1
|
Hsu SP, Lu CF, Lin BF, Tang CW, Kuo IJ, Tsai YA, Guo CY, Lee PL, Shyu KK, Niddam DM, Lee IH. Effects of bihemispheric transcranial direct current stimulation on motor recovery in subacute stroke patients: a double-blind, randomized sham-controlled trial. J Neuroeng Rehabil 2023; 20:27. [PMID: 36849990 PMCID: PMC9969953 DOI: 10.1186/s12984-023-01153-4] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Bihemispheric transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) can simultaneously modulate bilateral corticospinal excitability and interhemispheric interaction. However, how tDCS affects subacute stroke recovery remains unclear. We investigated the effects of bihemispheric tDCS on motor recovery in subacute stroke patients. METHODS We enrolled subacute inpatients who had first-ever ischemic stroke at subcortical regions and moderate-to-severe baseline Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score 2-56. Participants between 14 and 28 days after stroke were double-blind, randomly assigned (1:1) to receive real (n = 13) or sham (n = 14) bihemispheric tDCS (with ipsilesional M1 anode and contralesional M1 cathode, 20 min, 2 mA) during task practice twice daily for 20 sessions in two weeks. Residual integrity of the ipsilesional corticospinal tract was stratified between groups. The primary efficacy outcome was the change in FMA-UE score from baseline (responder as an increase ≥ 10). The secondary measures included changes in the Action Research Arm Test (ARAT), FMA-Lower Extremity (FMA-LE) and explorative resting-state MRI functional connectivity (FC) of target regions after intervention and three months post-stroke. RESULTS Twenty-seven participants completed the study without significant adverse effects. Nineteen patients (70%) had no recordable baseline motor-evoked potentials (MEP-negative) from the paretic forearm. Compared with the sham group, the real tDCS group showed enhanced improvement of FMA-UE after intervention (p < 0.01, effect size η2 = 0.211; responder rate: 77% vs. 36%, p = 0.031), which sustained three months post-stroke (p < 0.01), but not ARAT. Interestingly, in the MEP-negative subgroup analysis, the FMA-UE improvement remained but delayed. Additionally, the FMA-LE improvement after real tDCS was not significantly greater until three months post-stroke (p < 0.01). We found that the individual FMA-UE improvements after real tDCS were associated with bilateral intrahemispheric, rather than interhemispheric, FC strengths in the targeted cortices, while the improvements after sham tDCS were associated with predominantly ipsilesional FC changes after adjustment for age and sex (p < 0.01). CONCLUSIONS Bihemispheric tDCS during task-oriented training may facilitate motor recovery in subacute stroke patients, even with compromised corticospinal tract integrity. Further studies are warranted for tDCS efficacy and network-specific neuromodulation. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov: (ID: NCT02731508).
Collapse
Affiliation(s)
- Shih-Pin Hsu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Bing-Fong Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chih-Wei Tang
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Ju Kuo
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yun-An Tsai
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Po-Lei Lee
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan
| | - Kuo-Kai Shyu
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan
| | - David M Niddam
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - I-Hui Lee
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan. .,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan. .,Brain Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
| |
Collapse
|
2
|
Hsu SP, Lu CF, Tang CW, Lin BF, Kuo IJ, Tsai YA, Lee PL, Lee IH. Dual transcranial direct current stimulation for subacute stroke patients with compromised corticospinal integrity: a randomized, double-blind, sham-controlled study. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
3
|
Yang CY, Tsai YA, Wu PK, Ho SY, Chou CY, Huang SF. Pilates-based core exercise improves health-related quality of life in people living with chronic low back pain: A pilot study. J Bodyw Mov Ther 2021; 27:294-299. [PMID: 34391248 DOI: 10.1016/j.jbmt.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/09/2020] [Revised: 01/29/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the effects of Pilates exercise on improving health-related quality of life in people living with chronic low back pain. METHODS This was a single-blind, randomised clinical trial. Thirty-nine physically active subjects aged between 30 and 70 years with nonspecific chronic low back pain for more than three months were recruited. The study employed a pretest-posttest design, with a 4 -, 8 -, and 26-week follow-up. For eight weeks, the intervention group participated in a group-supervised, mat-based Pilates program, while the control group received the usual pharmacologic and rehabilitation standard of care, including patient education on chronic low back pain. The primary outcome was self-perceived health status measured using the EQ-5D questionnaire in a structured form and a visual analogue scale. Secondary outcomes included intensity of pain and degree of disability. RESULTS By the end of the 8-week Pilates program, the intervention group achieved a better health-related quality of life on the EQ-5D visual analogue score than the control group. In assessing the trends in each individual group regarding pain, the intervention group demonstrated an earlier pain reduction than the control group that lasted until the end of the trial. CONCLUSIONS An 8-week supervised Pilates-based core exercise program is an effective therapeutic modality for improving self-perceived health status in patients with chronic low back pain. This finding could inform clinicians of better alternatives when they suggest exercise interventions for chronic low back pain.
Collapse
Affiliation(s)
- Chen-Ya Yang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Chiayi and Wanqiao Branch, Chiayi, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yun-An Tsai
- Neural Regeneration and Repair Division, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pi-Keng Wu
- Department of Rehabilitation, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Sih-Ying Ho
- Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Chih-Yi Chou
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Fong Huang
- Neural Regeneration and Repair Division, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
| |
Collapse
|
4
|
Kuo IJ, Tang CW, Tsai YA, Tang SC, Lin CJ, Hsu SP, Liang WK, Juan CH, Zich C, Stagg CJ, Lee IH. Neurophysiological signatures of hand motor response to dual-transcranial direct current stimulation in subacute stroke: a TMS and MEG study. J Neuroeng Rehabil 2020; 17:72. [PMID: 32527268 PMCID: PMC7291576 DOI: 10.1186/s12984-020-00706-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 01/08/2020] [Accepted: 06/01/2020] [Indexed: 11/11/2022] Open
Abstract
Background Dual transcranial direct current stimulation (tDCS) to the bilateral primary motor cortices (M1s) has potential benefits in chronic stroke, but its effects in subacute stroke, when behavioural effects might be expected to be greater, have been relatively unexplored. Here, we examined the neurophysiological effects and the factors influencing responsiveness of dual-tDCS in subacute stroke survivors. Methods We conducted a randomized sham-controlled crossover study in 18 survivors with first-ever, unilateral subcortical ischaemic stroke 2–4 weeks after stroke onset and 14 matched healthy controls. Participants had real dual-tDCS (with an ipsilesional [right for controls] M1 anode and a contralesional M1 [left for controls] cathode; 2 mA for 20mins) and sham dual-tDCS on separate days, with concurrent paretic [left for controls] hand exercise. Using transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG), we recorded motor evoked potentials (MEPs), the ipsilateral silent period (iSP), short-interval intracortical inhibition, and finger movement-related cortical oscillations before and immediately after tDCS. Results Stroke survivors had decreased excitability in ipsilesional M1 with a relatively excessive transcallosal inhibition from the contralesional to ipsilesional hemisphere at baseline compared with controls, as quantified by decreased MEPs and increased iSP duration. Dual-tDCS led to increased MEPs and decreased iSP duration in ipsilesional M1. The magnitude of the tDCS-induced MEP increase in stroke survivors was predicted by baseline contralesional-to-ipsilesional transcallosal inhibition (iSP) ratio. Baseline post-movement synchronization in α-band activity in ipsilesional M1 was decreased after stroke compared with controls, and its tDCS-induced increase correlated with upper limb score in stroke survivors. No significant adverse effects were observed during or after dual-tDCS. Conclusions Task-concurrent dual-tDCS in subacute stroke can safely and effectively modulate bilateral M1 excitability and inter-hemispheric imbalance and also movement-related α-activity.
Collapse
Affiliation(s)
- I-Ju Kuo
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan.,Department of Neurosurgery, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Chih-Wei Tang
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan.,Department of Neurology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banqiao Dist, New Taipei City, 220, Taiwan
| | - Yun-An Tsai
- Department of Neurosurgery, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Shuen-Chang Tang
- Department of Neurosurgery, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Chun-Jen Lin
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan.,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Shih-Pin Hsu
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan
| | - Wei-Kuang Liang
- Institute of Cognitive Neuroscience, National Central University, No.300, Zhongda Rd., Zhongli Dist, Taoyuan City, 320, Taiwan
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, No.300, Zhongda Rd., Zhongli Dist, Taoyuan City, 320, Taiwan
| | - Catharina Zich
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, UK
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, UK
| | - I-Hui Lee
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan. .,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan.
| |
Collapse
|
5
|
Tang CW, Hsiao FJ, Lee PL, Tsai YA, Hsu YF, Chen WT, Lin YY, Stagg CJ, Lee IH. β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke. Neurorehabil Neural Repair 2020; 34:450-462. [PMID: 32321366 PMCID: PMC7250642 DOI: 10.1177/1545968320913502] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke.Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.
Collapse
Affiliation(s)
- Chih-Wei Tang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fu-Jung Hsiao
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Po-Lei Lee
- National Central University, Taoyuan County, Taiwan
| | - Yun-An Tsai
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Wei-Ta Chen
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yung-Yang Lin
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - I-Hui Lee
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
6
|
Liu YC, Yang YR, Tsai YA, Wang RY, Lu CF. Brain Activation and Gait Alteration During Cognitive and Motor Dual Task Walking in Stroke—A Functional Near-Infrared Spectroscopy Study. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2416-2423. [DOI: 10.1109/tnsre.2018.2878045] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
7
|
Tsai YA, Liu RS, Lirng JF, Yang BH, Chang CH, Wang YC, Wu YS, Ho JHC, Lee OK, Soong BW. Treatment of Spinocerebellar Ataxia With Mesenchymal Stem Cells: A Phase I/IIa Clinical Study. Cell Transplant 2017; 26:503-512. [PMID: 28195034 DOI: 10.3727/096368916x694373] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Ataxia is one of the most devastating symptoms of many neurodegenerative disorders. As of today, there is not any effective treatment to retard its progression. Mesenchymal stem cells (MSCs) have shown promise in treating neurodegenerative diseases. We hereby report the results of a phase I/IIa clinical study conducted in Taiwan to primarily evaluate the safety, tolerability, and, secondarily, the possible efficacy of intravenous administration of allogeneic adipose tissue-derived MSCs from healthy donors. Six patients with spinocerebellar ataxia type 3 and one with multiple system atrophy-cerebellar type were included in this open-label study with intravenous administration of 106 cells/kg body weight. The subjects were closely monitored for 1 year for safety (vital signs, complete blood counts, serum biochemical profiles, and urinalysis) and possible efficacy (scale for assessment and rating of ataxia and sensory organization testing scores, metabolite ratios on the brain magnetic resonance spectroscopy, and brain glucose metabolism of 18-fluorodeoxyglucose using positron emission tomography). No adverse events related to the injection of MSCs during the 1-year follow-up were observed. The intravenous administration of allogeneic MSCs seemed well tolerated. Upon study completion, all patients wished to continue treatment with the allogeneic MSCs. We conclude that allogeneic MSCs given by intravenous injection seems to be safe and tolerable in patients with spinocerebellar ataxia type 3, thus supporting advancement of the clinical development of allogeneic MSCs for the treatment of spinocerebellar ataxias (SCAs) in a randomized, double-blind, placebo-controlled phase II trials.
Collapse
|
8
|
Kuo IJ, Tang CW, Tsai YA, Juan CH, Lee IH. Abstract WP154: Bihemispheric Modulation of the Motor Cortex by Single-session Transcranial Direct Current Stimulation During Training in Subacute Stroke Patients. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp154] [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: 11/16/2022]
Abstract
Introduction:
Non-invasive transcranial direct current stimulation (tDCS) can induce polarity-specific changes in cortical excitability. Compared to unilateral anodal tDCS over the non-dominant motor cortex (M1), dual-hemispheric tDCS to the M1 may further accelerate motor reaction of the target hand and alter excitability of the corticospinal tract (CST). However, the effects and individual variability of bi-hemispheric tDCS to the M1 during motor training remain largely unclear in healthy and stroke subjects.
Purpose:
We assessed the hypothesis that bi-hemispheric tDCS during single-session motor training alter inter-hemispheric inhibition, CST excitability and bilateral cortical oscillations.
Methods:
We enrolled first-time, unilateral ischemic stroke patients between two and four weeks after stroke and matched healthy controls. They were subjected to two 20 min-sessions of dual-hemispheric tDCS (anode over non-dominant or ipsilesional M1, cathode over dominant or contralesional M1; 2mA for 20 mins) and sham tDCS (2mA for 2 mins) in a randomized crossover design during repetitive extension of the non-dominant or paretic extensor carpi radialis muscle. We compared the post-stimulation changes of motor evoked potentials (MEPs), ipsilateral silent period (iSP), short interval intracoritcal inhibition (SICI), as well as resting and unilateral finger lifting-related cortical oscillations by magnetoencephalography (MEG).
Results:
Compared to the sham tDCS, the dual-hemispheric tDCS significantly increased MEP amplitudes and reduced SICI at the anodal-stimulated M1, as well as decreased inter-hemispheric inhibition from the cathodal-stimulated M1 with shortened iSP for about 30 mins in healthy controls (n=8). In contrast, reduced MEP amplitudes were observed at the cathodal-stimulated M1. The tDCS effects on cortical oscillations and in stroke patients are currently under investigation.
Conclusions:
Task-concurrent dual tDCS may enhance activity-dependent motor plasticity in subacute stroke.
Collapse
Affiliation(s)
- I-Ju Kuo
- Taipei Veterans General Hosp, Taipei City, Taiwan
| | | | - Yun-An Tsai
- Taipei Veterans General Hosp, Taipei City, Taiwan
| | | | - I-Hui Lee
- Taipei Veterans General Hosp, Taipei City, Taiwan
| |
Collapse
|
9
|
Yamaguchi T, Fujiwara T, Tsai YA, Tang SC, Kawakami M, Mizuno K, Kodama M, Masakado Y, Liu M. The effects of anodal transcranial direct current stimulation and patterned electrical stimulation on spinal inhibitory interneurons and motor function in patients with spinal cord injury. Exp Brain Res 2016; 234:1469-78. [PMID: 26790423 PMCID: PMC4851690 DOI: 10.1007/s00221-016-4561-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 08/14/2015] [Accepted: 12/20/2015] [Indexed: 11/24/2022]
Abstract
Supraspinal excitability and sensory input may play an important role for the modulation of spinal inhibitory interneurons and functional recovery among patients with incomplete spinal cord injury (SCI). Here, we investigated the effects of anodal transcranial direct current stimulation (tDCS) combined with patterned electrical stimulation (PES) on spinal inhibitory interneurons in patients with chronic incomplete SCI and in healthy individuals. Eleven patients with incomplete SCI and ten healthy adults participated in a single-masked, sham-controlled crossover study. PES involved stimulating the common peroneal nerve with a train of ten 100 Hz pulses every 2 s for 20 min. Anodal tDCS (1 mA) was simultaneously applied to the primary motor cortex that controls the tibialis anterior muscle. We measured reciprocal inhibition and presynaptic inhibition of a soleus H-reflex by stimulating the common peroneal nerve prior to tibial nerve stimulation, which elicits the H-reflex. The inhibition was assessed before, immediately after, 10 min after and 20 min after the stimulation. Compared with baseline, simultaneous application of anodal tDCS with PES significantly increased changes in disynaptic reciprocal inhibition and long-latency presynaptic inhibition in both healthy and SCI groups for at least 20 min after the stimulation (all, p < 0.001). In patients with incomplete SCI, anodal tDCS with PES significantly increased the number of ankle movements in 10 s at 20 min after the stimulation (p = 0.004). In conclusion, anodal tDCS combined with PES could induce spinal plasticity and improve ankle movement in patients with incomplete SCI.
Collapse
Affiliation(s)
- Tomofumi Yamaguchi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Yun-An Tsai
- Center for Neural Regeneration, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,National Yang Ming University, Taipei, Taiwan, ROC
| | - Shuen-Chang Tang
- Center for Neural Regeneration, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mitsuhiko Kodama
- Department of Rehabilitation Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihisa Masakado
- Department of Rehabilitation Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
10
|
Wang JC, Chan RC, Tsai YA, Huang WC, Cheng H, Wu HL, Huang SF. The influence of shoulder pain on functional limitation, perceived health, and depressive mood in patients with traumatic paraplegia. J Spinal Cord Med 2015; 38:587-92. [PMID: 25296991 PMCID: PMC4535800 DOI: 10.1179/2045772314y.0000000271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 10/31/2022] Open
Abstract
OBJECTIVE To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain. DESIGN Cross sectional and comparative investigation using the unified questionnaire. SETTING Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan. PARTICIPANTS Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously). OUTCOME MEASURES Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale. RESULTS Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant difference was found in functional ability between groups. Greater shoulder pain intensity was related to higher depressive scores (r=0.278, P=0.017) and lower self-perceived health scores (r=-0.433, P<0.001) but not SCIM scores (P=0.342). CONCLUSION Although shoulder pain was unrelated to functional limitation, it was associated with lower perceived health and higher depressive mood levels.
Collapse
Affiliation(s)
| | | | | | | | | | - Han-Lin Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Fong Huang
- Correspondence to: Shih-Fong Huang, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei City 11217, Taiwan, ROC.
| |
Collapse
|
11
|
Yamaguchi T, Fujiwara T, Tsai YA, Liu M. The effects of different intensities of anodal tDCS on spinal plasticity induced by patterned electrical stimulation. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
12
|
Tsai PY, Wang CP, Hsieh CY, Tsai YA, Yeh SC, Chuang TY. Long-Term Sacral Magnetic Stimulation for Refractory Stress Urinary Incontinence. Arch Phys Med Rehabil 2014; 95:2231-8. [DOI: 10.1016/j.apmr.2014.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/24/2014] [Accepted: 07/10/2014] [Indexed: 11/25/2022]
|
13
|
Lin YL, Chang KT, Lin CT, Tsai MJ, Tsai YA, Lee YY, Chien SC, Huang WC, Shih YH, Cheng H, Huang MC. Repairing the ventral root is sufficient for simultaneous motor and sensory recovery in multiple complete cervical root transection injuries. Life Sci 2014; 109:44-9. [DOI: 10.1016/j.lfs.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/14/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
|
14
|
Chang PY, Chan RC, Tsai YA, Huang WC, Cheng H, Wang JC, Huang SF. Quantitative measures of functional outcomes and quality of life in patients with C5 palsy. J Chin Med Assoc 2013; 76:378-84. [PMID: 23664730 DOI: 10.1016/j.jcma.2013.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 11/09/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is generally understood that postoperative C5 palsy can occur with anterior or posterior decompression surgery, but functional measures of the palsy have not been well documented. This study aimed to investigate the incidence of C5 palsy in different surgical procedures, examine the correlations between muscle strength, upper extremity functional measures, and health-related quality of life, and to observe potential risk factors contributing to C5 palsy. METHODS Our investigation involved a retrospective study design. A total of 364 patients who underwent decompression surgery were indicated within the selected exclusion criteria. Additionally, 12 C5 palsy patients were recruited. The relationships between the manual muscle test (MMT), the action research arm test (ARAT), the Jebsen test of hand function (JTHF), and the European quality of life-5 dimensions (EQ-5D) were studied, and univariate analyses were performed to search possible risk factors and recovery investigation. RESULTS The data analyzed in the 12 cases and C5 palsy incidences (3.3%) were: 0.7% in anterior procedures (n = 2), 8.8% in posterior procedures (n = 6), and 36.4% in combined procedures (n = 4). Moderate-to-high correlations were observed between the ARAT, JTHF, EQ-5D visual analog scale scores, and MMT (r = 0.636-0.899). There were significant differences in patient age, etiology of cervical lesion, variable decompression procedures, and the number of decompression levels between the C5 palsy and non-C5 palsy groups. For female patients (p = 0.018) and number of decompression levels (p = 0.028), there were significant differences between the complete recovery and the incomplete recovery groups. CONCLUSION Patients undergoing combined anterior-posterior decompression surgery had the highest incidence of C5 palsy, and correlations between the ARAT, JTHF, EQ-5D visual analog scale clinical tools, and MMT scores supported these findings. Female status and lower decompression levels could also be predictive factors for complete recovery, although additional research is needed to substantiate these findings.
Collapse
Affiliation(s)
- Po-Yao Chang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | | | | | | | | | | | | |
Collapse
|
15
|
Hsu YF, Huang YZ, Lin YY, Tang CW, Liao KK, Lee PL, Tsai YA, Cheng HL, Cheng H, Chern CM, Lee IH. Intermittent theta burst stimulation over ipsilesional primary motor cortex of subacute ischemic stroke patients: A pilot study. Brain Stimul 2013; 6:166-74. [PMID: 22659021 DOI: 10.1016/j.brs.2012.04.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/15/2012] [Accepted: 04/19/2012] [Indexed: 01/24/2023] Open
Affiliation(s)
- Ya-Fang Hsu
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Huang SF, Tsai YA, Wu SB, Wei YH, Tsai PY, Chuang TY. Effects of intravascular laser irradiation of blood in mitochondria dysfunction and oxidative stress in adults with chronic spinal cord injury. Photomed Laser Surg 2012; 30:579-86. [PMID: 22891782 DOI: 10.1089/pho.2012.3228] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study investigated the clinical effects of intravascular laser irradiation of blood (ILIB) therapy on oxidative stress and mitochondrial dysfunction in subjects with chronic spinal cord injury (SCI) resulting from trauma. BACKGROUND DATA Little is known about how ILIB may generate antioxidant defenses in humans, and there is still a lack of randomized, sham-control studies to indicate its influence on different metabolic pathways. METHODS Twenty-four chronic SCI subjects (assigned to a sham and a study group), and 12 normal subjects were recruited. The study group underwent 1 h daily of ILIB for 15 days over 3 weeks. The sham group underwent ILIB with no laser power. RESULTS Baseline measurements established higher oxidative stress and mitochondrial dysfunction in the SCI subjects than in the normal subjects. At day 15 of therapy, the study group revealed a significantly higher mitochondrial DNA (mtDNA) copy number, white blood cell adenosine triphosphate (WBC ATP) synthesis, and total antioxidant capacity (TAC) with significantly reduced malondialdehyde (MDA), than did the sham group. The study group intragroup comparison revealed significantly increased mtDNA copy numbers, WBC ATP synthesis, and TAC, with significantly reduced MDA, compared with its baseline measurements. The sham group intragroup comparisons demonstrated no statistical differences. Low-density lipoprotein (LDL) in the study group was significantly reduced at days 10 and 15, with significantly higher high-density lipoprotein (HDL) at day 45. CONCLUSIONS Our study results contribute to the knowledge about the effectiveness of ILIB in alleviating oxidative stress and mitochondrial dysfunction in chronic SCI patients.
Collapse
Affiliation(s)
- Shih-Fong Huang
- Department of Neuroregeneration and Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
17
|
Hsu YF, Liao KK, Lee PL, Tsai YA, Yeh CL, Lai KL, Huang YZ, Lin YY, Lee IH. Intermittent theta burst stimulation over primary motor cortex enhances movement-related beta synchronisation. Clin Neurophysiol 2011; 122:2260-7. [DOI: 10.1016/j.clinph.2011.03.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 11/30/2022]
|
18
|
Wu JC, Huang WC, Chen YC, Tu TH, Tsai YA, Huang SF, Huang HC, Cheng H. Acidic fibroblast growth factor for repair of human spinal cord injury: a clinical trial. J Neurosurg Spine 2011; 15:216-27. [PMID: 21663406 DOI: 10.3171/2011.4.spine10404] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The study aimed to verify the safety and feasibility of applying acidic fibroblast growth factor (aFGF) with fibrin glue in combination with surgical neurolysis for nonacute spinal cord injury. METHODS This open-label, prospective, uncontrolled human clinical trial recruited 60 patients with spinal cord injuries (30 cervical and 30 thoracolumbar). The mean patient age was 36.5 ± 15.33 (mean ± SD) years, and the male/female ratio was 3:1. The mean time from injury to treatment was 25.7 ± 26.58 months, and the cause of injury included motor vehicle accident (26 patients [43.3%]), fall from a height (17 patients [28.3%]), sports (4 patients [6.7%]), and other (13 patients [21.7%]). Application of aFGF with fibrin glue and duraplasty was performed via laminectomy, and an adjuvant booster of combined aFGF and fibrin glue (2 ml) was given at 3 and 6 months postsurgery via lumbar puncture. Outcome measurements included the American Spinal Injury Association (ASIA) motor scores, sensory scores, impairment scales, and neurological levels. Examination of functional independence measures, visual analog scale, MR imaging, electrophysiological and urodynamic studies, hematology and biochemistry tests, tumor markers, and serum inflammatory cytokines were all conducted. All adverse events were monitored and reported. Exclusions were based on refusal, unrelated adverse events, or failure to participate in the planned rehabilitation. RESULTS Forty-nine patients (26 with cervical and 23 with thoracolumbar injuries) completed the 24-month trial. Compared with preoperative conditions, the 24-month postoperative ASIA motor scores improved significantly in the cervical group (from 27.6 ± 15.55 to 37.0 ± 19.93, p < 0.001) and thoracolumbar group (from 56.8 ± 9.21 to 60.7 ± 10.10, p < 0.001). The ASIA sensory scores also demonstrated significant improvement in light touch and pinprick in both groups: from 55.8 ± 24.89 to 59.8 ± 26.47 (p = 0.049) and 56.3 ± 23.36 to 62.3 ± 24.87 (p = 0.003), respectively, in the cervical group and from 75.7 ± 15.65 to 79.2 ± 15.81 (p < 0.001) and 78.2 ± 14.72 to 82.7 ± 16.60 (p < 0.001), respectively, in the thoracolumbar group. At 24-month follow-up, the ASIA impairment scale improved significantly in both groups (30% cervical [p = 0.011] and 30% thoracolumbar [p = 0.003]). There was also significant improvement in neurological level in the cervical (from 5.17 ± 1.60 to 6.27 ± 3.27, p = 0.022) and thoracolumbar (from 18.03 ± 4.19 to 18.67 ± 3.96, p = 0.001) groups. The average sum of motor items in functional independence measure also had significant improvement in both groups (p < 0.05). The walking/wheelchair locomotion subscale showed increased percentages of patients who were ambulatory (from 3.4% to 13.8% and from 17.9% to 35.7% in the cervical and thoracolumbar groups, respectively). There were no related adverse events. CONCLUSIONS The use of aFGF for spinal cord injury was safe and feasible in the present trial. There were significant improvements in ASIA motor and sensory scale scores, ASIA impairment scales, neurological levels, and functional independence measure at 24 months after treatment. Further large-scale, randomized, and controlled investigations are warranted to evaluate the efficacy and long-term results.
Collapse
Affiliation(s)
- Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Sung WH, Chiu TY, Chen JJ, Tsai YA, Chen H. The Effects of Low-cost Virtual Reality Hand Function Training for Subjects with SCI. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402459.92611.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
20
|
Chiu TY, Sung WH, Tsai YA, Chen H, Chen JJ. Driving Performance in Different VRDS Road Conditions of Subjects with Spinal Cord Injury. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000384599.08654.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
21
|
Tsai YA, Cheng H, Huang HC, Tang SC, Wang TT. Poster 367: The Effect of Repetitive Transcranial Magnetic Stimulation on Motor Recovery of Contralateral and Ipsilateral Limbs in Patients with Incomplete Chronic Spinal Cord Injury: A Preliminary Report. PM R 2009. [DOI: 10.1016/j.pmrj.2009.08.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
22
|
Wu JC, Huang WC, Huang MC, Tsai YA, Chen YC, Shih YH, Cheng H. A novel strategy for repairing preganglionic cervical root avulsion in brachial plexus injury by sural nerve grafting. J Neurosurg 2009; 110:775-85. [PMID: 19119881 DOI: 10.3171/2008.8.jns08328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECT In this study, the authors evaluated the efficacy of a new surgical strategy for reconnecting the injured brachial plexus with the spinal cord using fibrin glue containing acidic fibroblast growth factor as an adhesive and neurotrophic agent. METHODS Eighteen patients with preganglionic brachial plexus injuries, each with varying degrees of upper limb dysfunction, underwent cervical laminectomy with or without sural nerve grafting. The treatment of each avulsed root varied according to the severity of the injury. Some patients also underwent a second-stage operation involving supraclavicular brachial plexus exploration for reconnection with the corresponding segment of cervical spinal cord at the trunk level. Muscle strength was graded both pre- and postoperatively with the British Medical Research Council scale, and the results were analyzed with the Friedman and Wilcoxon signed-rank tests. RESULTS Muscle strength improvements were observed in 16 of the 18 patients after 24 months of follow-up. Significant improvements in mean muscle strength were observed in patients from all repair method groups at 12 and 24 months postoperatively (p < 0.05). Statistical significance was not reached in the groups with insufficient numbers of cases. CONCLUSIONS The authors' new surgical strategy yielded clinical improvement in muscle strength after preganglionic brachial plexus injury, such that nerve regeneration may have taken place. Reconnection of the brachial plexus to the cervical spinal cord is possible. Functional motor recovery, observed through increases in Medical Research Council-rated muscle strength in the affected arm, is likewise possible.
Collapse
Affiliation(s)
- Jau-Ching Wu
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
23
|
Chiu TY, Chen JJ, Sung WH, Tsai YA, Chen H. The Effects Of Adapted Virtual Reality Driving Simulator Training For Subjects With Spinal Cord Injury. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000354665.76284.b1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Wu JC, Huang WC, Tsai YA, Chen YC, Cheng H. Nerve repair using acidic fibroblast growth factor in human cervical spinal cord injury: a preliminary Phase I clinical study. J Neurosurg Spine 2008; 8:208-14. [DOI: 10.3171/spi/2008/8/3/208] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Object
The aim of this study was to assess functional outcomes of nerve repair using acidic fibroblast growth factor (FGF) in patients with cervical spinal cord injury (SCI).
Methods
Nine patients who had cervical SCI for longer than 5 months were included in pre- and postoperative assessments of their neurological function. The assessments included evaluating activities of daily living, associated functional ability, and degree of spasticity, motor power, sensation, and pain perception. After the first set of assessments, the authors repaired the injured segment of the spinal cord using a total laminectomy followed by the application of fibrin glue containing acidic FGF. Clinical evaluations were conducted 1, 2, 3, 4, 5, and 6 months after the surgery. Preoperative versus postoperative differences in injury severity and grading of key muscle power and sensory points were calculated using the Wilcoxon signed-rank test.
Results
The preoperative degree of injury severity, as measured using the American Spinal Injury Association (ASIA) scoring system, showed that preoperative motor (52.4 ± 25.9 vs 68.6 ± 21.5), pinprick (61.0 ± 34.9 vs 71.6 ± 31.0), and light touch scores (57.3 ± 33.9 vs 71.9 ± 30.2) were significantly lower than the respective postoperative scores measured 6 months after surgery (p = 0.005, 0.012, and 0.008, respectively).
Conclusions
Based on the significant difference in ASIA motor and sensory scale scores between the preoperative status and the 6-month postoperative follow-up, this novel nerve repair strategy of using acidic FGF may have a role in the repair of human cervical SCI. Modest nerve regeneration occurred in all 9 patients after this procedure without any observed adverse effects. This repair strategy thus deserves further investigation, clinical consideration, and refinement.
Collapse
Affiliation(s)
- Jau-Ching Wu
- 1Department of Neurosurgery and
- 2Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital
- 5School of Medicine and
| | - Wen-Cheng Huang
- 1Department of Neurosurgery and
- 2Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital
- 5School of Medicine and
| | - Yun-An Tsai
- 2Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital
- 3Departments of Physical Medicine and Rehabilitation and
- 5School of Medicine and
| | - Yu-Chun Chen
- 2Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital
- 4Family Medicine, Taipei Veterans General Hospital; and
- 5School of Medicine and
| | - Henrich Cheng
- 1Department of Neurosurgery and
- 2Neural Regeneration Laboratory, Neurological Institute, Taipei Veterans General Hospital
- 6Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
25
|
Chen CY, Chuang TY, Tsai YA, Tai HC, Lu CL, Kang LJ, Lu RH, Chang FY, Lee SD. Loss of sympathetic coordination appears to delay gastrointestinal transit in patients with spinal cord injury. Dig Dis Sci 2004; 49:738-43. [PMID: 15259492 DOI: 10.1023/b:ddas.0000030082.05773.c9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Patients with spinal cord injury (SCI) often suffer from many gastrointestinal (GI) complaints, while delayed GI transit exists in these patients. We are interested in whether the lost sympathetic activity is one of the mechanisms leading to disturbed GI transit in these subjects. Using a noninvasive hydrogen breath test representing orocecal transit time (OCTT) to study GI transit, 36 SCI patients and 12 age- and sex-matched healthy volunteers were enrolled in our study. Meanwhile, electrocardiogram was performed for all subjects. Finally, spectral analysis of heart rate variability (HRV) was then obtained to assess their sympathovagal balance. SCI patients had higher occurrences of GI symptoms, e.g., nausea/vomiting, belching/hiccup, and constipation, compared to controls (P < 0.05). OCTT was delayed in SCI patients compared to controls (180.8 +/- 10.7 vs 98.3 +/- 14.4 min; P < 0.001). The OCTTs of SCI patients were negatively correlated with their low frequencies of HRV (r = -0.384, P = 0.021). In addition, OCTT was further delayed in quadriplegic patients than paraplegic patients (195.8 +/- 14.5 vs 143.6 +/- 19.4 min; P = 0.031). However, neither the SCI etiology, the injury duration, nor the high frequency of HRV had any influence on the delayed OCTT in SCI patients. We conclude that the GI transit of SCI patients is delayed. This transit disturbance is probably due to loss of sympathetic activity, which is one of the essential components in the coordination of GI peristalsis.
Collapse
Affiliation(s)
- Chih-Yen Chen
- Division of Gastroenterology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Yin HP, Tsai YA, Liao SF, Lin PH, Chuang TY. The challenge of diagnosing psoas abscess. J Chin Med Assoc 2004; 67:156-9. [PMID: 15181971] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Diagnosing psoas abscess in patients with low back pain might be hampered by their atypical symptoms. We describe a case in which a 39-year-old retired provost marshal presented to our emergency facility with acute onset of low back pain following an episode of lumbar strain during a flight. His initial computed tomography of lumbar spine and abdominal sonography were inconclusive. Two weeks later, he was admitted to our rehabilitation unit for similar symptoms. One day later, leukocytosis and elevated c-reactive protein following rising body temperature were found. Fever of unknown origin (FUO) was impressed after series of laboratory studies. However, an inflammatory gallium scan performed 2 weeks later due to persistent fever revealed active infection in the L4 vertebra and soft tissue of the L5 paraspinal region. MRI was then performed and demonstrated abnormal enhancement at the bodies of the L2 and L3 vertebrae, prevertebral soft tissue and bilateral psoas muscles. A CT-guided percutaneous aspiration of 10 cc yellowish pus was attained, which yielded no pathogens. His symptoms subsided 1 week after being given appropriate antibiotics. This case showed the importance of nuclear scanning and MRI in patients with low back pain and FUO. It also suggests that repeated imaging study and/or other modality should be considered when the initial imaging result is not compatible with the clinical presentation of psoas abscess, which was initially missed by image studies.
Collapse
Affiliation(s)
- Hsin-Pei Yin
- Department of Physical Medicine and Rehabilitation, Chutung Veterans Hospital, Taiwan, ROC
| | | | | | | | | |
Collapse
|
27
|
Chen KS, Ho YT, Lai CH, Tsai YA, Chen SJ. Trends in concentration of ground-level ozone and meteorological conditions during high ozone episodes in the Kao-Ping Airshed, Taiwan. J Air Waste Manag Assoc 2004; 54:36-48. [PMID: 14871011 DOI: 10.1080/10473289.2004.10470880] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This work analyzes the variations in daily maximum 1-hr ozone (O3) concentrations and the long-term trends in annual means of hourly ambient concentrations of O3, nitrogen oxides (nitrous oxide + nitrogen dioxide), and nonmethane hydrocarbons in the three administrative regions of Kao-Ping airshed in southern Taiwan over a recent 8-yr period. The annual or monthly means of all maxima, most 95th percentiles, and some 90th percentiles of the daily maximum 1-hr O3 concentrations exceed the daily limit of 120 parts per billion by volume in all three regions, namely, Kao-hsiung City, Kso-hsiung County, and P'ing-tung County. The monthly means of daily maximum 1-hr O3 concentrations exhibit distinct seasonal variations, with a bimodal form with the maxima in autumn and late winter to the middle of spring and a minimum in summer. The long-term variations in the annual means of hourly O3 concentrations in the three regions exhibit increasing trends. These increases in O3 are associated with the decline in ambient concentrations of nitrogen oxides and nonmethane hydrocarbons. High O3 episodes occur most often in autumn and most rarely in summer. The seasonal mean mixing heights in descending order follow the order of spring, summer, autumn, and winter. Meteorological parameters in autumn and winter indicate that the ground-level O3 tends to accumulate and trigger a high O3 episode on a warm day with sufficient sunlight and low wind in a high-pressure system, consistent with the low mixing heights in these two seasons.
Collapse
Affiliation(s)
- Kang-Shin Chen
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kao-hsiung, Taiwan.
| | | | | | | | | |
Collapse
|
28
|
Chuang TY, Yu KJ, Penn IW, Chang YC, Lin PH, Tsai YA. Neurourological changes before and after radical hysterectomy in patients with cervical cancer. Acta Obstet Gynecol Scand 2003; 82:954-9. [PMID: 12956847 DOI: 10.1034/j.1600-0412.2003.00177.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The severity of bladder dysfunction in patients receiving radical hysterectomy for cervical cancer has been related to the delicacy and the degree of radicality of the hysterectomy. Our goal was to evaluate the effect of modified radical hysterectomy on the storage and evacuation of the lower urinary tract. METHODS In this prospective study, 18 patients underwent radical hysterectomy for cervical cancer with FIGO stages Ia, Ib and IIa. These patients participated in a pudendal motor nerve conduction study and a urodynamic study, including urethral pressure profile (UPP), cystometry (CMG) and uroflowmetry (UFR). These were carried out at preoperative baseline and at 2 weeks, 6 weeks, 3 months and 6 months following surgery. We used generalized linear models to evaluate, over time, the relationship between the different parameters marked in these profiles. RESULTS The average pudendal nerve motor latency was prolonged at 2 and 6 weeks after surgery but recovered to baseline at 3 months postsurgery. Maximal urethral closing pressure revealed a tendency to decrease, and the CMG showed a significant increase in maximum intravesical filling pressure and a marked decrease in compliance throughout the investigative course. Increased residual urine volume and decreased uroflow rates were detected in a series of UFR. However, these values headed for baseline at 6 months after surgery. CONCLUSION Transient neurological changes in the majority of our patients suggested that both somatic and autonomic demyelination with or without denervation might be responsible for the temporal changes in vesicourethral function after radical hysterectomy and recovery to baseline condition within 6 months.
Collapse
Affiliation(s)
- Tien-Yow Chuang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan
| | | | | | | | | | | |
Collapse
|
29
|
Chuang TY, Huang WS, Chiang SC, Tsai YA, Doong JL, Cheng H. A virtual reality-based system for hand function analysis. Comput Methods Programs Biomed 2002; 69:189-196. [PMID: 12204447 DOI: 10.1016/s0169-2607(01)00190-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The goal of this study was to demonstrate the usability and usefulness of virtual reality technology in assessing hand functions. Ten healthy, non-disabled right-handed adult volunteers were recruited. Each volunteer used a dataglove to insert three-dimensional virtual representations of a cylinder and a prism into the target holes. To verify the reliability of the tests, each subject was retested twice. The performance testing assessed the visual-motor coordination a person needs to achieve a task accurately and within a set time. For each trial, the root mean square (RMS) value of the hand movement trajectory was projected onto the X, Y, and Z axes. This projection enabled us to measure the extent of the genuine, summative displacement of the manipulating hand. The reproducibility of the virtual reality assessment was analyzed using the intraclass correlation (ICC) approach. The total ICC values of 10 subjects demonstrated a high task completion time and RMS on the X and Z axes for the transferring of the prism. However, the values were low for the transferring of the cylinder. Because the individual coefficients of variations (CVs) varied widely in the moving of both the cylinder and the prism, the total (CVs) showed a high reading for the task completion time. Although rehabilitation clinics routinely carry out peg-moving exercises for disabled patients, our model provides a valuable quantitative real time and off-line measure of whole hand functions.
Collapse
Affiliation(s)
- Tien-Yow Chuang
- Department of Physical Medicine and Rehabilitation, Veterans General Hospital Taipei and National Yang-Ming University, No 201 Shih-Pai Rd., Sec 2, 11217, Taipei, Taiwan.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
This study was undertaken to demonstrate the distribution of causative factors of brachial plexopathy (BP), to assess the association between the mechanism of injuries and the predominant level of the brachial plexus involved in the injuries, and to characterize the extent and degree of severity of injury in patients with BPI. It consisted of a cross-sectional, retrospective review of electrophysiological data of 5547 patients with 117 patients being identified as having BPI, of whom 86 patients were recruited into the study. The patients were divided into six subgroups according to the mechanism of the damage. The injury was subdivided according to the brachial plexus levels predominantly affected, and each component of the four major anatomical plexus levels-root, trunk, cord and nerve levels was analyzed. The affiliation between the type of injuries and the specified brachial plexus levels was calculated via a two-tailed Fisher's exact test. These findings demonstrated that the type of brachial plexus injury (BPI) is significantly related to the brachial plexus level involved. The motorcycle and birth injury groups were affected at the trunk level, the fall group at the nerve level, the automobile group at the cord level, and the blunt injury group at the cord or nerve level. Moreover, the majority of patients in the motorcycle, fall, and pedestrian groups suffered from severe, incomplete lesions, while the neurophysiological results of the other groups varied.
Collapse
Affiliation(s)
- Tien-Yow Chuang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, 201 Shih-Pai Road, Sec 2, Peitou, 11217, ROC, Taipei, Taiwan.
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
The electrophysiological evaluations and the British Medical Research Council (MRC) scale (0-5) findings of target muscles in brachioplexopathies before surgery and 1 year postsurgery were conducted. Each component of the brachial plexus was analyzed in 15 patients with injuries, among them, to 5 roots, 19 trunks, 7 cords, and 13 terminal nerves. In each of these cases, neurolysis and/or nerve transfer and/or neurotization were performed, within 3 weeks to 6 months after the injury was incurred, to ameliorate the resulting severe disabilities. The degrees of impairment were graded using a modified version of Dumitru's and Wilbourn's scale (mild: normal to slight decrease of SNAP amplitude and CMAP amplitude, and occasional denervation; moderate: profound decrease of SNAP amplitude and CMAP amplitude, constant denervation, and normal to slight decrease in motor unit recruitment; severe: absent SNAP amplitude, absent CMAP amplitude, marked denervation, and profound decrease or no volitional motor unit recruitment. mild = 1; moderate = 2; severe = 3). The motor power of the target muscles was graded through MRC scores. The presurgical versus postsurgical differences in the severity of the injury to each brachial plexus component, and differences in the grading of target muscle power, were calculated through the Wilcoxon signed-rank test. The presurgical degrees of the severity of injury, as measured by the electromyography (EMG) were 3.00 +/- 0.00 (mean +/- SD) in root, 2.84 +/- 0.50 in trunk, 3.00 +/- 0.00 in cord, and 2.85 +/- 0.38 in terminal nerves. The postsurgical results were 2.60 +/- 0.55 in root, 2.53 +/- 0.70 in trunk, 2.43 +/- 0.53 in cord, and 1.77 +/- 0.73 in terminal nerves. There was significant improvement at the trunk, cord, and terminal nerve levels after repair, but not at the root levels. Moreover, although the MRC grading showed significant motor recovery in the infraspinatus, deltoid, biceps, and triceps muscles, there was little apparent improvement in the pectoralis major, EDC, APB, and ADM muscles. Nerve repair was notably successful in all plexuses except at the root level. However, our cases demonstrated only poor motor power gains in the forearm and the hand muscles. Consequently, future surgical techniques for brachioplexopathy repairs need further improvement.
Collapse
Affiliation(s)
- Yun-An Tsai
- Neurophysiologic Laboratory, Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan
| | | | | | | | | | | |
Collapse
|