Guangdong Provincial Work Injury Rehabilitation Hospital

Guangzhou, China

Guangdong Provincial Work Injury Rehabilitation Hospital

Guangzhou, China
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Shen X.,Hong Kong Polytechnic University | Shen X.,Guangdong Provincial Work Injury Rehabilitation Hospital | Mak M.K.Y.,Hong Kong Polytechnic University
Neurorehabilitation and Neural Repair | Year: 2015

Objective. To examine the effects of technology-assisted balance and gait training on reducing falls in patients with Parkinson's disease (PD). Methods. Eligible subjects were randomly allocated to an experimental group given technology-assisted balance and gait training (BAL, n = 26) and an active control group undertaking strengthening exercises (CON, n = 25). The training in each group lasted for 3 months. The number of fallers and fall rate were used as primary outcomes, and single-leg-stance-time, latency of postural response to perturbation, self-selected gait velocity, and stride length as secondary outcomes. Fall incidence was recorded over 15 months after the baseline assessment (Pre). Other tests were performed at Pre, after 3-month intervention (Post3m), at 3 months (Post6m), and 12 months (Post15m) after treatment completion. Results. Forty-five subjects who completed the 3-month training were included in the data analysis. There were fewer fallers in the BAL than in the CON group at Post3m, Post6m, and Post15m (P <.05). In addition, the BAL group had lower fall rate than the CON group at Post3m and Post6m (incidence rate ratio: 0.111-0.188, P <.05), and marginally so at Post15m (incidence rate ratio: 0.407, P =.057). Compared with the CON subjects, the BAL subjects demonstrated greater reduction in the postural response latency and increase in the stride length against baseline at each assessment interval (P <.05), and marginally more increases of single-leg-stance-time at Post3m (P =.064), Post6m (P =.041) and Post15m (P =.087). Conclusions. Our positive findings provide evidence for the clinical use of technology-assisted balance and gait training in reducing falls in people with PD. © The Author(s) 2014.


Liao L.-R.,Guangdong Provincial Work Injury Rehabilitation Hospital | Liao L.-R.,Hong Kong Polytechnic University | Ng G.Y.F.,Hong Kong Polytechnic University | Jones A.Y.M.,Griffith University | And 2 more authors.
Physical Therapy | Year: 2015

Background. Whole-body vibration (WBV) has increasingly been used as an adjunct treatment in neurological rehabilitation. However, how muscle activation level changes during exposure to different WBV protocols in individuals after stroke remains understudied. Objective. The purpose of this study was to examine the influence of WBV intensity on the magnitude of biceps femoris (BF) and tibialis anterior (TA) muscle activity and its interaction with exercise and with severity of motor impairment and spasticity among individuals with chronic stroke. Methods. Each of the 36 individuals with chronic stroke (mean age 57.3 years, SD 10.7) performed 8 different static exercises under 3 WBV conditions: (1) no WBV, (2) low-intensity WBV (frequency 20 Hz, amplitude 0.60 mm, peak acceleration 0.96g), and (3) high- intensity WBV (30 Hz, 0.44 mm, 1.61g). The levels of bilateral TA and BF muscle activity were recorded using surface electromyography (EMG). Results. The main effect of intensity was significant. Exposure to the low-intensity and high-intensity protocols led to a significantly greater increase in normalized BF and TA muscle electromyographic magnitude in both legs compared with no WBV. The intensity exercise interaction also was significant, suggesting that the WBV-induced increase in EMG activity was exercise dependent. The EMG responses to WBV were similar between the paretic and nonparetic legs and were not associated with level of lower extremity motor impairment and spasticity. Limitations. Leg muscle activity was measured during static exercises only. Conclusions. Adding WBV during exercise significantly increased EMG activity in the TA and BF muscles. The EMG responses to WBV in the paretic and nonparetic legs were similar and were not related to degree of motor impairment and spasticity. The findings are useful for guiding the design of WBV training protocols for people with stroke. © 2015 American Physical Therapy Association.


Shen X.,Hong Kong Polytechnic University | Shen X.,Guangdong Provincial Work Injury Rehabilitation Hospital | Wong-Yu I.S.K.,Hong Kong Polytechnic University | Mak M.K.Y.,Hong Kong Polytechnic University
Neurorehabilitation and Neural Repair | Year: 2016

Postural instability and falls are complex and disabling features of Parkinson's disease (PD) and respond poorly to anti-Parkinsonian medication. There is an imperative need to evaluate the effectiveness of exercise interventions in enhancing postural stability and decreasing falls in the PD population. The objectives of our study were to determine the effects of exercise training on the enhancement of balance and gait ability and reduction in falls for people with PD and to investigate potential factors contributing to the training effects on balance and gait ability of people with PD. We included 25 randomized control trials of a moderate methodological quality in our meta-analysis. The trials examined the effects of exercise training on balance and gait ability and falls against no intervention and placebo intervention. The results showed positive effects of exercise intervention on enhancing balance and gait performance (Hedges' g = 0.303 over the short-term in 24 studies and 0.419 over the long-term in 12 studies; P <.05) and reducing the fall rate (rate ratio = 0.485 over the short-term in 4 studies and 0.413 over the long-term in 5 studies; P <.05). The longest follow-up duration was 12 months. There was no evidence that training decreased the number of fallers over the short- or long-term (P >.05). The results of our metaregression and subgroup analysis showed that facility-based training produced greater training effects on improving PD participants' balance and gait ability (P <.05). The findings support the application of exercise training to improve balance and gait ability and prevent falls in people with PD. © The Author(s) 2015.


Liao L.-R.,Hong Kong Polytechnic University | Liao L.-R.,Guangdong Provincial Work Injury Rehabilitation Hospital | Lam F.M.H.,Hong Kong Polytechnic University | Pang M.Y.C.,Hong Kong Polytechnic University | And 2 more authors.
Medicine and Science in Sports and Exercise | Year: 2014

Purpose: It has been previously shown that whole-body vibration (WBV) can augment muscle activity in young healthy adults. However, the EMG response of leg muscles during WBV in individuals with stroke is unknown. The objective of this study was to determine the influence of WBV on the activity of the vastus lateralis (VL) and gastrocnemius (GS) muscles during the performance of different exercises in chronic stroke patients. Methods: Forty-five chronic stroke patients were studied. Each subject was exposed to three WBV conditions of 1) no WBV, 2) low-intensity WBV protocol (peak acceleration: 0.96 unit of gravitational constant [g]), and 3) high-intensity WBV protocol (peak acceleration: 1.61g) while performing eight different static exercises involving upright standing, semisquat, deep squat, weight shifted forward, weight shifted backward, weight shifted to the side, forward lunge, and single-leg standing. Bilateral VL and GS muscle activity was recorded with surface EMG and expressed as a percentage of the EMG amplitude recorded during a maximal voluntary contraction of the respective muscles. Results: Two-way repeated-measures ANOVA revealed that exposure to WBV (low- and high-intensity protocols) significantly increased VL and GS EMG amplitude (large effect size, partial η = 0.135-0.643, P < 0.001) on both the paretic and nonparetic sides in different exercise conditions compared with no WBV. No significant difference in EMG magnitude was found between the high- and the low-intensity WBV protocols (P > 0.05). With a few exceptions, WBV enhanced EMG activity in the paretic and nonparetic leg muscles to a similar extent in different exercise conditions. Conclusions: Leg muscle activity was increased significantly with the addition of WBV. Further clinical trials are needed to determine the effectiveness of different WBV protocols for strengthening leg muscles in chronic stroke patients. © 2014 by the American College of Sports Medicine.


Yang F.Z.H.,Guangdong Provincial Work Injury Rehabilitation Hospital | Yang F.Z.H.,Hong Kong Polytechnic University | Pang M.Y.C.,Hong Kong Polytechnic University
Osteoporosis International | Year: 2014

Summary: The influence of various stroke impairments on bone health is poorly understood. This study showed that muscle function and small artery compliance were more strongly associated with the bone strength index at the tibial diaphyseal and epiphyseal regions, respectively. These impairments should be targeted in promoting bone health post-stroke.Introduction: This study examined the bone structural properties of the tibial distal epiphysis and diaphysis after chronic stroke and identified the clinical correlates of the bone strength index measured at these sites.Methods: The tibial distal epiphysis (4 % site) and diaphysis (66 % site) were scanned on both sides in 66 chronic stroke patients and 23 control participants using peripheral quantitative computed tomography. Dynamic knee muscle strength, balance function, spasticity, arterial compliance, and endurance were also measured in the stroke group.Results: At the 4 % site, multivariate analysis showed a significant side × group interaction effect (Wilk’s lambda = 3.977, p < 0.001), with significant side-to-side differences in total volumetric bone mineral density (vBMD), trabecular vBMD, and bone strength index in the stroke group, but not in the control group. A significant side × group interaction was also found at the 66 % site (Wilk’s lambda = 4.464, p < 0.001), with significant side-to-side differences in cortical vBMD, cortical area, cortical thickness, and bone strength index in the stroke group only. Balance and endurance were independently associated with bone strength index at both tibial sites in the paretic leg (p < 0.05) after adjusting for relevant factors in multivariate regression analysis. Small artery compliance and muscle strength were significantly associated with the bone strength index at the 4 % site and 66 % site, respectively.Conclusions: The influence of various stroke impairments on bone was region-specific. While muscle function was more strongly associated with the bone strength index in the diaphyseal region, the effect of vascular health was more apparent in the tibial epiphysis in the paretic leg. © 2014, International Osteoporosis Foundation and National Osteoporosis Foundation.


Zhang Z.J.,Hong Kong Polytechnic University | Zhang Z.J.,Guangdong Provincial Work Injury Rehabilitation Hospital | Fu S.N.,Hong Kong Polytechnic University
PLoS ONE | Year: 2013

Characterization of the elastic properties of a tendon could enhance the diagnosis and treatment of tendon injuries. The purpose of this study was to examine the correlation between the shear elastic modulus on the patellar tendon captured from a Supersonic Shear Imaging (SSI) and the tangent traction modulus computed from a Material testing system (MTS) on 8 fresh patellar pig tendons (Experiment I). Test-retest reliability of the shear elastic modulus captured from the SSI was established in Experiment II on 22 patellar tendons of 11 healthy human subjects using the SSI. Spearman Correlation coefficients for the shear elastic modulus and tangent traction modulus ranged from 0.82 to 1.00 (all p<0.05) on the 8 tendons. The intra and inter-operator reliabilities were 0.98 (95% CI: 0.93-0.99) and 0.97 (95% CI: 0.93-0.98) respectively. The results from this study demonstrate that the shear elastic modulus of the patellar tendon measured by the SSI is related to the tangent traction modulus quantified by the MTS. The SSI shows good intra and inter-operator repeatability. Therefore, the present study shows that SSI can be used to assess elastic properties of a tendon. © 2013 Zhang et al.


Shen X.,Hong Kong Polytechnic University | Shen X.,Guangdong Provincial Work Injury Rehabilitation Hospital | Mak M.K.Y.,Hong Kong Polytechnic University
Journal of Rehabilitation Medicine | Year: 2012

Objective: To examine the effects of repetitive volitional and compensatory step training with preparatory signals on the limits of stability, postural and gait skills, and spatiotemporal gait characteristics in patients with Parkinson's disease with no falls during the previous 12 months. Design: Randomized clinical trial with assessor blinded to group assignment. Subjects: Twenty-eight patients with Parkinson's disease with no falls during the previous 12 months. Methods: Eligible patients were randomly assigned to an experimental group, which undertook repetitive step training with preparatory visual cues, or a control group, which undertook lower limb strength training for 4 weeks. Outcome measures included limits of stability test, postural and gait sub-scores from Unified Parkinson's Disease Rating Scale motor score (UPDRS-PG), and spatiotemporal gait characteristics. All tests were conducted before and after training at patients' peak medication cycle. Results: The experimental group showed significant improvements in reaction time, movement velocity, and endpoint excursion of limits of stability, as well as UPDRS-PG score and stride length (p <0.05), compared with the control group. Both groups significantly increased gait velocity (p <0.05). Conclusion: Repetitive step training with preparatory cues can enhance limits of stability, postural and gait skills and spatiotemporal gait characteristics in patients with Parkinson's disease with no falls during the previous 12 months. © 2012 The Authors.


Liu H.,Hong Kong Polytechnic University | Liu H.,Guangdong Provincial Work Injury Rehabilitation Hospital | Au-Yeung S.S.Y.,Hong Kong Polytechnic University
Journal of the Neurological Sciences | Year: 2014

Transcranial magnetic stimulation (TMS) has been used to evaluate neuroplastic changes in the brain in clinical trials. The purpose of this study was to establish the test-retest reliability of 4 TMS measures of corticomotor excitability - (1) resting motor threshold, (2) slope of input-output curve, (3) peak motor evoked potential amplitude, and (4) cortical silent period duration for the corticospinal projections to the first dorsal interosseous of the contralateral hand. Fourteen healthy subjects (mean age 27.4 years) and 27 subjects with stroke-induced upper limb hemiparesis (mean age 61.3 years) completed 2 repeated sessions of assessment of 1 week apart. Good to excellent test-retest reliability of the TMS measurements was confirmed in the stroke subjects for both hemispheres with the ICC ≥ 0.88. Measurement reliability was good (ICC ≥ 0.75) for the 4 outcome measures in healthy subjects. Contrary to the similarity in standard error of measurements in both hemispheres for outcome measures (1) to (3) in the stroke subjects, that of the cortical silent period duration was larger in magnitude in the lesioned hemisphere. The test-retest reliability coefficients determined for the four corticomotor excitability measurements allowed the estimation of 95% minimal detectable changes of these outcome variables for the respective subject group in future clinical trials. © 2014 Elsevier B.V.


Shen X.,Hong Kong Polytechnic University | Shen X.,Guangdong Provincial Work Injury Rehabilitation Hospital | Mak M.K.Y.,Hong Kong Polytechnic University
Neurorehabilitation and Neural Repair | Year: 2014

Background. Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson's disease (PD). However, there are inconsistent findings on the effects of balance and gait training on balance confidence. Objective. To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups. Methods. A total of 51 PD patients were randomly assigned to a balance and gait training (BAL) group or to an active control (CON) group. The BAL group received balance and gait training with augmented feedback, whereas CON participants received lower-limb strength training for 12 weeks. Outcome measures included Activities-Specific Balance Confidence (ABC) Scale, limits-of-stability test, single-leg-stance test, and spatiotemporal gait characteristics. All tests were administered before intervention (Pre), immediately after training (Post), and at 3 months (Post3m) and 12 months (Post12m) after treatment completion. Results. The ABC score improved marginally at Post and significantly at Post3m and Post12m only in the BAL group (P < .017). Both participant groups increased their end point excursion at Post, but only the BAL group maintained the improvement at Post3m. The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3m and Post12m (P < .05). For gait characteristics, both participant groups increased gait velocity, but only the BAL group increased stride length at Post, Post3m, and Post 12m (P < .017). Conclusions. Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD. © The Author(s) 2014.


Liu X.,Guangdong Provincial Work Injury Rehabilitation Hospital
Chinese Journal of Rehabilitation Medicine | Year: 2014

Conclusion: Most of the patients with spinal cord injury need the service of assistive technology. And the assistive device can improve the abilities of activities of daily living(ADL) of the patients with spinal cord injury. The current assistive device and assistive service can not meet the needs of people with spinal cord injury. A sound service network, specification process of aids service and personnel training are recommended to improve the assistive devices service.Objective: To survey the needs and application of rehabilitation aids in hospitalized patients with spinal cord injury.Method: Using pre-designed questionnaire, by reading case histories and assistive devices equipped records, to survey the application of rehabilitation aids in patients with spinal cord injury.Result: Seventy-three patients with spinal cord injury involved in the survey. Forty cases (54.79%) were equipped with assistive devices before admission, but 61.54% of the assistive devices did not meet the needs of patients. Seventy-one patients (97.26%) were equipped with assistive devices after admission. The amounts of rehabilitation aids were 224 self-care aids, 101 orthopedics, 64 wheelchairs, 49 pressure garments, and 37 walking aids, respectively. Compared with before, the scores of modified Barthel index improved significantly (P<0.001) after using assistive devices in all the groups of cervical, thoracic and lumbar injury levels.

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