2 weeks after treatment and compared between the 2 groups. EuroQol-5 dimensions (EQ-5D) and EuroQol visual analog scale (EQ VAS) for QoL and subjective improvement were monitored. RESULTS In both groups, side-to-side difference of circumference after the treatment was decreased significantly from baseline (P < 0.05), and side-to-side difference of volume was reduced significantly in the SGB group (P < 0.05). No statistically significant difference was noted in the treatment effect between the 2 groups. Results of the EQ-5D, EQ VAS, and questionnaires regarding subjective symptoms administered at baseline and 2 weeks after each intervention revealed no statistically significant difference in the treatment effects between CDT and SGB. LIMITATIONS Further long-term follow-up studies with a greater number of patients that include analysis according to the severity and duration of symptoms are needed. CONCLUSIONS The results of this study suggest that SGB is an effective treatment for BCRL and may be considered as an alternative to CDT. KEY WORDS Stellate ganglion block, complex decongestive therapy, breast cancer, lymphedema, breast cancer-related lymphedema, quality of life, bioimpedance, secondary lymphedema.
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Affiliation(s)
- Myung Woo Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Physical Medicine and Rehabilitation, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sohyun Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lee SY, Kim W, Lee SU, Choi KH. Relationship Between Obesity and Lumbar Spine Degeneration: A Cross-Sectional Study from the Fifth Korean National Health and Nutrition Examination Survey, 2010–2012. Metab Syndr Relat Disord 2019; 17:60-66. [DOI: 10.1089/met.2018.0051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lee SH, Seo HG, Oh BM, Choi H, Cheon GJ, Lee SU. 18F-FDG positron emission tomography as a novel diagnostic tool for peripheral nerve injury. J Neurosci Methods 2019; 317:11-19. [PMID: 30684510 DOI: 10.1016/j.jneumeth.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/05/2018] [Revised: 12/28/2018] [Accepted: 01/22/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Glucose hypermetabolism in denervated skeletal muscle suggests the potential for developing a diagnostic tool for peripheral nerve injuries. Herein, we investigated the characteristics and molecular mechanism of this phenomenon. NEW METHOD Temporal course of glucose hypermetabolism and development of abnormal spontaneous activities (ASA) through electromyography (EMG) were investigated in rats with complete sciatic nerve injuries. Rats with partial sciatic nerve injuries were used to investigate the relationship between nerve injury severity and change in glucose metabolism. Rapamycin-treated rats were used to study molecular mechanism. Mean lesion-to-normal count ratios (LNRmean) was calculated as a numeric value of the 18F-FDG uptake. RESULTS Glucose hypermetabolism began 2 days after nerve injury and lasted up to 12 weeks, with the maximum increase at 1 week after denervation (10-fold increase compared to sham-operated muscle; LNRmean, sham, 1.360 ± 0.452; denervation, 10.340 ± 4.094; n = 5; P < 0.05). The metabolic changes showed similar temporal characteristics to ASA on EMG. The signal intensity of 18F-FDG uptake in denervated skeletal muscle was strongly related to nerve injury severity in a partial nerve injury model (Pearson correlation coefficient 0.63, P < 0.05). Suppression of mTOR by rapamycin treatment reduced the increase in peak glucose hypermetabolism in muscle denervation. COMPARISON WITH EXISTING METHOD Metabolic changes in 18F-FDG PET scans have a wider time span than abnormalities on EMG after denervation and it is correlated with the severity of nerve injury assessed by NCS. CONCLUSIONS 18F-FDG PET may be used to diagnose and evaluate peripheral nerve injuries.
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Affiliation(s)
- Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Incheon Workers' Compensation Hospital, Incheon, Republic of Korea; Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, 425 Sindaebang-dong, Dongjak-gu, Seoul 156-707, Republic of Korea.
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Nam HS, Han M, Choi HY, Song K, Kang S, Ahn SM, Lee SU. Effect of reclining angle on lumbar lordosis at driving posture: A radiological evaluation. J Back Musculoskelet Rehabil 2019; 31:923-930. [PMID: 29945341 DOI: 10.3233/bmr-170875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Optimal seatback angles for automobile drivers' seats have been investigated based on comfort and back muscle activities; however, radiology supported evidences are scarce. OBJECTIVE The aim of this study was to evaluate optimal range of the seatback reclining regarding torso angles for an automobile driver's seat to preserve lumbar lordosis. METHODS Thirty-one healthy volunteers were recruited among five body type categories. Lateral lumbar spine X-rays were obtained for the neutral sitting posture without seatback (reference), and with reclining angles of 23∘ to 33∘ by 2∘ intervals. The Cobb angles for the L1-L4, L4-S1, and L1-S1 segments were measured. RESULTS The Cobb angle for L4-S1 was nearest to the reference (18.74 ± 1.57∘, mean ± standard error mean) at reclining angles of 29∘ and 31∘ (14.51 ± 1.41∘ and 14.47 ± 1.43∘, respectively). The Cobb angle at L4-S1 between reclining angles of 27∘(12.02 ± 1.31∘) and 29∘ (14.51 ± 1.41∘) were significantly different (p< 0.001). Tall men showed relatively preserved lordosis angles at all reclining angles. Fat men and short women demonstrated prominent loss of lordosis with excessively kyphotic L1-L4 segment. CONCLUSIONS Reclining angles of 29∘ to 31∘ revealed to be optimal for preserving lordosis at the L4-S1 segment. Individualized healthcare-related guideline for driver's seat adjustment setting is necessary.
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Affiliation(s)
- Hyung Seok Nam
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Manyong Han
- Department of Mechanical and System Design Engineering, Hongik University, Seoul, Korea
| | - Hyung Yun Choi
- Department of Mechanical and System Design Engineering, Hongik University, Seoul, Korea
| | - Kyuman Song
- School of Architecture, Hongik University, Seoul, Korea
| | - Seonggyu Kang
- Hyundai Motors Namyang R&D Division, Hwaseong-si, Korea
| | - Sung Min Ahn
- Hyundai Motors Namyang R&D Division, Hwaseong-si, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Cha S, Kim I, Lee SU, Seo KS. Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy. Ann Rehabil Med 2019; 42:838-845. [PMID: 30613077 PMCID: PMC6325318 DOI: 10.5535/arm.2018.42.6.838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/11/2018] [Accepted: 07/02/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy. METHODS Hematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy. RESULTS There was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9-14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly. CONCLUSION In hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Kim
- Division of Hematology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Kwan Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Affiliation(s)
- Shi-Uk Lee
- Department of Physical Medicine and Rehabilitation, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Lee SY, Jung SH, Lee SU, Ha YC, Lim JY. Effect of Balance Training After Hip Fracture Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies. J Gerontol A Biol Sci Med Sci 2018; 74:1679-1685. [DOI: 10.1093/gerona/gly271] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although balance impairment after hip fracture surgery (HFS) can constitute a long-term problem of limiting mobility and increasing the risk of falls in older adults, little is known about the effect of balance training (BT) on physical functioning after HFS. Thus, we performed a meta-analysis to evaluate whether BT improved the overall physical functioning of patients after HFS.
Methods
We searched the PubMed-Medline, Embase, and Cochrane Library databases in January 2018 and included all randomized controlled trials comparing BT with usual care after HFS. We performed a pairwise meta-analysis using fixed- and random-effects models.
Results
Eight randomized controlled trials including a total of 752 participants were retrieved. The BT group showed significantly improved overall physical functioning after HFS compared with the usual care group (overall standardized mean difference [SMD] = 0.390; 95% confidence interval [CI] = 0.114–0.667; p = .006). Both, balance and gait improved (SMD = 0.570; 95% CI = 0.149–0.992; p = .008 and SMD = 0.195; 95% CI = 0.043–0.347; p = .012, respectively) in the BT group. Lower limb strength, performance task, activity of daily living, and health-related quality of life also improved significantly in the BT group.
Conclusion
Our meta-analysis revealed that BT after HFS improved overall physical functioning. Positive effects on balance, gait, lower limb strength, performance task, activity of daily living, and health-related quality of life were evident. Therefore, BT should be specifically included in postoperative rehabilitation programs and balance must be thoroughly checked in elderly patients with hip fractures.
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Affiliation(s)
- Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Dongjak-gu
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Dongjak-gu
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Dongjak-gu
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Beom J, Kim S, Suh HC, Kim DK, Kang SH, Lee SU, Lee SY. Association between sensory nerve action potential and lumbar dorsal root ganglion area. J Clin Neurosci 2018; 59:37-40. [PMID: 30446365 DOI: 10.1016/j.jocn.2018.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/18/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To quantify the cross-sectional area (CSA) of lumbar dorsal root ganglion (DRG) by magnetic resonance imaging (MRI) and investigate the relationship between the cross-sectional area (CSA) of DRGs and sensory nerve action potentials (SNAP) amplitude in the lower extremities. METHODS Thirty-eight DRGs (20 L5 roots and 18 S1 roots) in 10 adult subjects were reviewed retrospectively. The CSA of the DRG was calculated from MR images of the coronal plane. SNAP amplitudes of the superficial peroneal nerve and sural nerve were corresponded to L5 and S1-DRGs. RESULTS The mean CSA of DRGs was 66.6 ± 13.7 mm2 in L5-DRG and 79.5 ± 14.3 mm2 in S1-DRG. The means of SNAP amplitudes were 19.6 ± 6.2 μV in superficial peroneal nerves and 24.6 ± 9.0 μV in sural nerves. In multivariate regression analysis, the CSA of DRGs had a significant correlation with SNAP amplitude. CONCLUSION The area of L5 and S1-DRGs may be positively correlated with SNAP amplitude.
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Affiliation(s)
- Jaewon Beom
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hoon Chang Suh
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Si Hyun Kang
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
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Kim IH, Lee SU, Jung SH, Lee SJ, Lee SY. Effectiveness of the computerized balance rehabilitation after hip fracture surgery: A study protocol of a prospective and open-label clinical trial. Medicine (Baltimore) 2018; 97:e12199. [PMID: 30200127 PMCID: PMC6133532 DOI: 10.1097/md.0000000000012199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Although balance problems in older populations are directly correlated with hip fractures, the overall physical gain afforded by balance rehabilitation itself has not yet been fully investigated. Here we describe a protocol for an open-label clinical trial to evaluate the effectiveness of computer-based balance-specific exercise (BSE) on the performance and balance of elderly women who underwent hip fracture surgery (HFS). METHODS AND ANALYSIS Elderly female patients (≥65 years old) who underwent surgery for femoral neck, intertrochanteric, or subtrochanteric fracture regardless of surgery type will be included. The BSE will be conducted using a computed posturographic system for a 2-week intervention period following HFS. The primary outcome of this study is Berg balance scale score. All functional outcomes will be measured at 1 and 3 weeks and at 3 and 6 months after the surgical intervention. The data will be analyzed using the intention-to-treat principle.
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Affiliation(s)
- In-Hee Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital
| | | | | | - Soong Joon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Son SH, Oh SH, Kang SH, Kim DK, Seo KM, Lee SU, Lee SY. Independent factors associated with bicycle helmet use in a Korean population: A cross-sectional study. Traffic Inj Prev 2018; 19:399-403. [PMID: 29265886 DOI: 10.1080/15389588.2017.1418507] [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: 05/15/2017] [Accepted: 12/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Although identification of factors that influence helmet use during bicycle riding is necessary for the selection of groups that require safe cycling education, limited baseline data are available. The aim of the present study was to analyze the rate of helmet use and the demographic factors that were independently associated with helmet use among Korean bicycle riders. METHODS In this cross-sectional study, we used public data from the Sixth Korean National Health and Nutrition Examination Survey conducted in 2013 and 2014. Helmet users were defined as subjects who always, usually, or frequently wore helmets when cycling. Independent factors associated with helmet use were determined using odds ratios (ORss) adjusted for 5 demographic factors via multivariate logistic regression analysis. RESULTS In the total population, 4,103 individuals were bicycle riders; among these, 782 individuals (19.1%) wore helmets. A total of 21.1% of male riders used helmets, compared to 15.5% of female riders (P <.001). The adjusted logistic regression model revealed that female sex (OR = 0.665; 95% confidence interval [CI], 0.554-0.797), teenage status (OR = 0.475, 95% CI, 0.333-0.678), and low household income (OR = 0.657, 95% CI 0.513-0.841) were significantly associated with nonuse of helmets. CONCLUSIONS Female sex, teenage status, and low household income were independent factors associated with the nonuse of helmets. We identified factors associated with helmet use during bicycle riding through analysis of baseline data on helmet usage.
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Affiliation(s)
- Sun Han Son
- a Department of Physical Medicine & Rehabilitation , Chung-Ang University College of Medicine , Seoul , South Korea
| | - Sang Ho Oh
- a Department of Physical Medicine & Rehabilitation , Chung-Ang University College of Medicine , Seoul , South Korea
| | - Si Hyun Kang
- a Department of Physical Medicine & Rehabilitation , Chung-Ang University College of Medicine , Seoul , South Korea
| | - Don-Kyu Kim
- a Department of Physical Medicine & Rehabilitation , Chung-Ang University College of Medicine , Seoul , South Korea
| | - Kyung Mook Seo
- a Department of Physical Medicine & Rehabilitation , Chung-Ang University College of Medicine , Seoul , South Korea
| | - Shi-Uk Lee
- b Department of Rehabilitation Medicine , Seoul National University Seoul Metropolitan Government Boramae Medical Center , Seoul , South Korea
| | - Sang Yoon Lee
- b Department of Rehabilitation Medicine , Seoul National University Seoul Metropolitan Government Boramae Medical Center , Seoul , South Korea
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Lee SY, Kwon S, Chung SG, Kim DK, Lee SU, Kim K. Lumbar synovial cyst with chronic viral hepatitis: A case series and literature review. J Clin Neurosci 2018; 53:218-220. [PMID: 29724648 DOI: 10.1016/j.jocn.2018.04.016] [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: 11/28/2017] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
Cystic dilatation of synovial sheath, one of the targets of extra-hepatic manifestations associated with liver disease, is a main pathologic finding of lumbar synovial cyst (LSC). However, LSCs are not well documented in correlation with chronic viral hepatitis. In this case series, three patients with chronic viral hepatitis presented with radiating pain in the unilateral lower extremities. On magnetic resonance imaging of the lumbar spine, all had unilateral LSCs at the facet joint of the lumbar spine. Two did not have definite spinal instability at the LSC level. Ultimately, all three showed clinical improvements following epidural spine interventions.
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Affiliation(s)
- Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sohyun Kwon
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Sun G Chung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Lee SY, Jung SH, Lee SU, Ha YC, Lim JY. Can Bisphosphonates Prevent Recurrent Fragility Fractures? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Med Dir Assoc 2018; 19:384-390.e1. [DOI: 10.1016/j.jamda.2018.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 12/22/2022]
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Abstract
BACKGROUND Cognitive impairment is frequently seen in patients with stroke. The possible correlation between cognitive function and functional mobility has been proposed; however, the prognostic importance of early cognitive function in recovery of mobility has not been investigated in patients with stroke. OBJECTIVE The objective of this study is to investigate whether the cognitive function in the acute phase can independently predict the recovery of mobility after stroke, and to determine the cut-off value of each cognitive evaluation test for community ambulation at six months. METHODS Seventy two patients underwent four domain-specific neuropsychological evaluation tests at about two weeks after stroke; these included the word list memory test (WMT), construction praxis test (CPT), verbal fluency test (VFT) and Boston naming test (BNT). The Functional Ambulation Category (FAC) and ambulatory zone (AZ) at six months after stroke were investigated as outcome variables. The domain-specific cognitive function, along with other possible predictors for functional mobility, was analyzed with regression analysis. RESULTS The z-scores of WMT (p = 0.018) and VFT (p = 0.012) were related to the independence in ambulation. The z-scores of VFT (p = 0.006) and CPT (p = 0.009) were predictors for community ambulation, with the cut-off values of -2.215 for VFT, and of -0.845 for CPT. CONCLUSIONS Cognitive impairment in the acute phase of stroke can be an independent prognostic factor of functional mobility. Domain-specific neuropsychological evaluation tests should be considered in the acute phase of stroke to predict the recovery of functional mobility.
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Affiliation(s)
- Jihong Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Ban SP, Kwon OK, Lee SU, Bang JS, Oh CW, Jeong HJ, Cho MJ, Jeong EA, Kim T. Long-Term Outcomes of Patients with Stent Tips Embedded into Internal Carotid Artery Branches during Aneurysm Coiling. AJNR Am J Neuroradiol 2018. [PMID: 29519788 DOI: 10.3174/ajnr.a5583] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE During stent-assisted coiling of ICA aneurysms, stent tips are sometimes unintentionally embedded into ICA branches. Stent tips can be visualized because they have radiopaque markers. Concerns regarding stent tip misplacement include risks of artery perforation and occlusion. The aim of this study was to evaluate the long-term outcomes of ICA branches with embedded stent tips. MATERIALS AND METHODS ICA branches with embedded stent tips were identified among 35 patients with unruptured ICA aneurysms treated with stent-assisted coiling between November 2003 and November 2014. Patient clinical and angiographic outcomes associated with the embedded stent tip were analyzed. RESULTS Most of the 35 studied aneurysms were paraclinoid ICA aneurysms (n = 30). The most commonly involved ICA branch was the posterior communicating artery (26 patients, 74.3%), followed by the anterior choroidal artery (8 patients, 22.9%) and ophthalmic artery (1 patient, 2.9%). During the follow-up period (38.6 ± 17.9 months), no new neurologic deficits developed. Neither hemorrhagic nor thromboembolic events occurred. Angiography was performed during the final follow-up evaluation at a mean of 32.7 ± 18.0 months, and all ICA branches with embedded stent tips showed patent blood flow without severe luminal narrowing. CONCLUSIONS In our experience, placement of a stent tip into ICA branches during stent-assisted coiling was not associated with any major adverse events.
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Affiliation(s)
- S P Ban
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - O-K Kwon
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - S U Lee
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - J S Bang
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - C W Oh
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - H J Jeong
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - M J Cho
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - E-A Jeong
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - T Kim
- From the Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
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Oh SH, Kim DK, Lee SU, Jung SH, Lee SY. Association between exercise type and quality of life in a community-dwelling older people: A cross-sectional study. PLoS One 2017; 12:e0188335. [PMID: 29216283 PMCID: PMC5720695 DOI: 10.1371/journal.pone.0188335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 09/04/2017] [Accepted: 11/04/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the effects of three major representative exercises (resistance, flexibility, and walking) on quality of life (QoL) in a population of community-dwelling older adults. MATERIALS AND METHODS This cross-sectional study used public data from the Sixth Korean National Health and Nutrition Examination Survey in 2014 (n = 1,586 older people). Demographic factors, three types of exercise, five EuroQoL subsets (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and QoL scores (EQ-VAS) were investigated. The independent associations between each exercise and the five QoL subsets were determined using odds ratios (OR) adjusted for three demographic factors (age group, sex, and area of residence), using multivariate logistic regression analysis. RESULTS The EQ-VAS scores of the exercisers was significantly higher than those of the non-exercisers for all exercise types. Subjects with problems in mobility dimension performed less exercise of all types of than those with normal mobility (resistance: OR, 0.687; flexibility: OR, 0.733, and walking: OR, 0.489). The self-care dimension was independently correlated with flexibility (OR, 0.558) and walking (OR, 0.485). CONCLUSION All types of exercisers showed higher QoL scores than non-exercisers. Among the QoL dimensions, mobility and self-care were independently associated with flexibility and walking exercise in this older people, suggesting that engaging in regular flexibility and walking exercise is important for achieving higher QoL in the older people.
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Affiliation(s)
- Sang-Ho Oh
- Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
- * E-mail:
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Nam HS, Koh S, Kim YJ, Beom J, Lee WH, Lee SU, Kim S. Biomechanical Reactions of Exoskeleton Neurorehabilitation Robots in Spastic Elbows and Wrists. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2196-2203. [PMID: 28613178 DOI: 10.1109/tnsre.2017.2714203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Spasticity is an important factor in designing wearable and lightweight exoskeleton neurorehabilitation robots. The proposed study evaluates biomechanical reactions of an exoskeleton robot to spasticity and establishes relevant guidelines for robot design. A two-axis exoskeleton robot is used to evaluate a group of 20 patients post-stroke with spastic elbow and/or wrist joints. All subjects are given isokinetic movements at various angular velocities within the capable range of motion for both joints. The resistance torque and corresponding angular position at each joint are recorded continuously. Maximal resistance torques caused by low (modified Ashworth scale (MAS) 0, 1), intermediate (MAS 1+), and high (MAS 2 and 3) grade spasticity were 3.68 ± 2.42, 5.94 ± 2.55, and 8.25 ± 3.35 Nm for the elbow flexor ( , between each grades) and 4.23 ± 1.75, 5.68 ± 1.96, and 5.44 ± 2.02 Nm for the wrist flexor ( , for low versus intermediate, low versus high grade spasticity). The angular velocity did not significantly influence maximal resistance torque in either joint. The catch occurred more quickly at higher velocities for low and intermediate elbow flexor spasticity ( ). Spasticity caused considerable resistance to the robots during mechanically actuated movements. The resistance range according to the degree of spasticity should be considered when designing practical neurorehabilitation robots.
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Do KH, Chun MH, Paik NJ, Park YG, Lee SU, Kim MW, Kim DK. Safety and efficacy of letibotulinumtoxinA(BOTULAX®) in treatment of post stroke upper limb spasticity: a randomized, double blind, multi-center, phase III clinical trial. Clin Rehabil 2017; 31:1179-1188. [DOI: 10.1177/0269215516689331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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]
Abstract
Objective: To investigate a new botulinum neurotoxin type A, termed letibotulinumtoxinA(Botulax®) and compare its efficacy and safety for post-stroke upper limb spasticity with that of onabotulinumtoxinA(Botox®). Design: A prospective, double-blinded, multicenter, randomized controlled clinical study. Setting: Six university hospitals in Korea. Subjects: A total of 187 stroke participants with upper limb spasticity. Interventions: Two kinds of botulinum neurotoxin type A were used. One set of injection was performed and total injected doses were 309.21±62.48U(Botulax) and 312.64±49.99U(Botox)( P>0.05). Main measures: Primary outcome was measured using the modified Ashworth scale for wrist flexors at week 4 and secondary outcome was measured using modified Ashworth scale for wrist flexors, elbow flexors, finger flexors, and thumb flexors as well as Global Assessment in spasticity, Disability Assessment Scale, and Caregiver Burden Scale. Safety measures including adverse events, vital signs and physical examination, and laboratory tests were also monitored. Results: The mean ages for the Botulax group were 56.81±9.49 and which for the Botox group were 56.93±11.93( P>0.05). In primary outcome, the change in modified Ashworth scale for wrist flexors was -1.45±0.61 in the Botulax group and -1.40±0.57 in the Botox group, and the difference between the two groups was -0.06(95% CI:-0.23–0.12, P>0.05). In secondary outcome, both groups demonstrated significant improvements with respect to modified Ashworth scale, Global Assessment in spasticity, Disability Assessment Scale, and Caregiver Burden Scale ( P<0.05), and no significant difference was observed between the two groups ( P>0.05). In addition, safety measures showed no significant differences between the two groups ( P>0.05). Conclusions: The efficacy and safety of Botulax were comparable with those of Botox in treatment of post-stoke upper limb spasticity.
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Affiliation(s)
- Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Min Ho Chun
- Department of Physical Medicine and Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation, Seoul National University College of Medicine, Seoul, Korea
- Department of Physical Medicine and Rehabilitation, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Min-Wook Kim
- Department of Physical Medicine and Rehabilitation, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
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Abstract
Park, JH, Seo, KS, and Lee, S-U. Effect of superimposed electromyostimulation on back extensor strengthening: a pilot study. J Strength Cond Res 30(9): 2470-2475, 2016-Electromyostimulation (EMS) superimposed on voluntary contraction (VC) can increase muscle strength. However, no study has examined the effect of superimposing EMS on back extensor strengthening. The purpose of this study was to determine the effect of superimposed EMS on back extensor strengthening in healthy adults. Twenty healthy men, 20-29 years of age, without low-back pain were recruited. In the EMS group, electrodes were attached to bilateral L2 and L4 paraspinal muscles. Stimulation intensity was set for maximally tolerable intensity. With VC, EMS was superimposed for 10 seconds followed by a 20-second rest period. The same protocol was used in the sham stimulation (SS) group, except that the stimulation intensity was set at the lowest intensity (5 mA). All subjects performed back extension exercise using a Swiss ball, with 10 repetitions per set, 2 sets each day, 5 times a week for 2 weeks. The primary outcome measure was the change in isokinetic strength of the back extensor using an isokinetic dynamometer. Additionally, endurance was measured using the Sorensen test. After 2 weeks of back extension exercise, the peak torque and endurance increased significantly in both groups (p ≤ 0.05). Effect size between the EMS group and the SS group was medium in strength and endurance. However, there was no statistically significant difference between 2 groups. In conclusion, 2 weeks of back extensor strengthening exercise was effective for strength and endurance. Superimposing EMS on back extensor strengthening exercise could provide an additional effect on increasing strength.
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Affiliation(s)
- Jae Hyeon Park
- 1Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, South Korea; 2Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea; and 3Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
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Choi YA, Lee SU. The Strengthening Effect of Electrical Stimulation on Lumbar Paraspinal Muscles in the Sitting Position: A Randomized Controlled Trial. PM R 2016; 9:643-651. [PMID: 27840299 DOI: 10.1016/j.pmrj.2016.11.001] [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] [Received: 05/08/2016] [Revised: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sedentary lifestyle, a prevalent finding in modern society, can lead to weakness of the lumbar trunk musculature. Electrical stimulation (ES), in addition to lumbar strengthening exercises, has been shown to increase muscle strength. OBJECTIVE To assess the strengthening effect of ES on the lumbar paraspinal muscles during prolonged sitting. DESIGN Randomized, controlled, single-blind study. SETTING Tertiary hospital. PARTICIPANTS Thirty healthy subjects without low back pain. METHODS Thirty participants were randomly assigned to the ES group (n = 15) or the control group (n = 15). ES was administered over the lumbar paraspinal muscles, while subjects maintained a seated posture, at a maximal tolerable intensity for 60 minutes per day, three times per week, for 4 consecutive weeks. An identical protocol was used in the control group with muscle stimulation provided at the minimal sensory threshold intensity. MAIN OUTCOME MEASUREMENTS The isokinetic strength of the lumbar paraspinal muscles was evaluated at baseline, 4 weeks after the initiation of ES, and 8 weeks after the initiation of ES with an isokinetic dynamometer (Biodex Medical Dynamometer System-4) at 60°/s and 120°/s angular velocities. RESULTS The extension and flexion peak torque at 60°/s showed no significant interaction between the time and intervention or between the interventions. However, after 4 weeks of ES in the sitting position, the isokinetic extensor trunk muscle strength measured at 120°/s angular velocity significantly increased in the ES group (P < .05) compared with that in the control group. This effect was not maintained when measured at 4 weeks after the cessation of ES. CONCLUSIONS ES in a sitting position is a potentially effective and accessible rehabilitation treatment, which can lead to short-term improvement in the extensor trunk muscle strength of the lumbar paraspinal muscles. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Young-Ah Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea(∗)
| | - Shi-Uk Lee
- Department of Physical Medicine & Rehabilitation, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea(†).
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Lee CH, Nam HS, Lee SU. Usefulness of a Hanging Position With Internal Rotation of Shoulder in Ultrasonography-Guided Intra-articular Steroid Injection for Adhesive Capsulitis. Ann Rehabil Med 2016; 40:520-7. [PMID: 27446790 PMCID: PMC4951372 DOI: 10.5535/arm.2016.40.3.520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/22/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. Methods A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. Results The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively. Conclusion For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.
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Affiliation(s)
- Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Gyeongsang National University Graduate School of Medicine, Jinju, Korea
| | - Hyung Seok Nam
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.; Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Park J, Lee G, Lee SU, Jung SH. The Impact of Acute Phase Domain-Specific Cognitive Function on Post-stroke Functional Recovery. Ann Rehabil Med 2016; 40:214-22. [PMID: 27152270 PMCID: PMC4855114 DOI: 10.5535/arm.2016.40.2.214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 05/29/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022] Open
Abstract
Objective To assess whether the cognitive function in the acute stage evaluated by domain-specific neuropsychological assessments would be an independent predictor of functional outcome after stroke. Methods Forty patients underwent 4 domain-specific neuropsychological examinations about 3 weeks after the onset of stroke. The tests included the Boston Naming Test (BNT), the construction recall test (CRT), the construction praxis test (CPT), and the verbal fluency test (VFT). The Korean version of Modified Barthel Index (K-MBI) at 3 months and the modified Rankin Scale (mRS) at 6 months were investigated as functional outcome after stroke. Functional improvement was assessed using the change in K-MBI during the first 3 months and subjects were dichotomized into 'good status' and 'poor status' according to mRS at 6 months. The domain-specific cognitive function along with other possible predictors for functional outcome was examined using regression analysis. Results The z-score of CPT (p=0.044) and CRT (p<0.001) were independent predictors for functional improvement measured by the change in K-MBI during the first 3 months after stroke. The z-score of CPT (p=0.049) and CRT (p=0.048) were also independent predictors of functional status at post-stroke 6 months assessed by mRS. Conclusion Impairment in visuospatial construction and memory within one month after stroke can be an independent prognostic factor of functional outcome. Domain-specific neuropsychological assessments could be considered in patients with stroke in the acute phase to predict long-term functional outcome.
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Affiliation(s)
- Jihong Park
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gangpyo Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Lee WH, Do HK, Lee JH, Kim BR, Noh JH, Choi SH, Chung SG, Lee SU, Choi JE, Kim S, Kim MJ, Lim JY. Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study. Ann Rehabil Med 2016; 40:252-62. [PMID: 27152275 PMCID: PMC4855119 DOI: 10.5535/arm.2016.40.2.252] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 06/01/2015] [Accepted: 08/14/2015] [Indexed: 01/15/2023] Open
Abstract
Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear. Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments. Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups. Conclusion The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.
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Affiliation(s)
- Woo Hyung Lee
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.; Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Kyung Do
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joong Hoon Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ram Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Hyun Noh
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo Hyun Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ji Eun Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Seihee Kim
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Min Jee Kim
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Jae-Young Lim
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.; Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee SH, Seo HG, Oh BM, Choi H, Cheon GJ, Lee SU. Increased (18)F-FDG uptake in the trapezius muscle in patients with spinal accessory neuropathy. J Neurol Sci 2016; 362:127-30. [PMID: 26944132 DOI: 10.1016/j.jns.2016.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 10/23/2015] [Revised: 12/24/2015] [Accepted: 01/18/2016] [Indexed: 11/16/2022]
Abstract
UNLABELLED To investigate (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) signal changes of denervated muscles in patients with electrophysiologically confirmed neuropathy. METHODS This is a case series of three cancer patients who were referred to the electromyography laboratory in 2013 due to shoulder discomfort after surgery including neck dissection. Spinal accessory neuropathy was diagnosed based on electrophysiological studies. Patients' medical history, electrophysiological data, and FDG-PET images were reviewed retrospectively. Mean standard uptake values (SUV) of trapezius muscles were measured. RESULTS The patients (3 men, aged 61-78years) showed spinal accessory neuropathy with different degrees of severity. In all patients, preoperative or postoperative FDG-PET showed increased FDG uptake in the ipsilateral trapezius muscle. These results were compatible with previously reported glucose hypermetabolism in denervated skeletal muscles. CONCLUSION This is the first clinical report of increased FDG uptake by denervated muscles in electrophysiologically confirmed neuropathy.
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Affiliation(s)
- Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul 03080, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul 03080, Republic of Korea.
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul 03080, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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Beom J, Jang HJ, Han TR, Oh BM, Paik NJ, Yang EJ, Lee SU. Fatty replacement of rotator cuff in brain-injured patients is associated with hemiplegic arm function, but not with tendon tear: A multicenter study. NeuroRehabilitation 2015; 37:213-9. [PMID: 26484513 DOI: 10.3233/nre-151254] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association between fatty replacement of rotator cuff and hemiplegic upper extremity function has not been defined yet. Moreover, the relationships among rotator cuff tears, shoulder pain, spasticity, and fatty replacement were not clearly studied. OBJECTIVE We investigated the association of fatty replacement of the supraspinatus and infraspinatus muscles with tendon tear in stroke or brain-injured patients. METHODS A total of 72 hemiplegic patients were enrolled in 3 hospitals, and ultrasonography of both shoulders was performed once. Fatty replacement of the supraspinatus and infraspinatus was graded by the visibility of outer contours, pennate pattern, central tendon, and echogenicity. RESULTS Fatty replacement was observed in 22 (30.6%) out of the 72 patients (in 18 supraspinatus muscles and 12 infraspinatus). Inter-rater agreement (kappa value) between the 2 physiatrists was 0.530 for the supraspinatus, and 0.411 for the infraspinatus. The Fugl-Meyer assessment score, Brunnstrom stage, and modified Barthel index were significantly lower in patients with fatty replacement of the supraspinatus or infraspinatus (group 1) than in those without (group 2). The motor power of both shoulders, the pain-free range of motion, spasticity, and hemiplegic shoulder pain were comparable between the two groups. The tear rate of the supraspinatus, infraspinatus, or subscapularis tendon at the hemiplegic side was higher than that at the contralesional side in each group, although there was no significant difference between group 1 and group 2. CONCLUSION Disuse leading to muscle atrophy rather than rotator cuff tear might be the cause of fatty replacement of these muscles, which may be associated with decreased function of the hemiplegic upper extremities.
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Affiliation(s)
- Jaewon Beom
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hye Jin Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Rehabilitation Medicine, Gangwon Do Rehabilitation Hospital, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul MetropolitanGovernment Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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Nam HS, Park YG, Paik NJ, Oh BM, Chun MH, Yang HE, Kim DH, Yi Y, Seo HG, Kim KD, Chang MC, Ryu JH, Lee SU. Efficacy and safety of NABOTA in post-stroke upper limb spasticity: a phase 3 multicenter, double-blinded, randomized controlled trial. J Neurol Sci 2015; 357:192-7. [PMID: 26233808 DOI: 10.1016/j.jns.2015.07.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 11/17/2022]
Abstract
Botulinum toxin A is widely used in the clinics to reduce spasticity and improve upper limb function for post-stroke patients. Efficacy and safety of a new botulinum toxin type A, NABOTA (DWP450) in post-stroke upper limb spasticity was evaluated in comparison with Botox (onabotulinum toxin A). A total of 197 patients with post-stroke upper limb spasticity were included in this study and randomly assigned to NABOTA group (n=99) or Botox group (n=98). Wrist flexors with modified Ashworth Scale (MAS) grade 2 or greater, and elbow flexors, thumb flexors and finger flexors with MAS 1 or greater were injected with either drug. The primary outcome was the change of wrist flexor MAS between baseline and 4weeks post-injection. MAS of each injected muscle, Disability Assessment Scale (DAS), and Caregiver Burden Scale were also assessed at baseline and 4, 8, and 12weeks after the injection. Global Assessment Scale (GAS) was evaluated on the last visit at 12weeks. The change of MAS for wrist flexor between baseline and 4weeks post-injection was -1.44±0.72 in the NABOTA group and -1.46±0.77 in the Botox group. The difference of change between both groups was 0.0129 (95% confidence interval -0.2062-0.2319), within the non-inferiority margin of 0.45. Both groups showed significant improvements regarding MAS of all injected muscles, DAS, and Caregiver Burden Scale at all follow-up periods. There were no significant differences in all secondary outcome measures between the two groups. NABOTA demonstrated non-inferior efficacy and safety for improving upper limb spasticity in stroke patients compared to Botox.
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Affiliation(s)
- Hyung Seok Nam
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hea-Eun Yang
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youbin Yi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwang Dong Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Physical Medicine and Rehabilitation, Union Hospital, Daegu, Republic of Korea
| | - Jae Hak Ryu
- Clinical Research Team, Daewoong Pharmaceutical, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Lee CH, Choi YA, Lee SU. Ultrasonographic Diagnosis of Non-displaced Avulsion Fracture of the Acromion: A Case Report. Ann Rehabil Med 2015; 39:473-6. [PMID: 26161354 PMCID: PMC4496519 DOI: 10.5535/arm.2015.39.3.473] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/22/2014] [Indexed: 11/18/2022] Open
Abstract
Avulsion fracture of the acromion is rare. It is difficult to diagnosis because there is little displacement and it occurs even without direct trauma. We experienced a case without direct trauma that was diagnosed with ultrasonography. A 55-year-old male patient visited our outpatient clinic with shoulder pain resulting from a significant stress at the trapezius muscle during lifting of a steel reinforcement. Simple radiography revealed a calcific deposit over the acromion rather than a fracture. Avulsion fracture was identified with ultrasonography. This is the first report demonstrating that ultrasonography has an advantage over radiographs in the diagnosis of an avulsion fracture of the acromion of the scapula.
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Affiliation(s)
- Chang Han Lee
- Department of Rehabilitation Medicine, Maryknoll Medical Center, Busan, Korea
| | - Young-Ah Choi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Lee SH, Oh BM, Lee G, Choi H, Cheon GJ, Lee SU. Feasibility of 18F-FDG PET as a noninvasive diagnostic tool of muscle denervation: a preliminary study. J Nucl Med 2014; 55:1737-40. [PMID: 25104824 DOI: 10.2967/jnumed.114.140731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED The purpose of this study was to confirm glucose hypermetabolism in denervated muscle and investigate the feasibility of (18)F-FDG PET scanning for the detection of muscle denervation. METHOD A sciatic neuropathy model in rats was created by nerve resection of the left sciatic nerve and sham operation on the other side. Eight days after denervation, small-animal PET/CT scans of the hindlimbs were acquired. Muscle denervation was confirmed by electrophysiologic and histologic study. RESULTS All rats showed increased (18)F-FDG uptake in the muscles of the left (denervated) lower legs. The calculated maximum lesion-to-normal counts ratio of the left lower leg anterolateral (left, 11.02 ± 2.08; right, 1.81 ± 0.40, n = 6, P < 0.01) and posterior (left, 9.81 ± 4.58; right, 1.87 ± 0.44, n = 6, P < 0.01) compartment were significantly increased. The electrophysiologic and histologic study verified muscle denervation. CONCLUSION Glucose hypermetabolism in muscle denervation is an obvious phenomenon. (18)F-FDG PET scanning can be used to visualize muscle denervation.
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Affiliation(s)
- Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Gangpyo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea; and
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea; and
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
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Choi YH, Jung SJ, Lee CH, Lee SU. Additional effects of transcranial direct-current stimulation and trigger-point injection for treatment of myofascial pain syndrome: a pilot study with randomized, single-blinded trial. J Altern Complement Med 2014; 20:698-704. [PMID: 25083759 DOI: 10.1089/acm.2013.0243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic pain caused by myofascial pain syndrome (MPS) results in generalized and debilitating conditions. Trigger-point injection (TPI) is the mainstay of MPS management to reduce acute and localized pain. Other adjunctive intervention to modulate the central pain pathway might be helpful if they are combined with TPI. Transcranial direct-current stimulation (tDCS), which is a form of neurostimulation, has been reported to be safe and effective in treating chronic pain by changing cortical excitability. OBJECTIVES To determine whether there is an additional effect of tDCS and TPI to reduce pain in patients with MPS. PATIENTS Twenty-one patients with newly diagnosed MPS of shoulder girdle muscles. INTERVENTIONS Patients were randomly assigned into 1 of 3 groups (2 active and 1 sham stimulation groups) and received TPI. Immediately after TPI, tDCS (2 mA for 20 minutes on 5 consecutive days) was administered. For the active stimulation groups, tDCS was applied over 2 different locations (primary motor cortex and dorsolateral prefrontal cortex [DLPFC]). OUTCOME MEASURES Visual analogue scale (VAS), Pain Threshold Test, and short form of the McGill Pain Questionnaire were measured before and immediately after stimulation for 5 consecutive days. RESULTS The mean VAS values were decreased in all three groups after 5 days. There was a significant change between before and after stimulation only in the DLPFC group. The significant change in the mean VAS value was shown from after the second stimulation session (p=0.031), and this remained significant until the last stimulation session (p=0.027). CONCLUSION This study suggests that tDCS over DLPFC may have additional effects with TPI to reduce pain in patients with MPS. tDCS over DLPFC can be used to reverse central pain pathway by modulating cortical plasticity.
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Affiliation(s)
- Yoon-Hee Choi
- 1 Department of Rehabilitation Medicine, Seoul National University Hospital , Seoul, South Korea
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Jung SH, Kim J, Jeong H, Lee SU. Effect of the order of test diets on the accuracy and safety of swallowing studies. Ann Rehabil Med 2014; 38:304-9. [PMID: 25024952 PMCID: PMC4092169 DOI: 10.5535/arm.2014.38.3.304] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022] Open
Abstract
Objective To assess whether the order of test diets influences the results of swallowing studies with regard to their accuracy and safety. Methods Subjects with suspected dysphagia underwent a videofluoroscopic swallowing study (VFSS) and/or a fiberoptic endoscopic evaluation of swallowing (FEES) and repeated the study on the same day or within a week. The order of test diets comprised of two different sets: trial 1 with the fluid first and trial 2 with the semi-solid food first. Main outcome measurements were the modified penetration-aspiration scale (mPAS) and the pharyngeal residue severity scale (PRSS) for the vallecula and the pyriform sinus. Results Sixty-six patients (44 men and 22 women, aged 65.0±15.0 years) were enrolled in this study. Forty-three subjects were evaluated with VFSS only and 23 with both VFSS and FEES. As a result of the swallowing studies, there was no significant difference in each chosen diet sequence regarding mPAS and PRSS. Furthermore, there was no difference regarding the duration of studies, rate of premature study termination, rate of abnormal findings in post-study chest X-ray, and rate of fever or pneumonia post-study. Conclusion The accuracy and safety of the swallowing studies do not rely on the order of test diets.
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Affiliation(s)
- Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Juyong Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyeonghui Jeong
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Park JH, Kim HG, Oh BM, Lee MW, Hwang IK, Lee SU, Han TR. Comparison of different gum-based thickeners using a viscometer and line spread test: a preliminary study. Ann Rehabil Med 2014; 38:94-100. [PMID: 24639932 PMCID: PMC3953370 DOI: 10.5535/arm.2014.38.1.94] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 07/31/2013] [Accepted: 09/17/2013] [Indexed: 11/05/2022] Open
Abstract
Objective To compare fluid thickeners composed of starch polysaccharide (STA), guar gum-based polysaccharide (GUA), and xanthan gum-based polysaccharide (XAN) with the use of a viscometer and a line spread test (LST) under various measurement conditions. Methods The viscosity of thickened fluid with various concentrations (range, GUA 1%-4%, XAN 1%-6%, STA 1%-7%, at intervals of 1%) was measured with a rotational viscometer with various shear rates (1.29 s-1, 5.16 s-1, 51.6 s-1, and 103 s-1) at a temperature of 35℃, representing body temperature. The viscosity of STA showed time dependent alteration. So STA was excluded. Viscosities of GUA and XAN (range of concentration, GUA 1%-3%, XAN 1%-6%, at intervals of 1%) were measured at a room temperature of 20℃. LST was conducted to compare GUA and XAN (concentration, 1.5%, 2.0%, and 3.0%) at temperatures of 20℃ and 35℃. Results The viscosities of 1% GUA and XAN were similar. However, viscosity differences between GUA and XAN were gradually larger as concentration increased. The shear thinning effect, the inverse relationship between the viscosity and the shear rate, was more predominant in XAN than in GUA. The results of LST were not substantially different from GUA and XAN, in spite of the difference in viscosity. However manufacturers' instructions do not demonstrate the rheological properties of thickeners. Conclusion The viscosities of thickened fluid were different when the measurement conditions changed. Any single measurement might not be sufficient to determine comparable viscosity with different thickeners. Clinical decision for the use of a specific thickener seems to necessitate cautious consideration of results from a viscometer, LST, and an expert's opinion.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Geun Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Woo Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
| | - In-Kyeong Hwang
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Affiliation(s)
- Hyung Seok Nam
- Department of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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