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To investigate the effect of a conservative treatment regime in Parkinson's disease patients with camptocormia.
Nine patients with Parkinson's disease were included in a retrospective pilot study of the value of back extensor strengthening exercise. Six inpatients received a 30-minute treatment, twice daily for 5 weeks, being treated on average for 34 days; while three outpatients visited the clinic and were educated for home exercise and backpack wearing treatment. Outpatients should be scheduled to visit the outpatient department to check physical status every 2–4 weeks for an average of 3 months.
All patients except one showed statistically significant improvements in activities of daily living (ADL) and motor symptoms, as measured by flexion angle at standing posture, Unified Parkinson's Disease Rating Scale (UPDRS) II and III, and modified Hoehn-Yahr staging.
Conservative treatment is effective in postural correction of camptocormia in Parkinson's disease, as well as improvement in ADL and motor symptoms.
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To identify the clinical characteristics of proper robot-assisted gait training group using exoskeletal locomotor devices in non-ambulatory subacute stroke patients.
A total of 38 stroke patients were enrolled in a 4-week robotic training protocol (2 sessions/day, 5 times/week). All subjects were evaluated for their general characteristics, Functional Ambulatory Classification (FAC), Fugl-Meyer Scale (FMS), Berg Balance Scale (BBS), Modified Rankin Scale (MRS), Modified Barthel Index (MBI), and Mini-Mental Status Examination (MMSE) at 0, 2, and 4 weeks. Statistical analysis were performed to determine significant clinical characteristics for improvement of gait function after robot-assisted gait training.
Paired t-test showed that all functional parameters except MMSE were improved significantly (p<0.05). The duration of disease and baseline BBS score were significantly (p<0.05) correlated with FAC score in multiple regression models. Receiver operating characteristic (ROC) curve showed that a baseline BBS score of '9' was a cutoff value (AUC, 0.966; sensitivity, 91%–100%; specificity, 85%). By repeated-measures ANOVA, the differences in improved walking ability according to time were significant between group of patients who had baseline BBS score of '9' and those who did not have baseline BBS score of '9'
Our results showed that a baseline BBS score above '9' and a short duration of disease were highly correlated with improved walking ability after robot-assisted gait training. Therefore, baseline BBS and duration of disease should be considered clinically for gaining walking ability in robot-assisted training group.
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To investigate the long-term effects of complex decongestive therapy (CDT) on edema reduction in breast cancer-related lymphedema patients after axillary dissection, according to the initial volume of edema.
A retrospective review of 57 patients with unilateral arm after an axillary dissection for breast cancer was performed. The patients, treated with two weeks of CDT and self-administered home therapy, were followed for 24 months. Arm volume was serially measured by using an optoelectronic volumeter prior to and immediately after CDT; and there were follow-up visits at 3, 6, 12, and 24 months. Patients were divided into two groups according to the percent excess volume (PEV) prior to CDT: group 1, PEV<20% and group 2, PEV≥20%.
In group 1, mean PEV before CDT was 11.4±5.0% and 14.1±10.6% at 24 months after CDT with no significant difference. At the end of CDT, PEV was 28.8±15.7% in group 2, which was significantly lower than the baseline (41.9±19.6%). The reduction of PEV was maintained for 24 months in group 2.
The long-term effects of CDT were well-maintained for 24 months, but there was a difference in progression of PEV between the two groups. The patients with more initial PEV showed significant volume-reducing effects of CDT. In patients with less initial PEV, the severity of lymphedema did not progress to higher grades.
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To investigate the factors which contribute to the improvements of the gross motor function in children with spastic cerebral palsy after physical therapy.
The subjects were 45 children with spastic cerebral palsy with no previous botulinum toxin injection or operation history within 6 months. They consisted of 24 males (53.3%) and 21 females (46.7%), and the age of the subjects ranged from 2 to 6 years, with the mean age being 41±18 months. The gross motor function was evaluated by Gross Motor Function Measure (GMFM)-88 at the time of admission and discharge, and then, the subtractions were correlated with associated factors.
The GMFM-88 was increased by 7.17±3.10 through 52±16 days of physical therapy. The more days of admission, the more improvements of GMFM-88 were attained. The children with initial GMFM-88 values in the middle range showed more improvements in GMFM-88 (p<0.05). The children without dysphagia and children with less spasticity of lower extremities also showed more improvements in GMFM-88 (p<0.05).
We can predict the improvements of the gross motor function after physical therapy according to the days of admission, initial GMFM-88, dysphagia, and spasticity of lower extremities. Further controlled studies including larger group are necessary.
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To understand the injury pattern of contact burns from therapeutic physical modalities.
A retrospective study was done in 864 patients with contact burns who discharged from our hospital from January 2005 to December 2008. The following parameters were compared between patients with contact burns from therapeutic modalities and from other causes: general characteristics, burn extent, cause of burn injury, place of occurrence, burn injury site, treatment methods, prevalence of underlying disease, and length of hospital stay were compared between patients with contact burns.
Of the 864 subjects, 94 patients were injured from therapeutic modalities. A hot pack (n=51) was the most common type of therapeutic modality causing contact burn followed by moxibustion (n=21), electric heating pad (n=16), and radiant heat (n=4). The lower leg (n=31) was the most common injury site followed by the foot & ankle (n=24), buttock & coccyx (n=9), knee (n=8), trunk (n=8), back (n=6), shoulder (n=4), and arm (n=4). Diabetes mellitus was associated with contact burns from therapeutic modalities; the odds ratio was 3.99. Injuries took place most commonly at home (n=56), followed by the hospital (n=33), and in other places (n=5).
A hot pack was the most common cause of contact burns from therapeutic modalities, and the lower leg was the most common injury site. Injuries took place most commonly at home. The patients with contact burns from therapeutic modalities showed high correlation to presence of diabetes mellitus. These results would be helpful for the prevention of contact burns due to therapeutic modalities.
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Cerebral palsy (CP) was defined as "a permanent, but not unchanging disorder of movement and posture due to a non-progressive defect or lesion of the brain in early life" by the Little Club in 1964. This definition is not universally agreed but it is still widely used. It may be associated with cognitive, sensory and behavioral manifestations.
The prevalence of CP has changed very little over the past 40 years. As a result of improved survival of prematurely born infants with very low birth weight, more individuals have severe motor disability and associated handicaps. The incidence of CP is 2∼5/1,000 live births, but at 7 years of age, the rate is estrmated to be 2/1,000 births.
Management of a child with CP requires a multidisciplinary approach shared with the child and family and should support for them.
Numerous ways have been tried to moderate the abnormalities found in the different varieties of CP. The aim of treatment is to prevent the development of deformity, suppress unwanted or abnormal movements and promote optimal function. The well-known systems of physical therapy include those of the Bobaths, Vojta and the Peto.
Occupational therapy concentrates on eye-hand coordination and upper extremity motor control and other activities of daily life. Orthosis usually is prescribed to correct abnormal posture of the ankle and foot.
Topical injection of phenol, alcohol solution or botulinum toxin into the motor points or motor nerves of a spastic muscle creates a temporary neurolysis and consequent tone reduction lasting 5 to 6 months. Currently intrathecal baclofen is widely used. Where contractures have occurred in the hips and knees, soft tissue surgery around the hip, knee and ankle in a simple operation may be carried out.
Objective: Lymphoscintigraphy is the diagnostic test of choice in patients with suspected lymphedema. This reveals functional information rather than anatomic details. We evaluated the improvement of lymphatic function after complex physical therapy(CPT) in patients with lymphedema via lymphoscintigraphic follow-up examination.
Method: In 19 lymphedema patients(22 extremities) regardless of etiology, lymphoscintigraphy using Tc-99m antimony sulfide colloid was performed before and 3-month after CPT. Main lymphoscintigraphic findings of lymphedema and lymphoscintigraphic changes after CPT were evaluated.
Results: Main lymphoscintigraphic findings of lymphedema were the presence of dermal backflow(100%) and collateral vessels(68.2%), non-visualized or barely visualized lymph nodes (95.5%), and non-visualized or barely visualized lymphatic vessels(27.3%). The findings of lymphoscintigraphy suggesting improvement of lymphatic function after CPT were decreased dermal backflow(72.7%), increased radioisotope uptake of lymph nodes(9.1%) and increased radioisotope uptake of lymphatic vessels(27.3%). Increased dermal backflow itself with decreased total tissue pressure after CPT was not the finding implying deterioration of lymphatic function. There was no constant correlation between clinical improvement and lymphoscintigraphic improvement.
Conclusion: The lymphoscintigraphic follow-up examination combined with volumetry is useful in assessing the improvement of lymphatic function in lymphedema.
Complex Physical Therapy (CPT) is one of the variable conservative methods of lymphedema and recently used in many countries with great success. The main concept of CPT is to improve central lymph flow by opening non-functioning lymphatic pathway and by stimulating collateral lymphatic channels to drain the swollen area into adjacent areas where lymph flow is normal.
CPT consists of 4 main parts; 1. meticulous skin care, 2. manual lymph drainage, 3. multilayered non-stretching compression bandages and compression garments, 4. special exercise.
We tried to assess the immediate and maintenance effects of CPT in patients with lymphedema. CPT was used on 25 patients (male 5, female 20) with 10 upper and 15 lower extremity edemas for 2weeks such as 5 days per week, 1.5 hours per day at out-patient clinic.
Immediately, the reduction of edema volume was 25.5⁑13.8% at the upper extremity and 27.5⁑15.5% at lower extremity in 2 weeks after treatment. All these were well maintained following 3 months without any significant variation.
In comparison between proximal and distal parts, there was no significant difference except the immediate post-treatment result of the lower extremity. But the maintenance of volume reduction of distal part was better than proximal part through 3 months after treatment. We also found the reduction of skin subcutaneous thickness according to the volume reduction.
In conclusion, CPT is a effective treatment method for patients with lymphedema but follow up study will be needed for identifying long term maintenance effect.
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