Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: A double-blinded randomized controlled trial
Lee Y.-Y.,Chang Gung University |
Lin K.-C.,National Taiwan University |
Lin K.-C.,National Taiwan University Hospital |
Cheng H.-J.,National Taiwan University |
And 4 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2015
Background: Robot-assisted therapy (RT) is a widely used intervention approach to enhance motor recovery in patients after stroke, but its effects on functional improvement remained uncertain. Neuromuscular electrical stimulation (NMES) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic hand. Methods: This was a randomized, double-blind, sham-controlled study. Thirty-nine individuals with chronic stroke were randomly assigned to the RT combined with NMES (RT + ES) or to RT with sham stimulation (RT + Sham) groups. The participants completed the intervention 90 to 100 minutes/day, 5 days/week for 4 weeks. The outcome measures included the upper extremity Fugl-Meyer Assessment (UE-FMA), modified Ashworth scale (MAS), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale 3.0 (SIS). All outcome measures were assessed before and after intervention, and the UE-FMA, MAL, and SIS were reassessed at 3 months of follow-up. Results: Compared with the RT + Sham group, the RT + ES group demonstrated greater improvements in wrist flexor MAS score, WMFT quality of movement, and the hand function domain of the SIS. For other outcome measures, both groups improved significantly after the interventions, but no group differences were found. Conclusion: RT + ES induced significant benefits in reducing wrist flexor spasticity and in hand movement quality in patients with chronic stroke. Trial registration: ClinicalTrials.gov. NCT01655446 © 2015 Lee et al.
Chen C.-K.,Chang Gung Memorial Hospital at Taoyuan Linkou |
Chen C.-K.,Chang Gung University |
Pei Y.-C.,Chang Gung Memorial Hospital at Taoyuan Linkou |
Pei Y.-C.,Chang Gung University |
And 11 more authors.
Journal of Alternative and Complementary Medicine | Year: 2014
Objectives: To investigate the effect of sedative music on the different stages of the sleep cycle in young adults with various sleep latencies by using polysomnography (PSG). Design: Prospective, randomized, controlled, crossover study. Setting: Sleep center of a teaching hospital. Participants: Young adults with different sleep latencies. Poor sleepers (Pittsburgh Sleep Quality Index score ≥5) were excluded. Interventions: Each participant stayed one night in the sleep center for adaptation and on each of the following two nights was assigned to (1) music and (2) control (without music) conditions in random order. In the music condition, sedative music composed by certified music therapists was played on a compact disc player for the first hour the participant was in bed. Outcome measures: Sleep measures recorded with PSG, including sleep latency and durations of sleep stages. Results: Twenty-four young adults (mean±standard deviation, 24.5±2.6 years) participated. They were classified into the short sleep latency (SL) group if the baseline SL of the adaptation night was shorter than 10 minutes or into the long SL group if the baseline SL was 10 minutes or longer. Sedative music did not alter the SL in either group. Sedative music reduced stage II sleep in both SL groups (main effect of music, p=0.03; interaction effect, p=0.87) but increased the duration of deep sleep (stages III and IV) only in the long SL group (main effect of music, p=0.15; interaction effect, p=0.02). Conclusions: In participants with long SL, sedative music improved the quality of sleep by prolonging the duration of deep sleep. This effect provides an alternative and noninvasive way to improve sleep in selected persons experiencing sleep problems. © Copyright 2014, Mary Ann Liebert, Inc. 2014.
Yu D.-Y.,Chang Gung Memorial Hospital at Keelung |
Yu D.-Y.,Chang Gung Memorial Hospital at Taoyuan |
Yu D.-Y.,Chang Gung University |
Chen C.-H.,Chang Gung Memorial Hospital at Linkou |
And 8 more authors.
Annals of Plastic Surgery | Year: 2016
Background: Orbital fractures and the concomitant soft tissue injuries within the bony orbit result in well-recognized complications such as diplopia and enophthalmos. Guidelines for timing and indications for surgery for achieving an optimal outcome remain elusive. This study examined the effects of timing and fracture type on the outcome of orbital fracture repair. Material and Methods: Data on 255 patients treated for orbital fractures were retrospectively reviewed to determine the effects of the facial bones involved in the fractures, the types of orbital wall fracture, the timing of surgical repair, and diplopia evident before and after corrective surgery on surgical outcomes. Results: The incidence of posttraumatic diplopia increased with the number of orbital wall fractures (P < 0.001). The rate of diplopia resolution after corrective surgery was slow in the first 3 months irrespective of the severity of orbital wall fracture. The diplopia resolution rate for type I orbital wall fractures was significantly higher than that for type II and type III fractures. Patients treated within 2 weeks of sustaining an orbital fracture exhibited a higher diplopia resolution rate than did patients treated 2 to 4 weeks and more than 4 weeks after sustaining the fracture (58% vs 38.1%). Conclusions: A higher number of orbital wall fractures are associated with a higher incidence of diplopia and a poorer long-term result. The timing of surgical repair influences the diplopia outcome. Performing corrective surgery for orbital fractures with diplopia after 2 weeks tends to result in a slower complete recovery rate. © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Hsieh P.-H.,Chang Gung Memorial Hospital at Taoyuan |
Hsieh P.-H.,Chang Gung University |
Ueng S.W.,Chang Gung Memorial Hospital at Taoyuan |
Ueng S.W.,Chang Gung University |
And 6 more authors.
International Journal of Infectious Diseases | Year: 2010
Background: Liver cirrhosis is a well-known co-morbidity in prosthetic hip infection (PHI), but the results of treatment and prognostic factors that predict outcomes of PHI in cirrhotic patients have not been studied. Methods: We performed a cohort study of patients with liver cirrhosis who contracted PHI and were treated at our institution between January 1990 and December 2004. Results: Of 349 first-time episodes of PHI during the study period, 33 (9.5%) occurred in patients with liver cirrhosis. Debridement with retention of the prosthesis (DWROP) was the initial treatment modality for 24 (73%) episodes of PHI and cured the infection in seven (29%). A shorter median duration of symptoms (5 vs. 14 days; p=0.007) and absence of a sinus tract (p= 0.02) were associated with successful treatment. Excision arthroplasty (EA) was required in 26 (79%) episodes and eradicated PHI in 24 (92%). In 20 patients who had reimplantation of a new prosthesis, the infection recurred in six (30%). Patients who developed hepatic decompensation after reimplantation had a significantly higher risk of recurrent PHI than those who did not (relative risk 7.5; 95% confidence interval 4.8-9.5; p=0.018). Conclusions: Liver cirrhosis is a common co-morbidity in patients with PHI treated at our institution. DWROP should be considered only when there is no sinus tract and the duration of symptoms is very short (less than 10 days). EA is an effective procedure to cure infection. However, reimplantation of hip prosthesis in these patients carries a high risk of infection recurrence, especially in those who develop hepatic decompensation. © 2010 International Society for Infectious Diseases.
Wong A.M.K.,Chang Gung Memorial Hospital at Taoyuan |
Wong A.M.K.,Chang Gung University |
Chang W.-H.,Chang Gung Memorial Hospital at Taoyuan |
Ke P.-C.,Chang Gung Memorial Hospital at Taoyuan |
And 8 more authors.
PLoS ONE | Year: 2012
The key components of caring for the elderly are diet, living, transportation, education, and safety issues, and telemedical systems can offer great assistance. Through the integration of personal to community information technology platforms, we have developed a new Intelligent Comprehensive Interactive Care (ICIC) system to provide comprehensive services for elderly care. The ICIC system consists of six items, including medical care (physiological measuring system, Medication Reminder, and Dr. Ubiquitous), diet, living, transportation, education (Intelligent Watch), entertainment (Sharetouch), and safety (Fall Detection). In this study, we specifically evaluated the users' intention of using the Medication Reminder, Dr. Ubiquitous, Sharetouch, and Intelligent Watch using a modified technological acceptance model (TAM). A total of 121 elderly subjects (48 males and 73 females) were recruited. The modified TAM questionnaires were collected after they had used these products. For most of the ICIC units, the elderly subjects revealed great willingness and/or satisfaction in using this system. The elderly users of the Intelligent Watch showed the greatest willingness and satisfaction, while the elderly users of Dr. Ubiquitous revealed fair willingness in the dimension of perceived ease of use. The old-old age group revealed greater satisfaction in the dimension of result demonstrability for the users of the Medication Reminder as compared to the young-old and oldest-old age groups. The women revealed greater satisfaction in the dimension of perceived ease of use for the users of Dr. Ubiquitous as compared to the men. There were no statistically significant differences in terms of gender, age, and education level in the other dimensions. The modified TAM showed its effectiveness in evaluating the acceptance and characteristics of technologic products for the elderly user. The ICIC system offers a user-friendly solution in telemedical care and improves the quality of care for the elderly. © 2012 Wong et al.
Lin H.C.,Chang Gung University |
Hsu S.C.,Taipei National University of the Arts |
Huang Y.H.,Taipei National University of the Arts |
Yu T.C.,Chang Gung University |
And 3 more authors.
WIT Transactions on Information and Communication Technologies | Year: 2014
This study developed application objects for the elderly to help them take care of themselves. Elders’ physiological information as well as learning and exercise participation behavior information were converted into device design, public art design, and implementation of social contribution. A “Service Cloud” Service- Learning Creative Space was built, comprising four systems and a mechanism: a Cloud Community Information Management System, a “Life Memories” Interactive Wall System, a “To Play” Interactive Floor System, a “Three High” Interactive Table System and a Social Services Mechanism. There are two expected goals: (1) the elderly can live and learn with exercise; and (2) the elderly are social resources but not a burden. The devices were installed at Chang Gung Health and Culture Village (CGHCV). Six volunteers conducted system testing and evaluation, with an average satisfaction degree of 84.57%. Elders not only pay attention to their own health, but also actively support social services for the community. © 2014 WIT Press.
Huang C.S.,Chang Gung Memorial Hospital at Taipei |
Huang C.S.,Chang Gung University |
Chen Y.-R.,Chang Gung University |
Chen Y.-R.,Chang Gung Memorial Hospital at Taoyuan |
Chen Y.-R.,Chang Gung Memorial Hospital at Linkou
International Journal of Oral and Maxillofacial Surgery | Year: 2015
The surgery-first approach has become a new paradigm in orthognathic surgery. With the surgery-first approach, most of the patient's teeth are in their original positions and have not undergone orthodontic treatment prior to the patient undergoing orthognathic surgery. A 'treatable' malocclusion should be attained following orthognathic surgery. Orthodontists must ensure that they can manage the 'treatable' malocclusion by actively participating in the patient's surgical plan. Therefore, orthodontic principles and guidelines must be established. Three-dimensional computed tomography should be used to construct the midfacial plane and then to assess discrepancies in the midfacial structures as well as yaw and roll of the bilateral facial structures. Orthognathic surgery should be performed to improve the alignment of such discrepancies to attain a skeletal class I relationship and to attain an aesthetically pleasing face. The surgery-first approach uses osteotomy to solve most of the skeletal and dental problems and to simplify postoperative orthodontic treatment by providing a treatable malocclusion for which mostly only anteroposterior orthodontic movement is required, with minimal transverse or vertical orthodontic movements. Numerous studies have documented the efficacy and long-term stability. Patients undergoing the surgery-first approach benefit from an immediate improvement in facial aesthetics, oral function, and self-confidence, with a shorter total treatment period. © 2015 International Association of Oral and Maxillofacial Surgeons.
Lee Y.-Y.,Chang Gung University |
Hsieh Y.-W.,Chang Gung University |
Wu C.-Y.,Chang Gung University |
Lin K.-C.,National Taiwan University |
And 2 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2015
Objective To identify the baseline motor characteristics of the patients who responded to 3 prominent intervention programs. Design Observational cohort study. Setting Outpatient rehabilitation clinics. Participants Individuals with chronic stroke (N=174). Interventions Participants received 30 hours of constraint-induced movement therapy (CIMT), robot-assisted therapy, or mirror therapy (MT). Main Outcome Measures The primary outcome measure was the change score of the Upper Extremity Fugl-Meyer Assessment (UE-FMA). The potential predicting variables were baseline proximal, distal, and total UE-FMA and Action Research Arm Test scores. We combined polynomial regression analyses and the minimal clinically important difference to stratify the patients as responders and nonresponders for each intervention approach. Results Baseline proximal UE-FMA scores significantly predicted clinically important improvement on the primary outcome measure after all 3 interventions. Participants with baseline proximal UE-FMA scores of approximately <30 benefited significantly from CIMT and robot-assisted therapy, whereas participants with scores between 21 and 35 demonstrated significant improvement after MT. Baseline distal and total UE-FMA and Action Research Arm Test scores could also predict upper limb improvement after CIMT and MT, but not after robot-assisted therapy. Conclusions This study could inform clinicians about the selection of suitable rehabilitation approaches to help patients achieve clinically meaningful improvement in upper extremity function. © 2015 American Congress of Rehabilitation Medicine.
Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial
PubMed | Chang Gung University, Chang Gung Memorial Hospital at Taoyuan and National Taiwan University
Type: | Journal: Journal of neuroengineering and rehabilitation | Year: 2015
Robot-assisted therapy (RT) is a widely used intervention approach to enhance motor recovery in patients after stroke, but its effects on functional improvement remained uncertain. Neuromuscular electrical stimulation (NMES) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic hand.This was a randomized, double-blind, sham-controlled study. Thirty-nine individuals with chronic stroke were randomly assigned to the RT combined with NMES (RT+ES) or to RT with sham stimulation (RT+Sham) groups. The participants completed the intervention 90 to 100minutes/day, 5days/week for 4weeks. The outcome measures included the upper extremity Fugl-Meyer Assessment (UE-FMA), modified Ashworth scale (MAS), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale 3.0 (SIS). All outcome measures were assessed before and after intervention, and the UE-FMA, MAL, and SIS were reassessed at 3months of follow-up.Compared with the RT+Sham group, the RT+ES group demonstrated greater improvements in wrist flexor MAS score, WMFT quality of movement, and the hand function domain of the SIS. For other outcome measures, both groups improved significantly after the interventions, but no group differences were found.RT+ES induced significant benefits in reducing wrist flexor spasticity and in hand movement quality in patients with chronic stroke.ClinicalTrials.gov. NCT01655446.